Epidural - positive and negatives please

[lucybrad]

Hi All

I am currently pg 30 weeks, and previously had twins by elcs.

I am getting worried about labour now, but have been assured I can have an epidural if wanted.

Now I was wondering, if an epidural takes away all the pain, why doesnt everyone have one? I take paracetamol for a headache so why not get rid of the pain of this? Can anyone give me real life experience of the good and the bad points please...

Oh I also had the shaking, it was really horrible and freaked DH out as he thought I was having a seizure.

That sounds pretty horrible, Porcelain, you were really unlucky. I had a good experience of epidurals and no side effects so I was lucky. I don't think the baby's heart rate drop would have been caused the c/s though. I made a lot of enquiries about this before I had mine because it was something that worried me. I looked on pubmed, on the Obstetric Anaesthetists site and had a chat to the anaesthetist. He said it is not uncommon for the baby's heart rate to slow slightly after the epidural is sited which is why they monitor for thirty minutes but he said this isn't linked to the serious fetal heart rate abnormalities that cause caesareans.He also said that there are some advantages of epidurals to the baby probably because the mother is less stressed. Sorry it was so awful for you though.

First epidural: wonderful. Took the pain away, left me clear headed, was having a highly medicalised birth anyway and it just got me through the final stage. Was fine afterwards. Brilliant.

Second epidural: Was having a similarly highly medicalised labour. Requested an epidural. Worst decision ever. The guy struggled to put it in, was horribly unsympathetic, shouting at me to keep still while he repeatedly stabbed me in the spine with a fucking needle as my contractions got harsher and harsher. It didn't really work. I was in as much pain from inserting the ep as I had been from the contractions. The midwives in attendance were lacking experience and I tore massively because I relied on their (bad) judgement on when to push and how hard. Never, ever again.

Oh, and then ds was born blue and spent the 1st 20 minutes on a table across the room from me being seen to and I was stranded on my bed unable to move.

Although to be fair I prob couldn't have moved anyway as was haemorhaging badly and had to be sewn up quite comprehensively. Still, it did make me feel extra helpless.

Ushy, the heart rate drop came off the back of my blood pressure, my diastolic dropped down to 30. I'm not sure how it happened as all I know is one minute I was sitting up in bed feeling all warm and smug and the next thing I knew there was a crash team in my room and my arm was freezing as the midwife was squeezing the IV bag into my arm as fast as possible. I probably passed out.

To be fair my baby was already likely to be a touch distressed, I was being given synto as I had been in labour 2 days and had meconium in my waters, so there were lots of factors involved, but there is no doubt that my blood pressure dropping that much contributed, his heart rate had been solid up until that point. The section was kind of by choice, we had 3 more episodes with the crash team and I was told I could go to surgery then, or wait and see if it kept happening, I decided I couldn't bear the fear of losing my baby that came with every episode, or having a general anaethetic, which could have happened if we waited until it got really bad, so decided to cut my losses.

I didn't have one as DS born at home. Nothing against them per se but, looking back, if the pain had been dulled by an epidural, I don't think I would have pushed DS out unaided. Pushing as hard as possible took the pain of each contraction away so there was a massive incentive to PUUUUUUSHH. For 2 hours. I was shattered by the end (even though it was a fairly quick birth) and if the pain hadn't been there, I think I would have given up, and let the doctors take over. But in the end DS arrived at over 9lb without any tears (with huge thanks on that last count to a pair of wonderful midwives).

See how you go. I had 4 and a half days of first stage - over 1st 24 hours got to 4 minute - ish contractions and then slowed to every 15 mins for the rest. Couldn't eat (threw up) and couldn't lie down so by the time I went into hospital to get things going I was pretty exhausted. The epidural gave me a rest which I really needed. OK it took 3 gos to get it working properly and that's no fun at all (immobility and pain) but once it did I was able to take decisions and deal with what was happening. EMCS in the end - maybe the epidural but also little blighter was back to back so probably would have happened anyway. It is a choice and you may need it - so don't decide now, just know its there and the downsides.

Pro : pain relief. Every labour is different and everyone copes (or not) with pain differently. The only pro is good pain relief, which in turn may help you relax which sometimes allows the head to descend faster.

