Epidural? what's the down sides? I like the thought of less pain!

[JoeMommuh]

I had first birth with just gas&air and a shot of pethadine. Normal delivery, about 18 hours from losing the mucas plug to delivery - and 7 hours of proper labour i guess.

2nd birth - C-sec for reasons outside my control,decided long before labour started etc, no reason i couldn't delivery naturally 3rd time round time if baby is happy.

3rd birth - .... so whats the downside of an epidural? I know it sounds flippant but i'm picturing reading a magazine whilst i get up to 10cm instead of shouting and screaming and it's a nice fantasy!! I also have the choice of another c-sec which is also tempting... i don't enjoy pain :) have a meeting with consultant soon to discuss birth options and they might try and put my off an epidural for cost reasons, but i'm wondering what the people of mumsnet have to say about it if they've experienced it?

No downsides. No pain = rest during 24 hour first labour! I had a mobile epidural that ran out when I got to 10 cm so I could move around and feel baby and push. I was in agony with back to back labour contractions every 1 min.

I had epidurals with both of mine. With my first (18 years ago) I was confined to bed. With my second I could walk around and I went home within 2 hours of her birth.

No downsides as far as I was concerned, no pain at all.

Had epidural with both of mine.

1st one - had to have episiotomy
2nd one - no problems. Got my legs moving and out in 6 hours

Hooked up to monitors and not able to move. No pain at all but felt no sensation when pushing

Had brilliant births with both - would do it all again

Oh and when it was time for stitches, I pressed the top up button so I couldn't feel any of it. I'm pregnant again and hoping I won't need such pain relief this time but If I do, I'm ok with that

I've never had one, but I put them in for a living (amongst other activities). We would never refuse someone an epidural for cost reasons. Never. I actually have no idea how much an epidural costs, but none of the kit or drugs is that expensive, so it wouldn't be a great economy anyway.

IME the main reasons for a woman who asks for an epidural not getting one are 1) The anaesthetist is busy elsewhere - though in most hospitals they will try to find a spare one, it's not always possible; 2) It's not medically appropriate, either because she's too far on in labour or there is another contraindication like problems with blood clotting; or 3) The midwife never actually asks the anaesthetist! Some midwives don't like epidurals for a variety of reasons, or think that their patient is progressing well enough to manage without one, so they just don't call us.

Overall, they usually provide good or excellent pain relief, but they're not without complications. They can be difficult to site, especially in larger ladies, and while you do get better with experience, some patients are still difficult, often through no fault of their own, just anatomy! Patients having an epidural are more likely to need an instrumental (forceps/ventouse) delivery, though the C-section rate is unaffected. Whether this is due to the epidural itself or because women having difficult labours with babies in awkward positions are more likely to ask for an epidural is not clear. There is about a 1:100 risk of a severe headache afterwards, if they accidentally puncture the membrane around the spinal cord. There are rarer, but serious risks, or nerve damage or even paralysis, either from the needle itself or if there is bleeding or infection at the site afterwards - hence why it has to be inserted in a sterile way, and you can't go in the pool with one etc. These are exceedingly rare though.

If the OP (or anyone else) wants more information on pain relief options in labour, the Obstetric Anaesthetists' Association has put together some good guidelines: www.labourpains.com/ui/content/content.aspx?id=45 Would I have one? I think, like most people, I'd like to try without at first and see how I get on, but if I'm struggling, then absolutely I would.

Epidural positives:

When they work, they are the most effective form of pain relief currently available.
Epidurals do NOT cause long term back pain (good study looking at post partum back pain showed no difference between epidural group and non epidural group). Hormonal softening of ligaments and the centre of gravity changes with a frontal weight loading are mostly to blame.
If you're being induced or labour augmented, contractions can ramp up in both pain level and frequency faster than with a naturally progressing labour; epidurals are sometimes suggested before an induction drip is started.
Some women are in labour for several hours. Epidurals allow rest and regain of some strength for pushing. Occasionally the muscle relaxation of the pelvic area allows a head to descend better.
It's safer to have an epidural topped up for surgery than a GA (which will affect the baby far more too).
There is no increased risk of caesarean. Babies which are malpositioned (OP being a prime example) are more likely to take longer and hurt more to come down, hence these types of labour are where an epidural is more often requested. Malpresentation is the risk factor for Caesar.

Epidural negatives:

Takes about 20 mins to set up, 20mins to put in, 20 mins to work. They're not instant.
Not working properly - 1:8 quoted
Not working well enough to be topped up for Caesar -1:20
Dural puncture headache - 1:100. This is where a small hole is inadvertently made in the layer of tissue next to the epidural space, through which is spinal fluid - leaking of spinal fluid causes a low pressure headache when sitting or standing. Some medications are effective (gabapentin, theophylline, caffeine), or another epidural injection of your own blood to seal the hole can be offered.
Increased length of second stage of labour.
Increased rate of forceps or ventouse assisted delivery.
Risk of low blood pressure (makes you feel faint and sick, but easily treated).
Risk of change to the fetal heart rate (usually improves over 20 mins or so).
Risk of damage to nerves 1:5-10,00; permanent damage 1:20,000
Sudden loss of consciousness - can't remember figures off top of my head but very rare.
Permanent paralysis / inability to walk - around 1:250,000. Two reported cases that I know of (one UK, one Australia) relating to contamination of the epidural kit with skin cleaning prep (which is neurotoxic).
Anything involving a needle through the skin, epidurals included - bleeding, bruising, infection (obviously infection around the nervous system is serious).
Shivering.
Itching from the medication.
Urinary retention (or being unable to feel that you need to wee or unable to wee) - all patients should have a catheter. An overdistended bladder causes huge problems with labour (head can't come down) and later on with continence.

