Why is an epidural a big deal

[Muddytoes1]

Currently 30 weeks with my second and spoke to midwife today about the possibility of having an epidural this time round and she was all “well lots of options to consider before that” and started talking about the nice lighting etc in birthing room and aromatherapy etc. Didn’t want to be rude and point out that nice lighting isn’t the most effective pain relief option out there - she is really lovely and only trying to help. I didn't have any pain relief other than gas and air last time because NCT and midwives had made out that was the best option and yes I got through it but it wasn’t some amazing experience where I had a huge sense of achievement it was horrid. It hurt like hell and I don’t see why if there are better pain relief options out there I can’t use them? The main downside I can see to an epidural is not being able to feel pushing so increased likelihood of intervention but I never felt a pushing sensation anyway just lots and lots of pain which I think if anything was hindering the process not helping as I was fighting against it at every contraction rather than pushing. Anyway not really looking for any advice, just wanted someone to vent to and maybe reassure me that it’s ok to ask for pain relief in labour if I want it. Thank you x

I'm really sad to hear that people have been denied or discouraged from their choice of pain relief. I didn't have that experience, I was induced on the drip and in hindsight realise my first midwife was encouraging me to ask for an epidural (stupid me didn't pick up on this!) I was then offered it again when I said I needed more than gas and air. I opted for remifentanil but if I were to do it again I'd have the epidural 100%. So perhaps OP you might get lucky and find your trust / midwife are encouraging? Good luck x

I walked into the delivery suite at 6cms and the midwife was all oh we'll get you some gas and air. I politely declined and asked for the aneathatist he arrived with my epidural in tow about 5 mins later. Took about 20 mins to get it set up and in. I didn't feel a thing and the relief was great. I still had nice lights as well (battery powered tea lights ) and music via bluetooth speaker. It was all pretty calm and relaxed I sat watching the blizzard from my bed (DS arrived during The Beast from the East). I did have to have ventouse and episiotomy as DS got stuck but afterwards it wasn't too horrendous. If I have another baby I'll definately have another.

I had a fucking awful labour. Back to back and complete debilitating agony from the very first contraction. Had gas and air and pethedine. I'm scared of needles, and by the time I really needed an epi I couldn't speak to ask for one.

Ended up with a spinal and 30 seconds from emcs but they got baby out with forceps and ventouse on a last chance push.

I'm having an epidural next time if I have to do it my fucking self.

Our local hospital can’t do epidurals except for surgery, so that’s that really 😂 I would have loved one in my first labour, but subsequent labours were fine.

Of course you should have an epidural if you want one! I’d put it in massive letters on the front of your notes. Ugh it makes me so angry that women are fobbed off and denied adequate pain relief.

However just to offer a flip side, my first baby hurt like hell too but my second just popped out in the water. No one believes me but it was uncomfortable for 15 minutes and that was it (I was in labour for 3/4 hours but it was chilled). It was the most incredible experience. So you may not find you want/need an epidural after all, especially if you have access to water. And as a pp says, subsequent babies can come quite quickly so there may not be time. I wish you a relatively painless and calm birth regardless.

So many great replies though it does concern me how many people had to fight to get what I thought was a standard pain relief method. I will make sure it’s on the front of my notes and get dh to keep nagging until it’s done. Kind of stresses me that I might have to do that but needs must. I want to stay flexible as I know everything can change so quickly in labour I just wanted to try and feel in control on this one thing but that’s never really possible I guess.

I wanted an epidural in my first labour but the anaesthetist wasn't available until after I was fully dilated so it was considered too late. Ended up with one eventually as I needed an EMCS. I have to say, it was great when I got it!

Second labour I wanted to manage without as I was having a VBAC and DC1 was large so I thought it would be best to stay as mobile as possible. In the end I wasn't comfortable anywhere but lying on the bed, needed a ventouse delivery then had to have an epidural after the birth anyway so I could go and be stitched back up in theatre. I honestly wished I'd just had one in the first place!

My back to back baby made an epidural necessary- I wasn't coping and told everyone I was going home and couldn't do it. Then I was given one. I remember looking at the trace of mh contractions with awe as it was such good pain relief i had no idea they were happening. I vomited all over myself but not sure if the epudural caused that. I had a catheter which was a bit of a pain the next day. Forceps, episiotomy and loads of stitches for me.

