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?

The 8 day headache I had. It went from one shoulder up my neck across my forehead and down the other side of my neck to my other shoulder. It was horrible.

I also blame it for my slight prolapse as I didn't know when to push properly.

Much preferred the 2nd time around on gas and air.

I had an epidural and forceps delivery because DD got stuck. I felt completely dissociated from the birth, as I couldn't feel the contractions so didn't know when, or even how, to push without any feeling below my waist. I also obviously didn't feel her being born, so the whole thing just felt like it was happening to someone else.

Although it was nice to be free of the pain, I would not choose an epidural if I could possibly help it.

I actually had a horrible epidural, but would still do it again.
I had a young anaesthetist who took an age to get the thing in my back, in fact I think her colleague had to do it in the end.
It worked enough for me to get some rest, and cheer up a bit, but it wore off a few times and I had to have it topped up.

I had an EMCS in the end, but due to DS position, which is probably why my labour was long/painful in the first place.

I also had an epidural headache - unfortunately I also had quite a large PPH which muddied the waters with regard to treatment. After I had a blood transfusion the headache didn't go. I eventually had a blood patch and the relief was instant.

I remember having weak legs and hips which I assumed was a result of being laid up for so long, but this thread has made me realise was probably it was an effect of the epidural.

DS had to have formula a few times during his first days, but we were able to successfully BF for over a year.

I'm having an ELCS this time.

Re: research into epidurals, it's worth knowing that 33 of the 38 studies which make up the meta-analysis used by the NHS to advise on epidural use, DON'T compare mothers having epidurals with mothers having unmedicated, active labours in non-medicalised settings, but with women who have had pethidine, who are often spent large chunks of their labour lying on their backs.

So that's largely what's being compared. Women who are sedated with opioids and are mostly labouring in high tech settings with women labouring with epidurals in place.

NICE guidance says that epidurals don't increase the risk of c/s.

Low risk first time mums in the UK who choose to give birth in a setting where epidurals are readily available and don't require transfer have DOUBLE the rate of emergency c/s compared to similar low risk first time mums having their babies in settings where epidurals require transfer (birth centres).

Given the same protocols regarding monitoring and routine care practices are applied in the NHS for low risk mums across all care settings, it's a bit of a mystery what could be causing such a difference in c-section rates between similar groups, if epidurals are not part of the problem.

I also can't get my head around this: we know that continuous monitoring of low risk mums doesn't improve outcomes for the baby but does increase c-section rates, which is why NICE don't recommend it. And yet low risk mums having epidurals are largely continuously monitored. Is it that they stop being classed as 'low risk' as soon as they have an epidural, so aren't included in the research into the impact of CEFM on low risk labours?

LibrariesGaveUs - surely "for me" was implicit in what I was saying. I was talking purely about my experience. Obviously a lot of people out there haven't had a good experience of epidurals. There is no one-size-fits-all solution to the perfect birth. You can never predict how your birth will go or what will be best for you. All you can do is do your research and listen to others' experiences but no matter how much research or planning you do, there are obviously no guarantees. People who ask these questions want to bring a level of control into what is a very unpredictable situation with a lot of unknown and variable factors. Of course they want to; we all do! I speculated and theorised and researched and thought and worried before both my births and neither went the way I planned or expected - not that there is any harm hearing others' experiences.

In my case, I had no problems pushing either. Or rather - birth just happened and I got all of my babies out with a single push - whether it was with an epidural, or without. So that affecting pushing thing can't always be the case.

I saw upthread, that passing out is a rare complication. I had that with one of my two epidurals. I just felt this rather nice actually sensation of "Oops I'm fainting" then the next thing I know is the midwife is telling me that she had to hit the panic button and the room filled with people, for a few minutes... I had no memory of it whatsoever - just remember passing out. Something about it sent my blood pressure too low. But I wasn't particularly scared (although maybe the midwife was - I hadn't realised it was a rare thing to happen!) and that was the baby I went on to deliver whilst drinking a cup of tea...

I'd insisted on an epidural after having a labour that lasted 21 minutes that was truly horrendous, with nothing but gas and air (which did nothing). Luckily my third labour was a bit slower and I totally exaggerated how much pain I was in (almost none) at the time I requested the epidural as I knew they'd see on my notes I gave birth fast and refuse me an epidural, if they possibly could. Luckily my sneakiness paid off and for the third labour I managed to get an epidural in - just the complication of it only working down half my body then the passing out thing. I'd thought that happened a lot til I read this thread so didn't think it worth mentioning.

