Epidural or not?

[pregnant]

I am about 3 months pregnant, and need to decide the package that I will choose for giving birth. The normal and the one with epidural is not that big different, so I might go with one with epidural.

But how is it? Is it really free of pain? This is my second child, and the first one I went through without epidural, so if I can escape the pain, I'd love to.

Anyone has ever done it with epidural? Mind sharing with me how it feels?

Thanks a lot!

[WAHM]

I've never given birth with an epidural so I can't tell you how it feels. Purely a personal decision, I have nothing against people choosing epidurals so long as they know the downsides of them - my gripe is that so many times women choose them without knowing what they are letting themselves in for.

I am curious as to why you are considering an epidural this time around. Was your first birth a negative experience for you ? or are you just curious ? also why do you feel you need to decide at this stage - would it be possible for you to decide when you are actually in labour and can see how fast or slow you are progressing, how you are coping etc ?

Epidurals do take away the pain, that's for sure. But they don't come without risks. It's up to you to weigh up the benefits and risks and decide what's right for you.

The benefits of an epidural - no pain for the mother in around 90% of cases - sometimes women complain of "patchy" pain relief but that is rare.

Having an epidural put in should not be painful in itself although you will be asked to lie still while the anesthetist puts in the needle - can be difficult if you are having a contraction at the time. Once the drugs are in your system you should feel pain relief very quickly; of couse your legs will be numb so you won't be able to move around much if at all.

If you have an epidural you are basically immobile - even with a so-called "walking" epidural you will be on an IV and strapped to a fetal monitor so you won't be able to move around. You will also need to be catheterised.

Bear in mind also :

Epidurals tend to slow down the process of labour. This means a much longer birth overall. It can also mean you may have to be given drugs to speed it up again, or you may even end up with a cesarean for "failure to progress".  

Epidurals relax the muscles of the pelvic foor which help the baby to descend and rotate during the pushing stage - this makes you much more likely to end up with an episiotomy, vacuum extraction or forceps delivery as pushing is more difficult. (You could always ask for the epidural to be turned down for the pushing stage)  

With an epidural you will probably give birth on your back with your legs in stirrups - this  is possibly the worst position in the world for giving birth - you are effectively pushing the baby uphill, and also makes you much more likely to tear. Again, you could ask for the epidural to be turned down, and you could try alternative positions like side-lying or a supported squat but these are tricky when your legs are numb.  

The drugs cross the placenta - little is known about the effect of these drugs on the newborn. If narcotics are added to the IV as they often are, this can affect the baby's breathing and sucking after the birth.  

Epidurals tend to lower maternal blood pressure and can induce fever; low blood pressure needs to be treated by putting you on an IV; if the mother gets a fever it can lead to fetal distress so again, more risk of intervention.  

There are other, rarer risks to the mother such as severe headaches and backaches after the birth.

Finally, it's worth remembering that removing pain also prevents your body producing endorphins (natural pain killers) which are normally produced in labour - there is evidence that endorphins help with mother-baby bonding, and they also help the baby remain alert and responsive when it is born. They also make you feel good !

Finally, if you are interested in reducing pain in labour, why not look at other factors, not just drugs ? Have you considered alternatives such as TENS machines, relaxation, labour support (a doula), use of a birthing pool, there are lots and lots of ways to reduce pain in labour short of an epidural.

[This message has been edited by WAHM (edited 29-07-2003).]

[patchy]

I was one of those who had a less than successful epidural with my first child. Pain relief was patchy - seemed to work on one side only. I also had lots of difficulty pushing and after a v long labor ended up with episiotomy and forceps delivery done in theatre as it was touch and go whether to opt for emergency c-section.

Second child, just used nitrous oxide and baby popped out quickly and without complications. Go figure!

[How About?]

The experience of epidural administered births varies amongst women; depending on the woman's tolerance to pain, body reaction to pain relief drugs, size and maturity of baby, labour etc etc.

I too think that you need not make the 'premature' decision of whether to have epidural or not.  So long as you are NOT against it and wants to leave the options open, let your obs know and put it down in your birth plan.

Personally for myself, I knew from the very beginning that I would surely want an epidural because of my low tolerance for pain.  In addition, all the women in my immediate & extended family who have had several children - including a sister in the medical profession who swears by epidural - had successful deliveries with epidural, my fears of the risks, were pretty well managed.

