MOST MUMS-TO-BE HAVE A CLEAR PLAN IN PLACE FOR CHILDBIRTH. Some hope to experience labour as naturally as possible, without relying on pain relief, while others make sure everyone knows they want an epidural - an anaesthetic injected into the epidural space surrounding the spinal cord - as soon as they are through the hospital door.
Whatever the case, for most women out there, the pressure to decide for or against the use of something that will help manage the pain starts early on. It's probably safe to say that at some point during her pregnancy, every woman has asked herself questions like: Are epidurals dangerous to me or the baby? Will the use of an epidural damage my birth experience? Am I weak for wanting an epidural when others can cope without?
"Considering that at least 60 per cent of women today have an epidural for pain relief during labour, it's surprising how misunderstood this procedure is," says Dr Sreelatha Gopalakrishnan, specialist ob/gyn at Dubai London Clinic and Speciality Hospital. "With the advent of modern anaesthetics having an epidural is definitely an option for a pleasant experience in our journey through pregnancy, but only after the benefits and risks are discussed."
"Labour is painful, and it is important to be aware of the different options you have to relieve your pain," adds Dr Gowri Ramanathan, head of obstetrics and gynaecology services at Danat Al Emarat Hospital in Abu Dhabi. "It can be a difficult choice to make. Knowing what your options are will allow you to better make an informed decision based on the pros and cons of each method, as well as considering your own medical condition, goals and priorities. What worked for your mum, your sister or a friend may not work for you."
For the likes of Mariana Saraiva this decision was made before she even got pregnant. The Dubai-based Brazilian mother of a three-year-old girl says she never once considered having a baby without an epidural: "Why endure the torture of labour when you can make use of such effective pain relief? I just knew from the start that going au natural was not an option for me. It would have ruined my entire birthing experience. But this is a personal opinion - one I'm certain not every woman agrees with."
Sometimes this choice is not entirely up to the mums-to-be as certain medical conditions may determine the use or non-use of an epidural. "We recommend epidural analgesia for certain high-risk pregnancies as well as women with multiple pregnancies, with a history of asthma, epilepsy and cardiovascular complications," explains Dr Zofia Kotyra, head of anaesthesia at Danat Al Emarat Hospital.
However, in other instances an epidural may not be an option at all, says Dr Gopalakrishnan.
"If you use blood thinners, have a low platelet count, have a back or blood infection, if you are not at least 4cm dilated and if labour is moving too quickly then an epidural may not be an option to relieve pain in labour," she says.
The important thing is to speak to your doctor in advance, discuss your options, understand the procedure and, above all, be prepared physically and mentally to carry out your plan or embrace whatever curve ball life throws your way. As Dr Ramanathan says, "There really is no right or wrong here. Each choice comes with its benefits and risks. The key is finding out what works best for you."
Here are some of the main concerns women have about epidurals...
WHAT IS AN EPIDURAL?
Epidurals are the most popular form of medication-based pain relief in childbirth. They involve injecting a tightly controlled amount of anaesthetic into your back, which stops pain signals traveling from the spine to the brain so that you should no longer feel pain in the lower half of your body. With a low dose you are still able to move your legs, or even get up and walk around with a bit of help.
Because a single injection is often not enough to last throughout the entire birth, a catheter is usually put in and then attached to the patient's back. This thin plastic tube can be used to inject more anaesthetic or painkiller as needed, which may be supplied automatically by a pump, or manually by the doctor.
If you are having an epidural you may also have a thin tube called a cannula inserted into your arm and attached to a IV drip. This is a safety precaution, so that if your blood pressure suddenly drops the doctors are able to give you the right medication to raise your blood pressure easily and quickly.
The dose of the epidural anaesthetic is usually increased very gradually to avoid injecting too much at once. Pain relief is typically felt about 10 to 20 minutes later.
Read more: '7 Epidural Myths Busted'
WHAT ARE THE BENEFITS?
There are some obvious benefits to having an epidural to relieve pain during labour. Normally, an epidural will allow you to remain alert and be an active participant in your birth, and many women find they are able to feel the pressure and pushing sensation as they deliver their baby, just without the pain. If you deliver by caesarean then having an epidural will allow you to stay awake and involved while still providing effective pain relief.
When other types of coping mechanisms are no longer helping, an epidural can help you deal with exhaustion, irritability and fatigue, allowing you to rest, relax, get focused, and give you the strength to move forward as an active participant in your birth experience.
WHAT ARE THE RISKS?
Epidurals are very safe for the vast majority of patients. However complications do occur, and they range from the short-term and bothersome to the (far more rare) long-lasting or life-threatening. The most common side effect is a drop in maternal blood pressure (hypotension) but, with early identification and treatment, this has no consequences for the mother or baby. It means that your blood pressure will be routinely checked to help ensure an adequate blood flow to your baby. If there is a sudden drop in blood pressure, you may need to be treated with IV fluids, medications and oxygen.
You may experience a severe headache caused by leakage of spinal fluid. Less than 1 per cent of women experience this side effect. If symptoms persist, a procedure called a "blood patch", which is an injection of your blood into the epidural space, can be performed to relieve the headache.
