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Epidurals: the nuts and bolts

Updated: Jan 7, 2021

๐™ด๐š™๐š’๐š๐šž๐š›๐šŠ๐š•'๐šœ are a huge topic in the birth world for many reasons. The main reason is, they are considered to be the "golden standard" for pain relief during labour and birth, because compared to other pain medication options, ๐™ด๐š™๐š’๐š๐šž๐š›๐šŠ๐š•'๐šœ provide adequate relief the vast majority of the time, and do not effect the birthing persons mental state.



Photo by Sharon McCutcheon on Unsplash


I am going to talk about the ๐š‹๐šŽ๐š—๐šŽ๐š๐š’๐š๐šœ and ๐š›๐š’๐šœ๐š”๐šœ of ๐™ด๐š™๐š’๐š๐šž๐š›๐šŠ๐š•'๐šœ, but before diving into those, I want to talk about respecting peoples wishes around them, and this helpful tool, the ๐™ฟ๐šŠ๐š’๐š— ๐š–๐šŽ๐š๐š’๐šŒ๐šŠ๐š๐š’๐š˜๐š— ๐š™๐š›๐šŽ๐š๐šŽ๐š›๐šŽ๐š—๐šŒ๐šŽ ๐šœ๐šŒ๐šŠ๐š•๐šŽ (๐™ฟ๐™ผ๐™ฟ๐š‚).โญ

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+10 desire to feel nothing, even before labour begins

+9 fear of pain, lack of confidence in coping abilities, relies on staff for pain relief

+7 desire for epidural as soon as possible

+5 desire for epidural in active labour, wants to cope using comfort measures until then

+3 desire to use some medication, but wants to use as little as possible and rely on comfort measures

0 no preference

-3 wants to avoid pain medication, but wants to be given it as soon as they request it

-5 strong desire to avoid medication, mainly for babies benefit. Will accept medication if labour is difficult

-7 strong desire to avoid medication, for personal gratification and babies benefit. Would be disappointed if medication is used

-9 wants staff to deny them pain medication, even if requested

-10 doesn't want medication even for a c-section

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โญsome are not possible (+10, -9, -10) but it is SO IMPORTANT for your care provider(s) to know how you feel about pain medication for birth so they can support you! In nursing, pain is sometimes referred to as a vital sign and giving patients something for pain can be as routine as taking blood pressure. Birth is one of the only things that brings a person to a hospital where their pain often doesn't mean that anything is "wrong" and your wishes should be respected.


โญ๐™ฑ๐šŽ๐š—๐šŽ๐š๐š’๐š๐šœ/๐š๐šŽ๐šŠ๐šœ๐š˜๐š—๐šœ ๐š๐š˜ ๐š๐šŽ๐š ๐š˜๐š—๐šŽโญ

1) You want one! Everyone has a unique and personal relationship with pain, and for some people, an ๐™ด๐š™๐š’๐š๐šž๐š›๐šŠ๐š• is the difference between a traumatic birth and a positive one. You can let your support people/care providers know your preference, and importantly, you can change your mind. For some, pain can be traumatic and you might want to avoid pain as much as possible, and an ๐™ด๐š™๐š’๐š๐šž๐š›๐šŠ๐š• might become your new best friend and allow you to have a positive experience. Compared to other pain medication options during labour, ๐™ด๐š™๐š’๐š๐šž๐š›๐šŠ๐š•'s are the most effective and do not alter your mental state. For others, you might go through labour with a plan of not using medications and then decide that your experience would be better if you had one. This decision is yoursโญ

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2) In certain cases, such as the urge to push on a swollen cervix, an ๐™ด๐š™๐š’๐š๐šž๐š›๐šŠ๐š• can be medically useful and help you to have a physiological birth. As always, making informed decisions that are right for you is keyโญ (because there is hardly ever only one option!)


