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Epidural risks

(30 Posts)
saranga Fri 02-May-14 10:40:13

Has anyone got a link to an NHS/government (i.e. official) leaflet or website on the risks of an epidural? I've been googling and come up with a couple of things, but want to get more reading done.

mollysmum2012 Sun 04-May-14 22:45:42

an epidural is a personal choice when the individual weighs up the pros and cons. When faced with a prolonged labour, a malposition or an induced labour, it can be a godsend.It is not, however, a life saving treatment. A general anaesthetic is reserved for dire emergencies where mother or baby are at serious risk. This is because it is so much higher risk in pregnant women, not to mention that the baby effectively gets a general anaesthetic and will need help with breathing etc after birth. Even if you are entirely healthy, a general anaesthetic is no minor undertaking in pregnancy and it is absolutely wrong to compare it with an epidural. As Jcb77 says, the risk of death is rare but higher than the non-pregnant population, and greater than that of serious epidural complications. You would certainly never be offered one for pain relief as it would be bordering on malpractice.

theborrower Sun 04-May-14 20:09:29

JCB77 great posts, particularly re the natural vs intervention issue.

Jcb77 Sun 04-May-14 16:49:47

Part if the problem, as we all know, is that dr google spouts such rubbish. I've been horrified by some of the frank mistruths I've read about stuff i know about. I have to assume that stuff I know nothing about has the same level of rubbish written - I just don't know which is which. There is obv a lot of good stuff about labour and birth and analgesia out there but it can be difficult to understand without a stats degree or in depth understanding of how to read a paper (I'm rubbish at both). And of course, none of it applies to YOU. If you're the 1 in a squillion, you're still that one. Doesn't make it a squillionth as awful.
On a similar note, a lot of people on here seem to think that decisions to treat/not to treat are made for funding reasons. Clearly at the top of the tree this is an issue and it filters down to cover things like staffing levels (which has a direct impact on care) and which kit each trust buys (ditto), but when it comes to coal-face decision making about what is right for each patient, esp in labour and delivery, nope. If someone wants an epidural and it's clinically appropriate (whole other thread), it gets done. There might be a wait if the manpower is stretched, there are risks involved so the providers need to be sure it's what the woman wants and is appropriate, but not one anaesthetist I have ever met has made a decision about it based on cost. I would say the same for all the midwives and obstetricians and nurses I've spoken to too, at the coal face. Sure, you try not to drop things so you don't have to open another pack for example, and use sensible economy in what you do, as you would at home, but that's it. I suppose you do the best job you can in the safest most efficient way, but bottom line is the job gets done regardless of cost require once you're at that stage. Please don't go away thinking you've been denied an epidural/chance to labour in your own time because of costs. It just doesn't enter that bit of decision making. They are made on a clinical basis.

squizita Sun 04-May-14 10:02:01

And interestingly the risk of death from a general is about the same as the risk of paraplegia from an obstetric epidural. Now this is the kind of fact we need to hear, as I really feel 'political' motivation makes some online sources and even hcp (who will be believed) exaggerate the risk.

I got off the natural bus the day we discovered I can only carry on blood-thinning meds, so 'our bodies are designed to do this chemical-free' doesn't even apply to me. That ship has sailed. With regards to my birth plan webairn I think pain relief instructions are going to be "apply common sense and see how I am doing".

Thank you johull smile she is 35 hours old and has only spent about an hour max with her eyes open so far!

They didn't try to stop me but weren't encouraging either, understandably I suppose as it's resource-heavy. I think I was only about 4cm when I screamed asked for it. More screams when they said there were four women waiting already and again when it was finally sited and the anaesthetist said it would take 20 mins to work! Bliss when it did though.

johull Sun 04-May-14 08:10:33

Postman- congratulations on your bavy. Did you feel at any point that they were trying to prevent you from having an epidural? I've seen a few people on here saying they were told to wait or told no not yet even at 5-6cm dilated. Ty

Jcb77 Sat 03-May-14 22:30:10

You are right disco. In a young healthy person the risks of a general anaesthetic are low. The risks of a general anaesthetic in a young healthy pregnant person however are significantly raised (although still pretty low). For example a failed intubation is about 10 times higher in a pregnant person. That's not a situation you want ever to be in (on either end of the tube). And interestingly the risk of death from a general is about the same as the risk of paraplegia from an obstetric epidural.
Clearly each of us makes our own decisions based on how comfortable we are with the quality of the risk as well as the quantity of the risk though and seeing someone who has had a bad experience inevitably puts us off. I won't buy a silver car for that sort of reason. I know logically that silver cars aren't more likely to crash (given the same driver/conditions etc), but.....
It's also comparing apples with pears - you wouldn't get a GA in a circumstance that an epidural was being offered for analgesia.
Risk is very subjective and doesn't just boil down to numbers for most people. However, where labour analgesia (and a lot of labour as a whole) is concerned, an awful lot if people don't have any ideas about the numbers to help them make those gut decisions. That's the bit that gets me.

