Advice and experiences please... Epidurals v Pethidine

[Slippers101]

Hi, I'm nearly 39 weeks and suddenly feel like I can put off thinking about the birth no longer! I'd be really grateful for any advice or experience you could offer on the pros and cons of an epidural or pethidine. I'm stoically thinking that I'll last the distance on gas and air, but realistically understand that when push comes to shove I may well be screaming out for more!

I've had friends who have used pethidine but have been scared off a bit lately by stories of it making babies extra sleepy for several days and causing problems with breast feeding. At the same time I've been told that epidurals don't impact on the baby but are far more invasive and make for an uncomfortable, 'unnatural' feeling labour.

I'd really appreciate any thoughts. Thank you!

I'd vote epidural myself. (Don't like the sleepy baby problem, and friends who had it thought it made them feel less involved in the birth.)

Have you read some decent evidence based information on it? If you have the NHS Pregnancy Book that has info, or get the NCt book or something.

Epidurals may raise the risk of needing further interventions, such as forceps and C-section, possibly because with an epidural it's hard to have an active upright birth. The epidural may also not work properly - soemthing few people seem aware of! They usually work, but there is a chance it won't work fully or will only work on one side, so you could be left in pain AND unable to be active. There is also a small risk of headaches and back problems afterwards.

Pethidine shouldn't be used very close to the baby being born as it will affect them.

Have you talked to your MW about what options are available where you're planning to give birth? Epidurals aren't available at MLUs for example. On the other hand, some hospitals have further options, such as epi-fentanyl.

I don't have any scientific evidence, but I had both in my first labour, where the baby was lying with his spine against mine, and with every contraction, I felt my back was breaking in two.

Pethidine had little effect on the pain, but it sort of distances you from it, so you feel it doesn't matter.

An epidural is total pain relief. I can still remember the ecstasy of the anaesthetic going in.

If you're in agony, and the MW says "Oh, you're only 2cm", you know you're in for a long ride, and it might change your view on what pain releif you want. They also won't do an epidural too close to the delivery, probably because it costs too much money takes 45 minutes to get the anaesthetist to come and do it.

Oops, strikeout didn't work.

I personally had very bad experience with pethidine.
Was given it "against my will", but won't bore you with details here of why/ how, as I've talked about it on here before.

Anyway... DS was very sleepy for days after he was born (despite the fact that, after that, he has been an incredibly active, non-sleeping baby).
I had very big problems getting BF going (although I managed eventually...). But I don't think the initial sleepiness helped. He wasn't really interested in feeding at first. I had no magical moment of lying skin to skin while he searched for my breast. He just wasn't interested for a while...

Also, I didn't like the feeling of being "elsewhere" during labour. I just couldn't quite focus on where I was enough to put all my energy and concentration into the pushing stage. I also went into a deep sleep between contractions, and just felt completely out of it. Like when you're really really pissed and know what you're doing is odd/strange/bad/embarassing or whatever, but you just can't quite change what you're doing.

Having said that, friend who had a baby on the same day was given several shots of it, and had none of the problems I've just outlined. I guess you just never know.

Sorry if that just adds to any worry! Am sure it'll be fine (I'm nearly 37 weeks now and just in denial about the fact that it's all about to happen again! )

I had pethidine, mainly due to being exhausted after about 20 hours. It did allow me to have some rest to be honest so on that level it was great.

But, I do have to admit that I have often wondered if it impacted on my failure to breastfeed. Every midwife on the ward tried to get ds to latch and failed. Eventually they told me to use breastshields. 4 days later, exhausted and covered in blisters I gave up.

I wouldn't entirely blame the pethadine, it was a combination of bad advice and also being utterly unprepared myself. Naively, when pregnant I had no experience of babies and just thought breastfedding came as easily as changing nappies . I have often wondered if it was a faector though.