โญ๐™ฒ๐š˜๐š–๐š–๐š˜๐š— ๐š๐š’๐šœ๐š”๐šœโญand reasons to wait (๐š—๐š˜๐š ๐šŠ ๐šŒ๐š˜๐š–๐š™๐š•๐šŽ๐š๐šŽ ๐š•๐š’๐šœ๐š ๐š˜๐š ๐šŽ๐šŸ๐šŽ๐š›๐šข ๐šœ๐š’๐š๐šŽ-๐šŽ๐š๐š๐šŽ๐šŒ๐š):

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โญ๐™ป๐šŠ๐šŒ๐š” ๐š˜๐š ๐š–๐š˜๐š‹๐š’๐š•๐š’๐š๐šขโญ

๐™ด๐š™๐š’๐š๐šž๐š›๐šŠ๐š•'๐šœ usually take away someone's pain and most sensations from under the chest down, and involves staying in bed on a clear-fluid diet with a bladder catheter, EFM and (maybe) IV fluids. If you ask for a lighter dose or a "๐š†๐šŠ๐š•๐š”๐š’๐š—๐š ๐šŽ๐š™๐š’๐š๐šž๐š›๐šŠ๐š•", there is not a guarantee that it will be a light dose in your system as every body is different. A "๐š†๐šŠ๐š•๐š”๐š’๐š—๐š ๐šŽ๐š™๐š’๐š๐šž๐š›๐šŠ๐š•" is also mostly a misnomer, because many care providers will consider you a fall-risk and advise you to stay in bed. A light dose for you could allow you to have some mobility and be able to change positions in bed with minimal assistance, or you could not be able to feel someone touch your leg or move your lower body without help (heavy motor-blockade). The longer an ๐šŽ๐š™๐š’๐š๐šž๐š›๐šŠ๐š• is in your system, the more likely it is for other side effects to occur (๐™ด๐š™๐š’๐š๐šž๐š›๐šŠ๐š• ๐š‘๐šŽ๐šŠ๐š๐šŠ๐šŒ๐š‘๐šŽ, fever, low BP)

and for your movement to be restricted.

โญ๐™ธ๐š—๐šŒ๐š›๐šŽ๐šŠ๐šœ๐šŽ๐š ๐š›๐š’๐šœ๐š” ๐š˜๐š ๐šŠ๐šœ๐šœ๐š’๐šœ๐š๐šŽ๐š ๐š๐šŽ๐š•๐š’๐šŸ๐šŽ๐š›๐šขโญ

Due to feeling numbness from below your chest down, most people with ๐™ด๐š™๐š’๐š๐šž๐š›๐šŠ๐š•'๐šœ dont feel the urge to push which can prolong the pushing stage (*you can ask to have it turned off while pushing*) and increase the risk of an assisted delivery with forceps or a vacuum extractor, which also increases the risk of a perineal tear.

โญ๐™ธ๐š—๐šŒ๐š›๐šŽ๐šŠ๐šœ๐šŽ๐š ๐š›๐š’๐šœ๐š” ๐š˜๐š ๐š•๐š˜๐š  ๐š‹๐š•๐š˜๐š˜๐š ๐š™๐š›๐šŽ๐šœ๐šœ๐šž๐š›๐šŽโญ which can compromise oxygen flow to baby.

โญ๐™ธ๐š ๐š–๐šŠ๐šข ๐š—๐š˜๐š ๐š–๐šŠ๐š”๐šŽ ๐šข๐š˜๐šž๐š› ๐š•๐šŠ๐š‹๐š˜๐šž๐š› ๐šŒ๐š˜๐š–๐š™๐š•๐šŽ๐š๐šŽ๐š•๐šข ๐š™๐šŠ๐š’๐š—-๐š๐š›๐šŽ๐šŽโญ

In certain cases, an ๐šŽ๐š™๐š’๐š๐šž๐š›๐šŠ๐š• might not take labour pain away completely, or you may feel a window of pain somewhere in your body. Also, most care providers do not recommend an epidural until active labour (~5cm), so learning other coping techniques is still recommended (hire a ๐™ณ๐š˜๐šž๐š•๐šŠ!) But in the end, you need to do whatever it is that feels right for you!

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