Discobugsacha Sat 03-May-14 21:18:19

In a young healthy person the risks from a general are low. And don't include leaving you paralysed. It will be different for everyone, for me, I would rather a general over an epidural. The risk/benefit will be different for everyone though.

PenguinsLoveFishFingers Sat 03-May-14 21:09:37

Disco - But how do the risks of death/serious complications from a general stack up against those of an epidural?

weebairn Sat 03-May-14 21:06:28

I delivered on gas and air. I was keen to avoid an epidural beforehand. I'm glad i was lucky enough to have a straightforward labour, but I feel kind of differently afterwards - I can absolutely see the merits of epidurals and elective sections, and this is someone who's only really experienced a "good" birth speaking.

I think a lot of it is first time idealism.

Labour pain is no fucking joke!

Having said that, I think if a labour is progressing swiftly and remains straightforward AND a woman prefers to go without pain relief, there are advantages to mum and baby in avoiding them.

Lengthy, more painful, and obviously more complicated labours, including some types of induction - well I think epidurals should be more expected as part of management when things go that way, and in no way a failure at all. No one has a section without analgesia or even considers that they should or that this is failing and I think protracted and less straightforward labours should be viewed in the same light, really. My midwife mate who is very pro-natural birth feels that it's only "natural" to go without pain relief if the rest of the labour is not being medically managed. e.g. She advised me to have an epidural if I ended up being induced.

If someone wants an epidural because they just want one - that's also just personal choice and fair enough in my eyes.

I think it can be a little hard for a birth partner to determine what a woman really wants sometimes. I asked for an epidural near the end of my labour, and was encouraged to remain at home because that was what I'd said I wanted previously. I didn't fight the issue - and if I had I'd have been very angry if they'd refused. But they told me I was doing well, I was coping, it was going well - that was really what I needed at the time, the support. I can't really see how anything would have gone well if they'd put me in an ambulance at that first request, for my already slow labour to no doubt slow further, and how long would it have taken to get an epidural at hospital anyway? I needed that encouragement and I was so grateful for it. So there can be a tricky line between encouragement and denying a woman what she wants, I think. I guess some health care professionals are more skilled at this than others.

The flip side to very valid argument Jcb presents about women's feelings of failure after complicated deliveries, is that many other women are petrified of birth and go to hospital in a state of panic which does not really help labour. So I think this is the philosophy behind some groups when they try and keep antenatal groups positive. I personally think it's a bit of a shit tactic when not backed up by consistent, calm, caring one-on-one midwifery, which all of our hospitals struggle to deliver with staffing levels. And I am definitely not saying many or most women who have complicated labours could have delivered more easily if they'd tried harder or any crap like that. Some labours will always have had complications. But others could have been helped with better support and care and expertise. For every hopelessly idealistic first time mum I know (I was probably one of them) I know a first time mum who expects birth to be a complete horror show. It is extremely hard to labour well when you are terrified. I think being calm and positive really can help some labours - but is it better to put yourself in the best position to labour naturally even though it might inevitably fail, or to accept the statistics that many labours, first time ones in this country particularly, are not "natural" ones and therefore defend yourself against possible disappointment and feelings of failure, but perhaps not give yourself the best chance at labour? It's a tricky balance. We certainly could have better birth outcomes in this country, though as I said above I think this is far more an issue to do with midwifery staffing levels than women's state of mind. And of course we have a different demographic giving birth these days than in previous generations and other countries, so it is not straightforward to compare.

Sorry - bit of a ramble and maybe not exactly on topic. I have tried to tread carefully in what I say because I am very aware of some women's feelings of failure after complicated deliveries - I hope I have not implied anything that would add to any of those feelings, as that is certainly not what I believe. At the end of the day every mum has successfully birthed a baby.

Discobugsacha Sat 03-May-14 21:03:55

I looked after a lady recently who had been left paraplegic as the result of an epidural. This is rare but a known risk. I would never have one.
If it was that bad I would rather a GA.

PenguinsLoveFishFingers Sat 03-May-14 20:54:24

I agree that what JCB has said is very wise.

My own experience of epidural was pretty negative, for about half a dozen different converging reasons. But I still think that they are badly understood, even though it would take very, very extreme circumstances for me to have another.

parallax80 Sat 03-May-14 19:58:16

Jcb I love this post. I suspect we have the same job'

Greenstone Sat 03-May-14 11:20:05

* I was asleep before the anaesthetist left the room, and woke up 4 hours later to find that I was 9cm dilated. The midwife said sometimes the rest and relaxation an epidural can provide sometimes has this effect.*

That's what my midwife said too islasmaw. I wonder if it's because the body stops trying to 'close down' the pain.