I wouldn't rule out using it if I had the choice again as it did get me through the moment and you just don't know how you are going to cope until it happens. I'm all for keeping options open!

erm.. sorry.. the initial sleepiness DIDN't help!!

The evidence that epidurals increase need for c-section is fairly controversial - in 2000 the Cochrane meta-analysis showed no correspondence though there is some evidence that other interventions are increased and that early epidurals are linked to increased c-section rates.

Recent study showed that epidurals may offer protection against later bladder problems. Though forceps delivery increases that risk.

Pethidine is good for early labour as others have said here, though I would go for epidural as it is a more effective pain block if effective - pethidine is an opiate and you may react badly. You can still move around if they have an adminstered an epidural and there is a possibility you can give birth standing / squatting.

To add to what Japhrimel says - have you gone to an antenatal class and discussed options? That's really important and not too late.

I'm 39 weeks with DC2, and have requested no pethidine or diamorphine on my birth plan - if I need more than gas and air, I want to go straight to epidural. If I am too far gone (ie more than 8cm) at that stage, I want to stick it out, if at all possible. We'll see

I really really struggled to BF DD. Everyone said her position was right, she was latched on etc etc, but she was so drowsy those first few days, she just had no inclination to feed. I really feel that was down to the 2 shots of diamorphine (they don't use pethidine at my hospital) I had during labour. My labour was so long, I went on to have an epidural too!

At the time, the diamorph was heaven, as was the epidural when I had it, but hindsight is a wonderful thing.....

Obviously, I do not have a shred of evidence that the diamorphine caused the feeding problems. I may have exactly the same problems with DS, and have gone through a (possibly) more painful labour than necesary. But for me, at least I will know I have done my best to BF. Don't get me wrong, DD is a very happy, healthy, energetic 2.5 year old, and I really don't think formula has harmed her in any way. And I probably would have given up BFing after 4-6 months anyway. But at least it would have been my choice.

Sorry for the long post, as you can tell, it had a big effect on me and I feel strongly about it this time round.

Good luck with whatever choice you make :)

Thanks all, I really appreciate your comments. I have been to NCT classes which were really informative but obviously didn't advocate one approach over another (and I wouldn't have wanted them to). I was really keen to hear peoples actual experiences though, so that I could build up a bank of knowledge ready for the decision making time. At this stage I think that I wouldn't rule out either and will need to see how things progress, but your comments are so helpful in giving me additional things to think about and consider. Thanks again.

I know a few people for whom pethidine made them sick I haven't had it myself so can't comment.

I had an epidural (and appreciated it) for DD1 but it did slow down labour and I was given more drugs to speed it back up, plus episiotomy as well. Healthy baby at the end but the labour generally could have been less medicalised, but I wasn't to know I guess.

DD2 I had no pain relief at all not even gas an air. I was 100% there mentally and extremely focussed on what I was doing. Labour progressed much faster, I was up on my feet or knees most of the time, but delivered on my side and didn't actually push hardly at all, my body just seemed to know what to do. The period of the most intense pain lasted about 40 mins or so.

If I had a third I'd not have an epidural and just try to manage with distractions/breathing.

You'll know what is right at the time so just trust yourself and you'll be fine. My only advice is to keep and open mind and try and remain flexible. Best of luck!

I had an epidural with my first which was fantastic. A long, slow labour became much more bearable and it's a fantstic feeling when the pain just goes away. I didn't feel disconnected from the birth though, just nicely pain free.
With my second, much quicker labour, I asked for an epidural. The anaesthatist tried to give it to me, but couldn't hit the right spot and it didn't work. DD2 was born half an hour later though so I think it was just too late.
In my opinion, (not scientifically based) slow, tiring labours suit epidurals better than quick, extreme pain labours. I think in your position I'd keep my options open.

No experience of pethidine I'm afraid.

Used Pethadine with DD, it made me really sick and she slept for a full day after the birth although this had no effect on breastfeeding she took to it straight away when she was ready and tbh at the time I was glad she was asleep as I was knackered.