Consultant anaesthetist, have inserted hundreds of them. Happy to answer questions.

Well, I've just learned something new off DH!

I've just read out some of the comments to him after having an epidural at my DS's birth in March. I asked for it immediately after having the drip put in (was induced), my BP was raised and I'd been advised on the ward to ask for it to help keep it down. Midwife refused and made me start with gas and air (did nothing but make me feel sick), refused me diamorphine until I could stay on my left hand side to monitor baby for ten minutes (couldn't do it, didn't realise at the time but baby was back to back so the pain on my left was horrendous). Eventually agreed to epidural but forgot to do bloods so when the anaesthetist came he wouldn't put it in and had to go do a section. Midwife shot me up with diamorphine straight away (no waiting ten minutes in my left this time after she'd had a rollocking in the hall).

I was reading out the comments above about the risks and said that I'd not been told the risks. He says, yes you did. They read them out and made you sign a piece of paper. I have absolutely no recollection of this! Apparently it was after the diamorphine was given. Where I lost three hours of my life (not a clue what happened until the anaesthetist eventually came back after the section). DH had been out and got a KFC, gone home to feed the cats and I haven't got a bloody clue what I did!

But OP, the epidural and eventually forceps birth was absolutely fine and I wouldn't change a thing. I was up and about at 5 the next morning (DS born just after midnight) and was discharged at 5pm. I had the epi where I couldn't move from the bed but I could move my legs and feel everything, just not the pain. It was magical! If I decide on another baby, I'll definitely have one again but this time I'll be more forceful!

Lots of the downsides that have been posted on here are not necessarily caused by the epidural.

It's true that epidural = increased risk of instrumental delivery but what I don't think has been played out by research is whether that is because the epidural caused that increased risk OR another factor which caused the increased risk also caused the request for epidural (baby stuck in awkward position, long labour leading to exhaustion etc).

I've just remembered my epidural that I feel didn't work did numb my bladder. They forgot to empty my bladder and after I had ds I peed myself a lot! It wore off by the end of the day but I had to keep reminding myself to go for a wee as there was no urge. Childbirth truly is the least glamorous thing.

I've given birth with zero anaesthesia and I've given birth with epidurals. The last epudiral was 1995 so they will have improved since then but.... even then, if they get it in in time and all goes well.... zero pain. Nothing. Nada. It was bloody fantastic. I literally gave birth in the middle of drinking a cup of tea (ie: baby came out with one push whilst I had a cup in my hand). And that baby is now in his final year at uni so I'd imagine it's even better now.

Mind you they got it wrong at first and it only worked down one half of my body so I felt the pains but literally only down one side. But they soon calibrated it. Sadly I laboured too fast to ever get another one. And I pretended I was in far ore pain than I was to score that one.... As I knew I laboured fast and they do anything to try and force you to go without any pain relief if they think you are fast.

As your labours have been less precipitate, epidural is the way to go.

Ah no forceps, no stitches and both epidural babies out in one single push. I'd hugely recommend it.

Oh and something upthread reminded me - I gave birth around 10 AM, was discharged in a couple of hours and on the school run by 3:30, with the other baby in a pushchair. Totally nothing to write home about.

I was induced with my second baby and requested an epidural from the beginning. It never appeared. I think, like SockQueen says, this was mainly because the midwives decided I wasn't worthy. They were truly horrible. I was naive and too polite to get stroppy and ended up in unbearable, humiliating agony. Truly the worst experience of my life, and one that has damaged my relationship with my partner quite badly. It was possibly also because no anaesthetist was available. I don't know, no-one ever told us. If you are planning on having an epidural, I would make sure you are very assertive indeed. Very very best of luck with the birth, I really hope your experience is totally different than mine.

herethere I think it's been fairly well proven that epidurals are an independent risk factor for instrumental delivery. Caesarean sections no, but assisted delivery yes. It's related to prolonging the second stage of labour; there are guidelines which mandate intervention after 2h. It's also more difficult to coordinate effective pushing if you can't feel contractions or your perineum.

I had an epidural, it was amazing. I chatted my way to 10cms, watched tv and tried to sleep (was too excited about meeting DS though). I heard the other women in the labour suite screaming and felt so sorry for them, and wondered 'why aren't they having an epidural'?! There were a few drawbacks, I couldn't move myself (would have been nice to try and speed things up by getting into better position but wasn't a big thing as no pain), couldn't eat and had to get catheter (not everyone needs catheter). The catheter was biggest drawback as had to stay in 48 hours post delivery and was really awkward getting in and out of bed for baby, also (TMI alert) it meant I leaked blood all the time afterwards.

