Epidurals: the nuts and bolts

𝙴𝚙𝚒𝚍𝚞𝚛𝚊𝚕'𝚜 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, 𝙴𝚙𝚒𝚍𝚞𝚛𝚊𝚕'𝚜 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 𝚋𝚎𝚗𝚎𝚏𝚒𝚝𝚜 and 𝚛𝚒𝚜𝚔𝚜 of 𝙴𝚙𝚒𝚍𝚞𝚛𝚊𝚕'𝚜, but before diving into those, I want to talk about respecting peoples wishes around them, and this helpful tool, the 𝙿𝚊𝚒𝚗 𝚖𝚎𝚍𝚒𝚌𝚊𝚝𝚒𝚘𝚗 𝚙𝚛𝚎𝚏𝚎𝚛𝚎𝚗𝚌𝚎 𝚜𝚌𝚊𝚕𝚎 (𝙿𝙼𝙿𝚂).⭐

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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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⭐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.

⭐𝙱𝚎𝚗𝚎𝚏𝚒𝚝𝚜/𝚁𝚎𝚊𝚜𝚘𝚗𝚜 𝚝𝚘 𝚐𝚎𝚝 𝚘𝚗𝚎⭐

1) You want one! Everyone has a unique and personal relationship with pain, and for some people, an 𝙴𝚙𝚒𝚍𝚞𝚛𝚊𝚕 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 𝙴𝚙𝚒𝚍𝚞𝚛𝚊𝚕 might become your new best friend and allow you to have a positive experience. Compared to other pain medication options during labour, 𝙴𝚙𝚒𝚍𝚞𝚛𝚊𝚕'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 yours⭐

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2) In certain cases, such as the urge to push on a swollen cervix, an 𝙴𝚙𝚒𝚍𝚞𝚛𝚊𝚕 can be medically useful and help you to have a physiological birth. As always, making informed decisions that are right for you is key⭐ (because there is hardly ever only one option!)

⭐𝙲𝚘𝚖𝚖𝚘𝚗 𝚁𝚒𝚜𝚔𝚜⭐and reasons to wait (𝚗𝚘𝚝 𝚊 𝚌𝚘𝚖𝚙𝚕𝚎𝚝𝚎 𝚕𝚒𝚜𝚝 𝚘𝚏 𝚎𝚟𝚎𝚛𝚢 𝚜𝚒𝚍𝚎-𝚎𝚏𝚏𝚎𝚌𝚝):

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⭐𝙻𝚊𝚌𝚔 𝚘𝚏 𝚖𝚘𝚋𝚒𝚕𝚒𝚝𝚢⭐

𝙴𝚙𝚒𝚍𝚞𝚛𝚊𝚕'𝚜 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 "𝚆𝚊𝚕𝚔𝚒𝚗𝚐 𝚎𝚙𝚒𝚍𝚞𝚛𝚊𝚕", there is not a guarantee that it will be a light dose in your system as every body is different. A "𝚆𝚊𝚕𝚔𝚒𝚗𝚐 𝚎𝚙𝚒𝚍𝚞𝚛𝚊𝚕" 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 𝚎𝚙𝚒𝚍𝚞𝚛𝚊𝚕 is in your system, the more likely it is for other side effects to occur (𝙴𝚙𝚒𝚍𝚞𝚛𝚊𝚕 𝚑𝚎𝚊𝚍𝚊𝚌𝚑𝚎, fever, low BP)

and for your movement to be restricted.

⭐𝙸𝚗𝚌𝚛𝚎𝚊𝚜𝚎𝚍 𝚛𝚒𝚜𝚔 𝚘𝚏 𝚊𝚜𝚜𝚒𝚜𝚝𝚎𝚍 𝚍𝚎𝚕𝚒𝚟𝚎𝚛𝚢⭐

Due to feeling numbness from below your chest down, most people with 𝙴𝚙𝚒𝚍𝚞𝚛𝚊𝚕'𝚜 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.

⭐𝙸𝚗𝚌𝚛𝚎𝚊𝚜𝚎𝚍 𝚛𝚒𝚜𝚔 𝚘𝚏 𝚕𝚘𝚠 𝚋𝚕𝚘𝚘𝚍 𝚙𝚛𝚎𝚜𝚜𝚞𝚛𝚎⭐ which can compromise oxygen flow to baby.

⭐𝙸𝚝 𝚖𝚊𝚢 𝚗𝚘𝚝 𝚖𝚊𝚔𝚎 𝚢𝚘𝚞𝚛 𝚕𝚊𝚋𝚘𝚞𝚛 𝚌𝚘𝚖𝚙𝚕𝚎𝚝𝚎𝚕𝚢 𝚙𝚊𝚒𝚗-𝚏𝚛𝚎𝚎⭐

In certain cases, an 𝚎𝚙𝚒𝚍𝚞𝚛𝚊𝚕 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 𝙳𝚘𝚞𝚕𝚊!) But in the end, you need to do whatever it is that feels right for you!