Talk to me about Epidurals...

[Normando91]

This has probably been asked and exhausted several times. But I’m a FTM and up until today I’ve been pretty relaxed about giving birth in a matter of weeks (35+1)

Today, someone asked me if I would be getting an epidural. I’ve always had the mindset that I would just take things as they come, if the pain becomes too much, I’ll have one. But then I started reading about them and fixating on the negative side effects- mainly women who have had back pain ever since...

So, what was your experience of an epidural?
Or if you didn’t get one, what did you do/have to manage the pain?

It's worth reading about back to back labour as well and how it can be different from labour when the baby is in a good position. It's not the end of the world, but it does happen to a proportion of mothers (about 10-20% IIRC?) and the problem is that it means if you're trying to follow all of the standard no-epidural advice WRT positioning and trying to get the baby to move down, it won't be effective and you'll end up exhausted, plus these positions result in more painful contractions if the baby isn't positioned right, and the labour can be longer and the pain very different in quality.

I didn't know this, I've had two back to back labours, I didn't realise it until reading up about it in preparation for my third (which, honestly, I'm going in with the assumption my chances are much higher than 0-20%, perhaps more like 50/50). So I'm actually thinking about writing two birth plans. When I go into hospital I'm going to ask them to feel and tell me what position they think the baby is in. Then if it's back to back, I'll follow the back to back plan and if it's front to back (normal) I'll follow a different birth plan which might actually have a chance of working out (!)

"Normal" position birth plan will probably be roughly:

1. Positioning - upright, active, moving as long as I can stand it
2. Pool - once I really start to struggle/get into a panicked headspace - NOT too early, pref at least 4cm dilated (in the UK they won't let you in before this anyway).
3. G&A - once the pool is not providing relief any more, or for the end stages

Also, regular checks to see if things are progressing, with actual info (last time they kept being really cagey about this which I later realised was so they did not discourage me). If they are not progressing and/or the pool/G&A aren't making any difference, epidural as soon as I realise this so that I can stay relatively still. If I've already got relatively far without, probably just carry on and shout at people...

"Back to back" birth plan will be more like:

1. Positioning - whatever is recommended to turn baby in the very early stages (still need to research more)
2. Epidural ASAP while I still have gaps and can be relatively calm, unless the baby turns in the meantime and I start making progress.
3. Any kind of positioning I am still able to do which helps - possibly side lying (though have heard horror stories that it can cause the epidural to only work on one side!)

Skip all of the natural stuff, because from experience it won't be enough, and once the labour gets going the CTX are too unbearable/close together to relax for the epidural. Once the epidural is in, will probably be more go with the flow about whatever is suggested to me.

Also, will fill in all epidural consent forms in advance. Because that was just a pointless waste of time when I was frantic last time. Ask your midwife about this. If you can't do it in advance of labour, ask to do it as soon as you go into hospital, even if you're not sure whether you'll need an epidural later or not.

A good book which actually has a great section about this is Juju Sundin's Birth Skills (most of the book is dedicated to the more common experiences of labour so it's well worth it for everyone!) - ironically I actually read this last time, but never got to the section on back labour! What I liked about this book is it covers all types of birth and suggests coping skills for all different situations.

Yes I need to ask at my hospital whether there are any different types of epidural available or whether it's just the standard kind.

Apparently in some places you can have a push button type one where you control the amount of pain relief that is being sent in yourself - this self-controlled nature is apparently why so many women feel positively about gas and air, even though it is so (relatively) ineffective most places don't use it. That factor of being in control of the pain relief yourself is incredibly powerful, and combined with a very effective form of pain relief like epidural, was found in trials to be an extremely good option. But it's not something they do everywhere.

I think for me I am not so much worried about long term side effects. I know they can happen, but they are rare. They are probably a good reason not to just routinely give epidurals to everyone but offer them only to women who actually want one. For me the downsides and parts that worry or scare me about having one are as follows:

• May slow labour down (although I suppose a slower labour wouldn't be as bad if pain free! But perhaps potential for more risk for baby? I am not sure if that is a thing.)
• May be more likely to result in instrumental delivery - that scares me for the after effects and potential effect on baby. Not so much the actual experience of it, as you wouldn't feel it.
• Can't move around which seems weird/scary and again potentially higher chance of complications due to being unable to be in an optimal position.

I think it's the instrumental delivery injury risk to me/any increased risk to baby that worries me personally. So probably those are the things I should talk over with the medical professionals. It would be useful to try and boil down what your concerns are about epidural and discuss those. And what your concerns are about managing without epidural and discuss those. Your midwife will have experience of childbirth - she should be able to easily discuss these things with you and if she does not know she may be able to arrange for you to talk to somebody else.

I hadn't heard of the low dose epidural but I did have the patient controlled one which was very good so I can imagine the mobile one being superb! It was very odd being stuck and having to have assistance to reposition legs when needed but as I wasn't in pain I think I could see it as a funny thing.

I absolutely agree about getting it plumbed in as early as you can if possible, I didn't even notice mine as I was barely 2cm when it was done before I had my ARM and drip, I stipulated that before agreeing to go on the drip. I can imagine it being a real challenge for everyone if you're having contractions close together when you need it doing, but I can see how that situation would arise very often too.

I definitely wouldn't have a drip without one but if I was induced again with just the pessary needed to get going then I'd probably hold off a bit...but not too long. I don't know how it is if you don't press the button at all as I imagine there's a base level all the time, I just kept myself nicely topped up as I was ill and exhausted.

@Normando91 Absolutely loved my epidural. Would have it again in a heartbeat. My daughter was transverse and after my waters broke, I was having contractions every minute in extreme pain at only 2cm because of her position. This carried on for 9 hours and it was a massive relief to have the epidural.