Wonderful post Jcb77. It should be framed and put on the wall of every antenatal waiting room !

Jcb77 Fri 02-May-14 16:26:02

I think epidurals are very poorly understood. The idea of 'having a needle in your spine' is understandably pretty hideous, even though that's not actually what happens. The idea of 'being paralysed' is also very off putting. Again, that's not really what happens (although you can get very weak legs) and it's reversible once you turn it off.
That, in comparison with an injection of a drug that many people will have had personal or family experience of, and fear of the unknown puts people off. Totally understandable but that's why information and education is so important and so irritatingly woeful! I see a lot of women post epidural (it's part of the job) and only a minority wouldn't have another one. If they don't want one it's usually because it didn't work (which happens in about 15% of epidurals - but can often be sorted if the anaesthetist is made aware). The fear is often so much worse than the reality.
I think part of the whole 'problem' with birth dissatisfaction is the speed at which things can change. The idea that you can have 'control' over what happens is a bit of a myth really. You can react to events according to your wishes but you can't really control the birth process. It will be what it will be. For a lot of people I think this is an unpleasant surprise.

islasmaw Fri 02-May-14 15:58:49

Totally agree, Jcb77 - I found first time round that epidurals were portrayed pretty negatively antenatally. I remained fairly open-minded - my preference(!) would have been for a water birth, but after 60 hours of painful, regular contractions, pretty much constant monitoring ( so no water), and still only 3-4cm, exhausted and completely saturated with gas and air, my midwife strongly suggested an epidural. I was asleep before the anaesthetist left the room, and woke up 4 hours later to find that I was 9cm dilated. The midwife said sometimes the rest and relaxation an epidural can provide sometimes has this effect. I was easily able to feel enough to push, and after 3 days of hell, the couple of hours leading up to my daughter's arrival were calm and enjoyable, and I was completely 'with it' when she was born. For me (contrary to everything I'd been told), the epidural was a 100% positive experience - it did not cause extra interventions, and it did not lengthen the labour - the opposite if anything.

I'm now expecting no. 2 and, while I'd love a water birth in the mw-led birthing centre, my experience with DD1 taught me that with the best will in the world, you cannot order a particular type of birth. To be honest, so long as this one arrives safe and well too, I'm really not too bothered; it's a means to an end. I now find myself getting slightly irritated by the veneration of doing it 'naturally'. Fine, if your labour works out that way, but for many it just doesn't; things can change in the blink of an eye that are completely out of your control, and no one should feel like they've failed for doing what's necessary to deliver their baby. I had no such feelings until my SIL remarked one day when I said to a mutual friend that giving birth was easy compared to being a parent that it was "ok for you, you had an epidural". Indeed, after 3 days in labour (compared with her 6 hours total).

As a side issue, I've never understood why epidurals get such a bad press compared with pethidine / opiate-based drugs. To me, the fact that my pain relief didn't cross the placenta made it far preferable to having something that would also affect the baby.