Cons : it's a medical procedure, it has risks. The anaesthetist will go through them all while you're in labour and you probably won't remember half of them. Or care! Main risks are failure (1:10), epidural headache from puncturing the dura (bag of fluid around spinal cord, ~1:100), nerve injury (~1:10000). Side effects are motor block (not being able to move your legs), increase in risk of assisted delivery (forceps / ventouse), shaking, high block (where the level of numbness goes too high - this is rare but can be serious and may result in a GA section), catheter (epidural drugs can affect the bladder function and some people can't pee properly with a numb bum), risk of infection (rare but reported), and low blood pressure (makes you feel crap and can make baby's heart rate slow down).

There isn't a known causal relationship between epidurals and EMCS although it's likely that labours which are painful enough early on to need an epidural are heading in that direction anyway.

A spinal block is completely different - much smaller needle and the drugs are injected directly into the spinal fluid. The epidural space is a potential space just next to the spinal fluid, not in it.

The OAA leaflet linked to earlier is a good one

FWIW, I had 2 epidurals with DS1 and 2 and would have one again. No pain, easy labour, normal deliveries, stress free experience.

The biggest negative of an epidural as far as I'm concerned is that if you're unlucky, it will be me the midwives wake up at 3am to put it in!

Gosh 1:10 failure rate seems high TK, hadn't realised it was that high! Is that complete or partial failure?

I am interested that in looking at your list of side effects I had several of them: motor block, catheter, forceps delivery and slowed baby's heart rate. Hadn't put the latter two down to the epidural though.

3 kids = 3 epidurals, what works for you, works for you, and it is your choice.

I have had 3 epidurals, out of 4 births. I think I would of got away without one for dc3 as it was only there for an hour and it wasn't excruciating before I had it.
With dc4 I had it in for over 36 hours due to inducing not leading to established labour. Dc4 is almost 3 months and I still have some pain left from the epi site.
I know I'm just unlucky as the other 2 times I was fine after and if I hadn't of been induced I prob wouldn't of needed it.

You know, I'd forgotten about the shaking until it was mentioned here! I didn't feel comfortable trying to hold DS for a while as I was shaking so badly.

I have one DD and was induced with an epidural about 12 hrs after labour started. It was bloody amazing. Topped up constantly, didn't feel a thing. I did nearly need a CS but in the end, it was a forcep delivery but I felt no pain at all. DD was fine and I was bf immediately.
Only downside was my legs were swollen like balloons for quite a while afterwards (but that was also down to being induced and having had swollen legs already) and I couldn't feel myself doing a wee for about a day. I would definitely have one again.

OK, so two things are bugging about me about this thread:

1. Lots of assertions that x,y,z (drop in blood pressure, emergency c-section, intervention etc) were CAUSED by the epidural. I think there may be some confusion between correlation and causation and only an expert opinion could say whether the epidural actually caused the c/s. After all, someone may have requested an epidural because there labour was long and they were completely exhausted from the pain. The long labour may have been caused by the baby being in a bad position thus c/s was somewhat inevitable.

2. People chipping who haven't actually had epidurals.

Other than that am delighted to see so many coming forward to give a balanced view of epidurals. I felt when I was pregnant it was almost a dirty word and I was ashamed to ask for one. I was the only one in my NCT group who said she would be open to one and I was made to feel like a failure. In the end seven out of eight of us had one!

I know that people can have bad experiences with epidurals but for me it definitely contributed to a positive birth experience -baby born with no intervention and I had loads of energy afterwards to bond with her, chat with husband etc. I recovered very fast and had no trouble with weeing etc. I feel bad when I hear about mothers who have staunched through days of very painful labour to finally "succumb" to an epidural and then feel like a failure.

But the question (or one of them) in the OP was "why doesn't everyone have one?" It seems reasonable for people who haven't had one to chip in and answer that one.

Sorry, was just going by the title and forgot the specific questions in the OP. I guess I just worry that people who haven't actually had one are making claims about epidural that are unsupported and just perpetuate myths about epidurals.

Prof I got the shakes really bad after dc 4. I put it down to 36 hours on my back with the syntocontin drip, or the fact the labour (only 3 hours) was so calm I was just in shock. Had never felt that way before epi or not.

