To Epidural or Not to Epidural: A Guide to Making the Best Decision for Your Birth

Woman in labour

What pain relief you might choose to cope during labour is a major decision and not one which is easy to make in advance.

It is impossible to know how well you will cope with the pain of active labour and so it's a good idea to learn about the different pain relief options available so you can make an informed decision.

One option many women choose to control pain during labour is an epidural. This is an extremely effective form of pain relief but you will need to be in a hospital as it must be administered by an anaesthetist.

This means it is not an option during a homebirth or if you are giving birth at a midwife-led unit, which is not attached to a labour ward.

What is an Epidural?

An epidural is a type of pain relief which is given by a thin tube, called an epidural catheter, which is inserted into the lower back using an injection.

It will numb the lower half of your body to make childbirth less painful and the dose can be adjusted depending on the level of pain you are in.

The catheter will usually remain in place until your baby is born. An epidural can either make you completely numb or partially numb and you will remain awake throughout.

When you are given an epidural, you will normally be given an injection of local anaesthetic first before the catheter is inserted. You will either be asked to sit down and lean forwards or if you are lying down, you will be asked to turn on your side and lift your knees up towards your chest.

The epidural will not work immediately, the pain relief which is inserted through the catheter will take between 20 minutes to 30 minutes to take effect. A drip will also be inserted into your arm to give you fluids - this means you will have to stay in bed during labour and won't be able to move around.

However, some hospitals do offer the option of a mobile epidural. This involves a lower level of pain relief but this means you will still be able to move around and walk during labour.

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Will I Always Be Able to Get an Epidural?

There may be some circumstances where an epidural is not an option for you. If you are at an advanced stage of labour, there may not be time for an epidural to take effect.

There may also be a medical reason why an epidural is not suitable for you, especially if you have a history of spinal problems or you are taking certain medications. If this is the case, it is likely to be discussed with you during pregnancy when you are writing your birth plan.

You will also only be able to have an epidural if the hospital or birth centre you are at offers them and there is an anaesthetist available to carry the procedure out.

What Are the Benefits of Having an Epidural?

The pain relief administered during an epidural is very effective and allows you to remain alert and awake during your baby's birth.

It can also be an advantage if you are likely to need an emergency caesarean section for any reason as the epidural could be quickly used to make sure the area is completely numb and ready for surgery.

Unlike some pain relief options offered during labour, an epidural should not make you feel nauseous and it is generally very safe.

Are There any Disadvantages to Having an Epidural?

Having an epidural can cause your blood pressure to drop which can then make your baby's heart rate slow down. This is unusual, however, as fluids are given through an IV drip before the epidural is administered to prevent this from happening.

The other main disadvantage is that it can slow down the second stage of labour and make it more likely that you will need intervention like a ventouse or forceps to deliver your baby.

This is because some women are unable to feel their contractions and so need to be told when to push by a midwife.

Are There any Side Effects From an Epidural?

Epidurals are very safe procedures but as with any medical treatment or intervention, there are occasionally side effects.

You may experience some soreness where the catheter was inserted, although this is not common. Sometimes, women will experience a severe headache if the spinal cord sheath is accidentally punctured during the epidural but this only happens in one per cent of the procedures carried out.

In very rare cases, an epidural can cause a seizure.

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What Are the Alternatives to an Epidural?

An epidural is only one form of pain relief available during labour.

Some women find that they cope well without any medication, using techniques like hypnobirthing, focused breathing, distraction, a massage or giving birth in water.

There are also other pain medications which you can use. The most common is Entonox, usually known as gas and air. This is a mixture of oxygen and nitrous oxide, which you will breathe in when you are having a contraction.

This can make the pains you are experiencing more bearable and there are no harmful side effects. However, some people will not like the feeling they get from taking gas and air, although any effects will go away quickly when you stop breathing it in.

You may also be offered pethidine, diamorphine or remifentanil, which will help you relax if you are struggling to cope with the pain. However, these drugs can make you feel sick and can affect the baby#s breathing if they are given too close to delivery.

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