Jcb77 Fri 02-May-14 13:26:48

Squiz- I think there's an element of truth to that. Birth is seen (and is) such a natural process, 'owned' by the female side of the community is a way that very little else historically has been. It seems that for many, the interference in any part of it is seen as a failure or unnecessary. And yes, it is very natural. But so, unfortunately, is death and pain and disability - all of which happen in shockingly high numbers in places without the ability to intervene. In this country, we are blessed to almost never see the really awful stuff and have ways of managing the pretty bad stuff. It gets forgotten that 'natural' is not synonymous with 'good' or 'best'. And quite equally, neither is 'intervention'. In the same way that 'natural' remedies and foods are not always the 'good/safe/healthy' option, neither are natural births. Most women will manage an intervention free delivery with few problems, if they chose. For those where it can't or doesn't happen I think there is a high sense of failure. Your body has 'failed' to do something as natural as breathing. It can be very difficult to pick apart which bit(s) went 'wrong' and an easy blame is the intervention. The alternative is to blame yourself, which is an awful place to be and has all sorts of repercussions with pnd etc.
If the focus changed slightly to having a healthy baby (by whatever means) rather than a birth experience, it might be better. These days, with IVF so common, no-one fusses about how you got pregnant, the key is that you got pregnant. Despite the fact that IVF can be bloody horrible quite frankly.
Antenatal education about analgesia and intervention is awful. The risks and advantages (it's not always just about pain relief) are very poorly understood or explained. For those who want to look into it deeper for themselves, google provides a mine of useless, misleading and inaccurate information and a lot of good stuff that can be bloody difficult to make head or tail of and how it relates specifically to you. Even if you have experience of reading such articles.
I once offered to run an evening session talking about analgesia for labour in a bit more depth for those mothers that were interested. Sort of antenatal plus. I ran it by several midwives and basically got told to butt out. It went against the promoting natural as best policy. Suspect the whole breast vs bottle thing is very similar.
Many midwives in my experience are anti analgesia. I am fortunate to work in a unit that is not but still have occasional issues. I have no problem with a woman soldiering on as long as she wants without an epidural. If I don't need one, great - I won't be asking for one. I do have a problem with the situation where a woman is exhausted, has been in awful pain for hours (often unexpectedly so for her), is being cajoled by her partner not to have one and quite clearly feels she has somehow 'failed'. It's horrible. I've also seen women refuse to look at their baby let alone hold it after an urgent (but very straightforward) section because they don't feel they 'deserve' it because they didn't push it out.
The whole societal concept has to change. Yes, some women and some labours are 'easy' and fulfilling and great. A lot aren't. So many women (first timers especially) seem to go into it with massively unrealistic plans, expectations and hopes of control. When it goes out of the window they are disappointed, confused, angry and feel they have somehow failed. Despite the fact that both mum and babe are safe and well.
I think those that push the 'natural is best, anything else is somehow less than perfect' approach are woefully misguided and in the case of hcps unprofessional.
For some women sadly, one of the biggest 'risks' of intervention (of whatever sort, analgesia or otherwise) is the resultant sense of unhappiness that it was needed.
Sorry OP. Seem to have gone a bit off topic. Shall shut up now.

Greenstone Fri 02-May-14 13:17:40

Congratulations, PostmanPat How are you doing?

My epidural experience was identical to yours - I gave birth on my side with leg hoisted in the air (so dignified eh) and could feel everything.

I had a good experience with it after a crashingly full-on contractions. I'm pregnant again and although I'll probably do my best to avoid an epidural this time - there are risks - I just wanted to add my experience, since a lot of what you read about epidurals will be overwhelmingly negative. In fact I had been extremely anti-epidurals myself prior to labour smile

squizita Fri 02-May-14 12:00:33

One thing that frightens me is the 'political' element of epidurals.

I have heard of anecdotes about midwives (and doulas) with a couple of friends, who were opposed to some pain relief and doggedly refused/discouraged 'spiral of intervention' (not a debate to have when one person is out of their mind with pain) even when it became clear the mum hadn't anticipated the pain/size/back-to-back/length of the labour. Then another MW would come over and say "for god's sake give her one she can't go on without it!". Then it is resolved.
JCB I do wonder whether some women in all their pain conflate the late pain relief as failure and it contributes to birth trauma? Kind of like the difference between and emergency and elective c-section: if it has to happen, let it be explained early and not tied up with ideas of 'failure' to get by on gas and air.
Online, you find few vocal pain relief fans... whereas in real life, lots of women I know tend to be angry if it has been refused or discouraged without good reason. Interesting contrast and I wonder why?

Jcb77 Fri 02-May-14 11:37:50

*vaginally. Or 'baginally' if you'd prefer I suppose....

Jcb77 Fri 02-May-14 11:36:33

There is no increased risk of c-section because of an epidural. There is an increased risk of instrumental delivery (forceps or ventouse) delivery being required. Without an epidural it is about 7%, with an epidural it is about 14%.
The 'cascade of intervention' is a very thorny issue. There is correlation as well as causation to be considered. So big, poorly positioned babies, for example, lead to longer, slower, augmented, more painful labours, that result in further interventions, including but not because of, an epidural. This is often disregarded and everything 'blamed' on the epidural. It is possible to deliver baginally with an epidural or a spinal anaesthetic (and even whilst unconscious with no idea about pushing) the body is designed to expell) but it doesn't always work for a whole host of reasons.
The OAA website gove a lot of good information, written by specialist obstetric anaesthetists, about labour epidurals specifically and a load of other stuff about pain relief in labour. It's under the labour pains website as mentioned above. It also give up to date references from peer reviewed journals. Several other sources I have read use data for 40years ago. Things have changed significantly since then.

squizita Fri 02-May-14 11:15:28

There is also this site I found via Mumsnet, factual information about all the main pain relief types: www.mumsnet.com/Talk/pregnancy/2068157-www-LabourPains-com-launched-with-thanks-to-mumsnet?

saranga Fri 02-May-14 11:12:24

Thansk.

I was able to prop myself on my side with leg up, could feel her descending so knew when to push without needing to be told, got the baby out in a couple of contractions. So it doesn't have to be a negative experience. The pain pre-epidural was unbearable.

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