I decided I didn't want pethadine again with DS mainly because I wasn't sure I actually needed it first time round more it was offered and I said yes as I didn't know how bad it was going to get. The sickness really put me off it though. Managed DS with gas and air then nothing for the pushing.

I had both in my 5 day labour!
The pethadine enabled me to get some sleep on night 3 which was a welcome relief but at the time I remember thinking it wasn't all it was cracked up to be.

On day 4 I had an epidural as it transpired DD was back to back and I really couldn't cope with the pain - It was so good I told the anethetist I would marry him were I not already married! the relief was incredible, DD arrived arrived the next morning in the operating theatre with the help of forceps which wasn't nice but I was just glad she was out.

I would have an epidural again!

I had gas and air for a while which just didn't touch the pain at all and didn't dilate. Then I had diamorphine which I thought was wonderful but still didn't dilate. I had a couple of very bad hours after the diamorphine wore off and before they could get me an epidural and still didn't dilate. Finally had an epidural and everything finally got going and I felt so much better and then laboured very quickly, I had a walking one though and could still move around a bit and did know I was pushing etc.

However, I was an early induction, which is very hard on the body... and was told I would need an epidural. Glad I held out for so long in a way but I think the pain I was in may well have hindered my progression.

I think if you are induced or the baby is back to back you may well want an epidural... so you might have to see how things go.

Slippers I was going to point you in this direction, but if you've been to NCT Classes you are probably quite well informed already.

Haven't got any personal experience of either although Pethidine was ruled out for me due to my Mum having it during labour with me and us both ending up in Resus. Close family members have had the same problem so it was probably best to avoid in my case.

I didn't need the epidural. The fact that it can lengthen your labour and you risk intervention more put me off completely, I just wanted the baby out as quick as possible. Although I can completely understand when women opt for one.

G&A won't make the pain go away but if your labour is straightforward, it should be enough to help you through.

Other things you could try are a waterbirth as this can help with pain and having your baby at home is supposed to help too.

I'm sure you'll be fine.

I had both Diamorphine and an epidural in my first labour. The baby was back to back. The diamorphine did absolutely nothing at all apart from make me feel itchy. It did not even feel as if it took the edge off. I was already throwing up - threw up every 20 mins through the whole labour - so the diamorphine was not to blame for that.

The epidural was fantastic to start with and then didn't work. (It turned out after delivery that the connector was faulty and it had mainly been dripping into the pillows, so I only had the benefit of the initial dose)

The thing is with epidurals I think, you are much more likely to opt for them in those labours which are long and painful - like when the baby is back to back - it is not just because of the epidural that the labour is longer, you get more tired, and more interventions become more likely.

I was induced at 40+12 and progressed very quickly, going to fully dilated in 4 hours. The midwives almost didn't believe how fast it went (I was on the floor in agony and they offered me 2 co-codamol, it was too early for other pain relief apparently ) and by the time I finally got to the labour ward, I begged for an epidural, as it was too late I was given some pethidine, which I'd originally had down in my birth plan as something I didn't want.

It didn't take the pain away exactly but I was away with the fairies and snoozed between pushing DD out. She had a score of 9, breastfed within half an hour of being born and has continued ever since! She definitely wasn't sleepy. I felt drunk for up to 6 hours after, not in a bad way just very spaced out.

I would keep an open mind and go with the flow. My carefully written birth plan went straight out of the window and looking back I wouldn't have changed a thing.

Had to reply to Dinosaurs point - pethidine would not cause such a reaction in a newborn, narcain, the antedote to opiates would have been used if his failure to establish regular respirations was caused by pethidine (only seen this used once in 11 years BTW). Needing cardiac compressions and adrenaline is more than likely a consequence of a problem during labour/delivery. Just thought best to clarify so not to cloud the judgement of those following the thread.

And why not use diamorphine instead or pethidine, most women find this much more effective? Just an idea............