I wouldn't let that put you off, though. It was totally worth it for the pain relief. And it had no effect on me pushing. I think the baby just popped out. 20 years on and he's never arrived on time again.

"There is no downside " doesn't really imply personal anecdote to me. It's a statement of fact. "I had no downside" is a personal story.

Low risk first time mums in the UK who choose to give birth in a setting where epidurals are readily available and don't require transfer have DOUBLE the rate of emergency c/s compared to similar low risk first time mums having their babies in settings where epidurals require transfer (birth centres).

Just a guess but wouldn't the settings were epidurals are available also be the ones where c-sections are available? I would rather think that it's the availability of a c-section that makes them more likely.

"Just a guess but wouldn't the settings were epidurals are available also be the ones where c-sections are available? I would rather think that it's the availability of a c-section that makes them more likely."

Unplanned C-sections are also available after transfer to women labouring in birth centres and at home.

Unplanned c-s aren't done on a whim. Most first time mums in the UK who have one after a diagnosis of fetal distress (more common with an epidural) combined with 'failure to progress'. This can happen to women in all birth settings but seems to happen more often to women in settings with high rates of epidural use.

nicoleshitzinger You need to consider WHY women are requesting epidurals. If women are coping fine, then they're not going to request epidurals. If they are requesting epidurals, they're not coping and perhaps this is indicative of a more serious problem with the delivery than "just" maternal pain? Indeed this is the case - evidence shows that epidurals are correlated with increased intervention, not that they are causative of increased intervention.

There's a great write up here, complete with links to the research she describes:

www.slate.com/articles/health_and_science/medical_examiner/2012/01/the_truth_about_epidurals.html

I bloody loved my epi.

First labor with DC1 - hypnobirth. Awesome, took it in my stride, no pain relief necessary.

Second labor with DC2 - epidural. Baby had to be monitored so I couldn't move around, it was late and I was tired. Epidural was sited about half hour after I requested it when the pain was ramping up a notch. Felt nothing, got comfy in bed. DH and I fell asleep, woke up 6 hours later by my OBGYN to let me know to start pushing.

Fucking fabulous.

"If they are requesting epidurals, they're not coping and perhaps this is indicative of a more serious problem with the delivery than "just" maternal pain? Indeed this is the case - evidence shows that epidurals are correlated with increased intervention, not that they are causative of increased intervention."

I understand that the issue is complex, and that women with long labours and malpositioned babies are more likely to request an epidural - hence correlation rather than causation. This actually makes any meaningful comparison impossible: because the impossibility of randomising women to a 'no epidural' arm of a trial. All trials involving epidurals will have huge cross-overs between the non-epidural and epidural arms and almost all will be done in high tech settings where women labouring without an epidural will be subject to obstetric practices such as CEFM which increase the likelihood of c/s.

BUT

If you take two similar populations of low risk women having their first baby and put them in two different settings - one where epidurals are available and one where they require transfer to access, and apply the same protocols of care according to NICE guidance, the group which labours in the setting where epidurals are used more frequently will have double the number of c-sections and assisted deliveries.

I appreciate it could be things other than epidurals which account for similar women who are being cared according to the same NICE mandated protocols to have vastly different labour outcomes in different settings, but I can't think what else could account for such a striking difference.

What do you think it could be if epidurals have nothing to do with it?

nicole I have to say lack of ob-gyns and epidurals have ruled out the birth centre for me straight away. As an older mother with a large baby I was never going to risk it, when the best possible care in the UK was available just a few miles down the road.

My feeling is that lack of general ob-gyn care, only two scans for the entire 9 months (i.e. the cheaper midwifery approach) could be a reason for high complications and / or epidurals. I have absolutely no proof for this, and seen no statistics comparing the two approaches. It was just my impression.
On the day I gave birth there were all sorts of complications and they gave me a scan. Ob-gyn "Oh well, things look a lot less low-risk than they did at your scan." I was very polite and did not scream "That was 20 weeks ago!!!! Things obviously changed, like I have a fully-developed human in my tummy by now."