2nd baby- no pain relief at all as I totally misjudged the progress of labour. The pain was so different as baby wasn't back to back. Much more manageable. So by the time I got to hospital (he was nearly born in the car) I didn't have time for any pain relief.

Ultimately the risks (albeit small) with an epidural include permanent nerve damage, paralysis or death.

I had an epidural with both my labours. Only one worked (but felt like a real blessing).

Both times the worst pain for me when recovering was the site of the epidural injection in my back. Ouch ouch ouch.

There are other side effects as others have mentioned....

Look up the risks and benefits and make your own decision.

I had an epidural OP after nightmare induction and it was amazing. They just turned the amount down/turned it off or something just before time to start pushing so I could feel the baby bearing down a bit which worked fine for me.

Not sure how it is in UK hospitals but in the US you can request to have it in your birth plan. Then, depending on the size of the hospital, they ensure an anesthetist is on staff at the time. It’s kind of like they schedule it a bit. Yes, your baby can arrive at anytime within a range of days, but they try to take that into account. This “No anesthetist on duty” malarkey wouldn’t really happen unless you’re in a small rural hospital or something. And even then, they’d grab the one doing surgeries to come over to help. I can’t believe the stories on here about women having to suffer so much. Be forceful and make sure your advocate is able to be extremely forceful on your behalf as well.

I'd happily have one now!
I think they don't like them as it means the nurses have to do more post birth as you might not be mobile, but I could be wrong.
Also, given that it's the NHS, they are probably thinking of money.

I had them with all three of mine I was induced and given the drug to speed things up. I was never catheterised and could still stand up with it. I also had no interventions with any of them just some slight grazing. Would definitely use it again.

Not sure about pethadine but I don’t like the sound of being drugged up on anything that strong.

But often epidurals contain opioids. So you are still drugged up on a very similar drug to pethidine. If you want an epidural and don't want opioids at all you need to be really clear about that. At my hospital there wasn't an option for me to have an epidural without opioids

I’m with those who are outraged at the anecdotes of delayed or denied pain relief.

Epidurals are a safe, effective form of pain relief. Like all medical interventions, there is a risk of some side effects and your doctor should talk you through those. However the pain relief benefits of an epidural are entirely unmatched by any other Labour pain relief option.

There is some awful nonsense spouted against epidurals on this thread. A really good blog about epidurals is called The Adequate Mother by a Canadian anasthesist and she explains lots about the benefits and risks. There is no evidence that epidurals increase interventions - while there is a correlation, the cause may well be the other way round. Interventions are needed because e.g. the baby is badly positioned, the positioning makes Labour longer or more painful, a longer or more painful Labour makes it more likely for the woman to request and receive an epidural. There is no evidence whatsoever of an effect of the epidural drugs on your baby, unlike for example pethidine.

Pain relief is seen as a fundamental tenant of good medical practice. The push for “natural” nonsense and the promotion of entirely ineffective pain relief methods is crazy. Pethidine is a case in point - it’s such an ineffective pain relief that it is almost entirely obsolete anywhere else but childbirth. And it can have side effects for the mother and for the baby. Why it is promoted the way it is in British hospitals is beyond me.

You sound like you are very clear on your preferences and if your midwife won’t support you on that, insist on a change of midwife. Have your request for an epidural documented now on your notes and repeat it clearly to everyone you see in Labour until you get it.

Best wishes.

I requested it in my birth plan. I had a very long labour (nearly 40 hours) and I had Meptid twice, which was lovely - took the edge off before I was ready for the epidural. Then when the time came for the epidural I had that, and it was glorious. I was too tired to push by that stage and was dozing off between contractions that were a minute apart, so I had to have the ventouse. But that was because it was nearly 40 hours since my first contraction and no sleep!

Second time around there wasn't time for it, just gas and air, and I was NOT HAPPY but the midwife was adamant that by the time the anaesthesiologist got there I would be holding a baby, and sure enough, dd2 was born 4 mins later after a 3 hour labour.

All in all, I felt that my choices were fully respected both time.

I had one with my first and it was good, certainly took the edge off the pain after quite a long slog. I could however feel everything still which I didn't expect based on stories I'd heard.