TBH, I think the best approach is to go in to labour completely open-minded. If I could have given birth without an epidural then fine (it is not like I was going to beg for one if I didn't feel like I needed one) but to go into labour adamant that you shouldn't have one can set too high a standard for yourself.

I imagine in my next labour I probably won't need one (at least, that is what my MW said) but I wouldn't want to set myself a challenge of not having one as though it was all some sort of competition.

One thing with epidurals though is that it is best to ask early. I asked as soon as I was dilated enough and the MW set me up for it. It still took FOUR HOURS for the anaethetist to arrive due to emergency surgery. I would have hated to have been at the point where I could bear it no longer and then be being set up for it.

I didn't have an epidural for the following reasons:

1. because I've always worried, ever since I was a child, "suppose my body can't push the baby out" (well, it's not something you can truly practise, and I have a history of problems pooing). So, reading about forceps possibly being linked to epidurals, and women not being able to feel when to push, that discouraged me!
2. When I did investigate the possibility of having an epidural during labour, the (lovely) anaesthetist (who was actually trying to encourage me) said, "it'll just be a bee-sting in your back". Bee-sting? Bee-sting?! I really didn't like the thought of trying to keep still while feeling anything like a bee-sting in my back.

I felt convinced that I would twitch horribly during the process, and cause it to go horrendously wrong.

3. I was in stop/start premature labour, and the doctor told me having an epidural would mean committing to delivery in the next 24 hours. I was still really hoping that labour would stop, and had spoken to the SCBU paediatrician earlier, who'd told me that SCBU was overloaded, and there was a possibility that new admissions would be shipped to a different hospital.

I've had 2 vbirths and 2 epidurals, both occasions laboured through the night, completely knackered so had epidural. Both were brilliant.. and I think because it slowed the labour right down I didn't tear with either, and that was 7 and 9lb babies..

I had no problems and was able to walk again within an hour of the birth..

Downside was it did slow the labour right down so I was in labour for 3 or 4 more hours than I needed to be..

Chaya - you are SO right!! There is a lot of misinformation about epidurals. There have been a couple of studies comparing a whole hospital's intervention rate before they had an epidural service and then after it was introduced and widely taken up. There was no difference in overall intervention rates before or after. However, those who used epidurals had more interventions. The conclusion was that women in more pain (and therefore more complicated labours) ask for epidurals more often and they inevitably have more interventions but this is not caused by the epidural - more the epidural is a result.

I haven't read the whole thread, but I think the key is WHEN you have the epidural. Due to having a VERY BAD midwife (!), I had my epidural when I was 9cm dilated. It was one of the most wonderful experiences of my life! But also not to be recommended. It made my labour too long and did lead to a cascade of intervention, ending in forceps and a third degree tear.

I think epidurals are great early on. Also if you are very distressed. I was distressed (various reason), and was not breathing well, so passed my distress to the baby. Once I'd had the epidural, I (and baby) calmed down completely.

Most of my friends though have had their babies without epidural and been totally fine. They all seem sold on Hypnobirth. So you could always give that a go as well.

I have long been asking myself the question why doesn't everyone have one.

After all, they seem near automatic on the continent and it seems daft to turn down pain relief when someone's been clever and kind enough to go to the trouble of inventing it.

Having said that, I had an epidural w DC1 because he was induced, stuck, back to front, forcepsed out and 3rd degree tears in process. So so glad it was invented. DC2 and 3 I didn't and it never occurred to me to have one. I'm a big believer in the forces of gravity and I simply can't see how being flat on your back is going to help your body push a baby out.

Don't start worrying. Remind everyone you see that you might want an epidural and see how you get on in tiredness and pain. Ultimately it doesn't really matter so long as it works for you. Good luck.

Warning - negative story coming up...

I had a shocking experience.

The aneasthetist couldn't get it in right. He repeatedly hit nerves (leaving me screaming in agony) and capillaries (leaving blood pissing out of my back). I was terrified there was going to be some permanent damage (there wasn't, just terrible brusing) and am still having flashbacks about it now.

To top it all off, it didn't really work and I was still in a lot of pain, although I lost sensation in my legs and had to have a catheter in.

Someone from the anaesetists team came to see me the next day and said he hoped my experience wouldn't put me off having an epidural next time. It would. Never again for me I'm afraid.

I guess I was just unlucky.