Ask your obs which anaethetist s/he usually pairs up with.  Your obs is only human and naturally he or she will have preferences whom he or she teams up best with.  It is best not to insist on a anaethetist who is unfamiliar to your obs so as not to introduce unnecessary considerations for your obs.  Ask to meet your probable anaethetist; discuss the procedure, your fears etc.  It will help loads in your decision making.

[pregnant]

Thanks a lot! It certainly gives me better picture about epidural. Well, my first experience in giving birth was not too bad actually. The labour was only about 4 hours. Only when I remember the pain, I feel like if I can escape it, I would love to. But perhaps considering the side effect, I might have to consult with the gynea again.

Anyway, thanks a lot!

[Natural Mum]

I chose to deliver both of my children without any pain-killers or intervention.

There were moments of intense. . . how shall I say. . .discomfort but the feeling of euphoria after baby was born (esp. #2) was the most intense high of my life. There really must be something to letting your body work through the pain and generate endorphins.

[Grub]

Hi Pregnant, first of all congratulations on your new baby! I gave birth 7 weeks ago, to my second child, and for both kids, did not use any drugs at all. WAHM has summed up very well the pros and cons of epidural so I will not repeat what she said.

However, you will find that your labour with the second child will be much faster than the first, so maybe you will only have to endure the pain for a shorter time. With my first, I laboured hard and long for almost 11 hours. I was seriously considering the epidural but didn't want the drug to affect my baby, as it would make him drowsy. (Both babies were alert when they popped out, they were looking around the room!) With my second child, I laboured for 1.5 hours!!! That was such a great birth, a wonderful experience. Even though it was painful, I felt empowered that I could do it without assistance.

This may be something that may help you make a decision seeing that your labour will be shorter this time around.

Also, in order to manage the pain, I went on my fours, crouched, squatted, went into the shower - had very warm water sprayed on my back.(that worked wonders for me) Keeping upright is less painful than lying down so bear that in mind.

Good luck, I know it is not an easy choice.

[This message has been edited by Grub (edited 29-07-2003).]

[Buffy]

Well just to balance out the negative bias...I had an epidural with my first and so far, only child. I have a very low tolerance for pain and also banned the word blood from the birth suite as I faint easily. During the pregnancy we had all the options presented to us at our pre-natal class but before we(I) could start to seriously consider pain management preferences the matter was more or less taken out of our hands as the baby had to be induced at 37 weeks. Perhaps it was because I was induced (on a picotin drip) my experience of the epidural was very positive.
I had the sensation of "bread" rising during the contractions and no pain. I recall it was a little scary and awkward curling into a ball to have the epidural administered. I began the picotin at about 8 am, epidural at 9.30am  and delivered at 3.30pm.
During the whole time I was in bed , very calm and comfortable listening to my relaxation music and dozing.  When time drew close I had a little bit of an anxiety attack but no pain.
I delivered in 3 pushes ...but as I misunderstood the instructions, I could have done it in 2. I had no problem whatsever in telling my muscles what to do. I had no tears and no stitches, and no pain recovering from the epidural....just one really long trip to empty my bladder which was because of all the fluid adminstered by i v drip.
I consider myself incredibly fortunate to have had such an easy and pain free birth, I have had worse period pain and dental visits. I do not feel that I missed out in any way , I have only  some curiosity as to whether I would have gone into labour early if it were not for the intervention because elsewhere in the world (including here in Australia) I would not have had the ultrasound that detected the extremely low level of amniotic fluid in my womb.  
So my point is that no matter what you may plan be prepared for all possibilities and if that does involve an epidural it can be a very positive experience.
all the best with your pregnancy!

[lady_lou_lou]

Hi,

My doctor advised me not to make a decision until i was actually in labour, because the pain varies from woman to woman. I went into labour and fully intended on doing it without pain relief.... when i got to the 12th hour and i was only 5cm dilated and in extreme pain with every contraction, my doctor advised me to choose a form of pain relief to help me get through the next 5cm, that were obviously gonna be more painful than the first 5cm. I had tried gas and air and that did absolutely nothing for me.... so i chose the epidural. I had it done and all i felt from a contraction was a slight tightening around my tummy and NO PAIN!! It was wonderful and a great relief for me cos i really thought another 5cm would kill me, with no exaggeration. I dilated to 10cm in 6 hours and i felt some pressure on my bottom and the nurse checked me and the head was down. I pushed 3 times and out popped my son, no help needed it was great.