I would however (if you have one) make sure it's topped up as mine had totally run out by pushing / stitches time. X

Also, you should absolutely be able to request whatever you need. I agree that lighting would do absolutely nothing! X

As a Brit living abroad who had both my babies under private healthcare (DS1 hypnobirth, DS2 epidural monitored birth), I watch these threads from afar and find the fact that women who are birthing humans have to fight for pain relief during labor absolutely fucking barbaric.

The whole statement that epidurals lead to a cascade of intervention has to be flawed as previous posters have said, there are more likely to be greater interventions necessary with a back to back labor in any event and that has nothing to do with an epidural.

My cynical self says that the major reason women are discouraged from having epidurals is cost. What the NHS doesn't seem to consider is that the cost of rehabilitating birthing injuries for women, be they mental or physical injuries, will cost the NHS far more long term than the cost of an epidural and anesthetist.

I had incredible birthing experiences with both my kids. The fact that other women have such awful experiences and are emotionally and physically scarred because their feelings and requirements are dismissed makes me damn blood boil.

Hardly anyone ever seems to mention mobile epidurals. I had one. Fan-fucking-tastic. No pain at all, had a wee nap which was fab as I'd been labouring for about 24 hours. Was still aware of contractions and the bearing down sensation. Was able to walk about, go for a wee, and when it came to the pushing stage I was upright for almost all of it (except DD was malpositioned despite my mobility and gravity and needed forceps, but even then the fact that the epidural was in place meant they could pop in a full spinal block really quickly).

Mobile Epidural. Ask your hospital.

I totally relate to not feeling any sense of ‘achievement’ or positivity from getting through labour/birth with no epidural. I found the pain horrific and unbearable. I was completely out of control and couldn’t take in anything that was happening other than the pain. I was shell-shocked and traumatised. My friend had an epidural and says she even managed to doze off, that she was able to be aware and enjoy the moments of the child’s birth, capable to talk through decisions regarding the birth with staff and that sort of thing.

I do know others who managed fine without an epidural though so it is a very personal thing..

I didn't want one as I didn't want to increase the risk of further interventions. All my births have been sub 3 hours though. I imagine if I had had my poor mother's experiences I would have been demanding an epidural at some point!

It's your choice, your body, your experience. No one should be shamed for wanting or not wanting one. Whatever works for you is fine.

I'm an anaesthetist, I work on labour ward quite a lot. I can honestly say I have no real idea how much an epidural costs, and that is never ever a consideration for whether a woman can have one or not. I'm pretty sure the midwives aren't interested in the cost either, though may have other reasons for delaying asking for one. The only time I would not do one, if I am free, is if there is a clinical contra-indication e.g. metalwork in the spine or use of anticoagulants, or if the woman is already fully dilated.

However, out of hours I am very often the only anaesthetist covering labour ward, and that means sometimes I'm busy with something else. Even the most straightforward theatre case takes 45-ish minutes from start to finish (and unlike the surgeons I am in there the whole of that time) and we have to take the woman to the post-op recovery area and handover after that. A difficult CS or complicated instrumental with perineal repair can take 2+ hours, which is a looooong time for any poor woman who asks for an epidural just after we've started a case. Even if I'm just doing another epidural for someone else on labour ward, that takes 45 minutes including getting kit and doing paperwork. There are some arrangements for getting a second pair of hands to come and help, but they aren't 100%, especially in smaller hospitals - there may only be one other anaesthetist in the hospital and they may have their own theatre cases. It's not fair on women who are kept waiting and I always apologise.

For my own birth, I was completely open to the idea of epidural if needed, but I'm well aware that they're not a totally risk-free procedure, so I wanted to try gas & air first and see how it went. In the end I was lucky and had quite a straightforward labour and didn't need one. Currently pregnant with DC2 and planning the same approach again!

Be aware that they don't work for everybody.

I found this out the hard way

@SockQueen thanks so much for your response. Really good to hear from someone who actually does this for their job! That makes so much sense now why people often put off if anaesthetist isnt available, sounds like you are very busy people. Would totally understand if that was the case but it seems strange why midwives wouldn’t just say “yes, on the condition there is someone available to give it”. What if find strange is people who seem to be delayed or put off for no obviously apparent reason as I was at this appt. I wonder if maybe they know how busy you are so try to minimise the load for you or something? It’s stressful being told there are pain relief options when the reality is they may not actuallly be options at all. Feels like you have to go into labour just hoping there’ll either be a pool free or an anaesthetist available and if not basically you’re on your own. Might look into pethadine a bit more as a back up option.