I also had to have forceps delivery as baby was wrong way round, he may well have been the wrong way round without the epidural though and the pain would have been worse.

At the end of the day though, I would go for an epidural again. Good luck with your delivery whatever you decide!

I got the leaky spinal fluid thing. It was pretty bad. Rare, but can happen to anyone. Stops the epidural working, plus you're then flat on your back (literally, can't even have. A Pillow) for 1-2 weeks afterwards, munching paracetomal for the headache. But I still got a nice baby, so worth it in the end.

Four dc here, one birth with epidural.

Pros: Less pain. I still felt the contractions but they weren't painful. However, I still had a long early stage of labour that was every bit as painful as my other births, so I didn't really get off that lightly, having had strong but ineffective contractions 2 mins apart for over 24 hours.

Cons: Risk of spinal headache (this didn't happen to me). Higher risk of intervention - forceps (with all the associated risks of forceps delivery - incontinence in mother, brachial plexus injuury in baby). Higher risk of c section. Needing a catheter - risk of infection. Being immobile afterwards. Needing to stay longer in hospital.

On balance, I preferred my natural home births but they were bloody painful. My worst birth was the one where I transferred to hospital and gave birth there without an epidural!

The catheter was the worst part - it is routine with epidural in our hospital.

I had to have my epidural due to pre-eclampsia. My blood pressure was too high to risk it. Rather than discourage me, the midwives told me I had no other reasonable option.

I was upset at the time but it was the best thing, without a doubt. I was induced with the hormone drip and the 2 hours before the anaesthetist came were hellish. Because of the drip my contractions were not regular and were lasting for ages when they did come. They planned to turn it down so I could push but that never happened as I had further complications (not caused by the epidural).

I'd have one again any day!

I had a bad case of the spinal shakes. The whole bed was shaking and I couldn't talk properly through it. It was bloody awful. It was for a section though, so I needed anaesthesia!

Epi after nearly 20 hours of induced labour. Demanded epi as they were putting in the drip. Meh. Didn't work first time but second was amazing. Going from agony to napping and watching a film.

Oh and to the person worried about impact on feeding, DS started feeding as we were leaving theater (forceps delivery as he was in a weird position).

Highly recommended.

First birth I was in the pool with gas and air. Second birth they wouldn't let me in the pool so I ended up choosing an epidural. Refused to let them examine me as I suspected i was too far along for one - and I was right. They put it in and then just as it started to work I yelled that I needed to push, and pushed her out. Must have had it in for about 20 mins tops! I did have a very big case of the shakes straight after, like going into shock or something, but I don't know if that was the general birth trauma or the epidural. I had no other after effects. Those few contractions that I experienced without pain were amazing - I could SEE my stomach contracting extraordinarily painfully but I couldn't feel a thing. I think I needed it at this point. If I had been in the pool I'd have coped without.

Call me crazy but I think you need to experience a bit of labour pain to feel really connected to the birth experience. They won't let you have one until 4cms I believe anyway so that's a given (that took over 12 hours with my first!)

Hi OP, my summary:
1st birth. Horribly long, had epidural, couldn't feel much at all. Laid in bed a long time. Unable to push properly (couldn't feel when to)
Really struggled getting her out.
Tear and very sore for ages
Blood clot in leg 2 weeks after birth.... on warfarin for 3 months.

2nd birth. Pethadine and gas and air, obviously more painful but easier and much faster.

3rd birth. Only just made it to hospital, some gas and air and a few minutes..... he was out. No tears or anything luckily.

I still believe the epidural played a part in my DVT.

For my first and second births I had an epidural. I requested it from the outset. NCT instructor nearly disowned me! I went to sleep during the first one and had to be woken up when it was time to "push". I couldn't really push but with a bit of help, out came DD. No pain, except when the first epidural shot wears thin and you need a top up!!! Wham, bang dreadful pain. I cannot see why anyone puts up with this. So what if you have to stay in hospital for a night? No-one says you have to be doing your normal routine from hour 1. Why can't a new mum chill out for a couple of days? Let someone else collect the other child from school!

Second DD was much quicker. I felt the need to push. I held a sensible conversation with DH both times. I was stunned at the screaming going on elsewhere. If you are totally risk averse, and like screaming, go for any natural birth you like. If you want to stay calm and in control of your faculties (and don't care if your legs do not move for a bit) have an epidural. It was the best decision I made. Apparently I have a sinuey back and it is difficult to inject.

Does anyone know of any long term studies on childbirth, PTSD and PND regarding pain management?

It is worth pointing out that if you have basically cruised through life with no major traumas then suddenly spend 48 hours undergoing torture it doesn't necessarily end when the baby arrives.

I am now 5 years down the line and still haven't resolved the mental health issues I gained in that 48 hour period.

Pain can destroy you.