Epidurals: the nuts and bolts
Updated: Jan 7
π΄πππππππ'π 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, π΄πππππππ'π 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 ππππππππ and πππππ of π΄πππππππ'π, but before diving into those, I want to talk about respecting peoples wishes around them, and this helpful tool, the πΏπππ ππππππππππ ππππππππππ πππππ (πΏπΌπΏπ).β
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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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βsome 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.
βπ±πππππππ/πππππππ ππ πππ πππβ
1) You want one! Everyone has a unique and personal relationship with pain, and for some people, an π΄πππππππ 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 π΄πππππππ might become your new best friend and allow you to have a positive experience. Compared to other pain medication options during labour, π΄πππππππ'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 yoursβ
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2) In certain cases, such as the urge to push on a swollen cervix, an π΄πππππππ can be medically useful and help you to have a physiological birth. As always, making informed decisions that are right for you is keyβ (because there is hardly ever only one option!)
βπ²πππππ πππππβand reasons to wait (πππ π ππππππππ ππππ ππ πππππ’ ππππ-ππππππ):
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βπ»πππ ππ ππππππππ’β
π΄πππππππ'π 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 "πππππππ ππππππππ", there is not a guarantee that it will be a light dose in your system as every body is different. A "πππππππ ππππππππ" 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 ππππππππ is in your system, the more likely it is for other side effects to occur (π΄πππππππ ππππππππ, fever, low BP)
and for your movement to be restricted.
βπΈππππππππ ππππ ππ ππππππππ ππππππππ’β
Due to feeling numbness from below your chest down, most people with π΄πππππππ'π 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.
βπΈππππππππ ππππ ππ πππ πππππ ππππππππβ which can compromise oxygen flow to baby.
βπΈπ πππ’ πππ ππππ π’πππ ππππππ ππππππππππ’ ππππ-ππππβ
In certain cases, an ππππππππ 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 π³ππππ!) But in the end, you need to do whatever it is that feels right for you!