However i have heard that with each child the labour gets shorter and easier, so if your first one was only a couple of hours i'd say go for it without anything if you can.

GOOD LUCK!!

[SS Oz]

I am 4 months into my 2nd pregnancy and was going through the same dilemma of should I/shouldn't I have an epidural (but obviously this is for planning, not concrete decision!).

On the one hand I really would like to try going without, but then I remember the pain of the first labour, and I start to think that logically why experience the pain when you can avoid it. But I also remind myself that my first labour was not a positive experience because:
- was in Taiwan and language was an issue, coupled with very conservative labour techniques (IV, fulltime fetal monitor, stay in bed etc)
- baby arrived in 37th week and hubby was in Bangkok (got back in time due to long labour!)
- as a result I think I hit the breaks in terms of allowing the labour to progress. So, since the labour wasn't progressing when my hubby finally arrived (I'd been in hospital for 10 hours at that stage, since 8am), they decided to speed it up with a drip. Once the drugs set in I was in increasing pain - as well as vomiting from the pain. I was tired and hungry (they hadn't let me eat all day, not since my light breakfast) and frustrated as to how long it was all going to take. So at 3:30am, after 19 hours in hospital and after about 7 hours on the inducement drugs, I gave in an had an epidural. It was a wonderful relief - all of a sudden I felt calm, I dozed and relaxed. After about an hour the nurse said it was time to push, and helped me visualise how to push (as I couldn't feel any sensation to push). I was really excited at this stage. Then I was taken into the delivery room, popped in stirrups and again told to push and the baby was born relatively fast, although with help of vacuum and epist'y (both unknown to me at the time). I was on a total high that everyone mentions, and must say that after receiving the epidural, the labour became a most positive experience for me. I recovered very well, and baby seemed unaffected by the epidural.
But, having said all that, it nags at me that maybe my need for an epidural was because of all the negatives associated with the labour, and maybe 2nd time round it will all progress normally and maybe I can endure and go without. So, I've decided to keep an open mind, try and go without, but if I change my mind on the day, then so be it, and I won't feel any negativity or feelings of failure about having opted for an epidural.
All the best to you!

[pregnant]

*phiew*

That's quite a good news that I can hope that this second delivery would be shorter.

Grub,
Since what month of pregnancy do you start doing the squat and fours thing?

Thanks!

[Grub]

Hi Pregnant,
I was squatting and going on fours DURING the labour in the hospital. My doctor was quite good in the sense that he went down to the floor to do a vaginal exam on me. I gave birth on the floor, in a squatting position too.

[twice]

Good post earlier re the pros and cons of epidural, but:-
I've had 2 babies, epidural both times, and they arrived in 4 and 3 hours respectively, so it doesn't always slow things down
during the second, I actually slept for an hour or so just before the delivery - my best sleep for quite a while!

Also the points about the drugs crossing the placenta are not correct - the drugs are injected into the epidural space of the spine, not the bloodstream, so there is no carryover to the baby.

[SA chick]

i also had an epidural during both of my labours - i now have two very healthy babies.  despite people also warning me that the procedure of the epidural is painful and awkward i did not find it so - i think it depends on the quality of your aneathatist (not sure of how to spell that!) also the extent of the pain relief also depends on the how good the aneathatist is (all this is information supplied by my obs and was used in a discussion that we had when having my first child i also expressed concerns about epidural - my obs also mentioned if there are modern methods of pain relief available and there is no need to go through pain why do so)  if, however, you are concerned the best person to talk to is your obs who would give you a more medical and proffessional view point but then again it all boils down to whether you want to suffer or not.

whichever way you devide i wish you all the best with your pregnancy and the birth of your baby and i hope you have a beautiful and healthy baby as in the end that is all that matters

[factsonly]

Hi Twice,

Sorry to tell you your info is wrong. Although it is injected into the epidural space, drugs (the -caine drugs like lidocaine and opioid drugs) still get into the mother';s system. They still cross the placenta.They still affect the baby. And the fact is whilst it's immediate effects on the baby are medically documented and acknowledged, the long term effects have yet to be studied. Bottomline: Anything that enters the mother's body enters her system and affects her unborn baby!