After your epidural is placed, you will need to alternate sides while lying in bed and have continuous monitoring for changes in fetal heart rate. Lying in one position can sometimes cause labour to slow down or stop. Sometimes having an epidural makes pushing more difficult and additional medications or interventions may be needed such as forceps or caesarean. It is important to talk to your doctor when creating your birth plan about what interventions he or she generally uses in such cases.
For a few hours (generally one to two) after the birth the lower half of your body may feel numb, which will require you to walk with assistance.
And in rare instances, permanent nerve damage may result in the area where the catheter was inserted.
WILL IT AFFECT MY BABY? Any medication that you take to relieve pain will reach the baby, however, with an epidural the amount that enters your bloodstream is quite small and, while further studies are needed, it is not known to cause any serious harm. Although many factors can affect the health of a newborn, certain studies suggest that some babies whose mothers had an epidural will have trouble "latching on", which can cause breastfeeding difficulties. Another possible side effect is that while in-utero, a baby might become lethargic and have trouble getting into position for delivery.
These medications have also been known to cause respiratory depression and fetal heart rate variability, thus potentially increasing the need for forceps, vacuum, caesarean deliveries and episiotomies.. However, since dosages and medications can vary, concrete information from research is currently unavailable.
DOES HAVING AN EPIDURAL HURT?
The answer depends on who you ask. Typically epidurals are placed when the cervix is dilated to 4-5cm and you are in true active labour, and some women describe an epidural placement as creating a bit of discomfort in the area where the back was numbed, and a feeling of pressure when the small tube or catheter was placed.
HOW WILL I FEEL AFTERWARDS?
The nerves of the uterus should begin to numb within a few minutes after the initial dose. You will probably feel the entire numbing effect after 10-20 minutes. As the anaesthetic dose begins to wear off, more doses will be given - usually every one to two hours.
Depending on the type of epidural and dosage administered, you can be confined to your bed and not allowed to get up and move around. If labour continues for more than a few hours you will probably need urinary catheterisation, because your abdomen will be numb, making urination difficult. After your baby is born, the catheter is removed and the effects of the anaesthesia will usually disappear within one or two hours.
Some women report experiencing an uncomfortable burning sensation around the birth canal as the medication wears off.
WILL I BE ABLE TO PUSH?
You might not be able to tell that you are having a contraction because of your epidural anaesthesia. If you cannot feel your contractions, then pushing may be difficult to control. For this reason, your baby might need additional help coming down the birth canal. This is usually done by the use of forceps. Using less anaesthesia (called a light epidural) may reduce the likelihood of needing a caesarean delivery.
DOES IT ALWAYS WORK?
According to data , less than 5 per cent of women have unrelieved labour pain after receiving an epidural. This can be caused by the baby's position, but sometimes the anaesthesiologist simply needs to give more medication. Occasionally, the pain is relieved on only one side of the body, either because the catheter is mispositioned or dislodged or because the mother stays in the same position for too long, but this is easily remedied. An increasingly popular option is patient-controlled epidural analgesia; the woman can control the amount of relief she gets, yet overdosing is extremely unlikely.
79% OF BABY & CHILD READERS HAVE HAD OR WOULD CONSIDER HAVING AN EPIDURAL
We asked mums and experts to share their thoughts
Lisa Brannan Midwife at Bump and Baby Education (BABE) "As a first-time mum and midwife, I have both personal and professional experience of epidurals and find them to be effective. Prior to my labour, I was very open minded about having an epidural and did not rule one out. However, I knew I wanted to experience labour before making a set decision about pain relief. I think it is extremely important for all women to have the correct information about the options available to them beforehand so that when the time comes they're able to make an informed choice.
"As a midwife I have cared for lots of women in labour, resulting in many positive experiences both with and without epidurals. Some women do not want to feel any pain and request an epidural at the start of labour while others are adamant they do not want one. I personally tried other methods of pain relief before having an epidural, but after a long and tiring labour decided it was the best choice for me. I certainly don't regret having one, but appreciate they are not for everyone. I feel it is important for women to base their decision on what is best for them and not what their husbands, family or friends feel is best."
Zoe Cresswell Midwife and personal trainer
"As a midwife, I have most typically met three types of women when it comes to opinions on epidurals - A: I don't want to feel any pain whatsoever, give it to me asap. B: Under no circumstances let me have one, even if I'm begging you. C: I'll just see what happens.
"Behind the decision for most of the first type, woman A, is fear. While it is not my place to have an opinion on whether a woman has an epidural, what I do care about is why we have a generation of women who fear their own bodies. Women are strong, powerful and courageous and I welcome a conversation about epidurals to allow me to remind someone just that.
"I would have the same conversation with woman B as a senior colleague many years ago had with me. Childbirth (and motherhood) is all about managing expectations. What other time in our lives would we tell ourselves 'under no circumstances, even if I'm begging you'. And what if we do? Have you failed or let yourself down? No!
"I believe woman C has got it about right. Why not just wait and see what happens? Educate yourself, but not too much! Never google it. Ever. My own childbirth experience was nothing near to what I'd imagined. But I'm healthy and, most importantly, so is my son. I think that's all any mother could wish for."
Note to birth partners. Watching someone you love in pain is so hard. Accept this. Just be there for her, love her harder, breathe with her, mop away her sweat, remind her to drink and then hold the cup for her (and the straw).
My own childbirth experience was very clinical, nothing near to what I'd imagined. But I'm healthy and most importantly, so is my son. I think that's all any mother could wish for.
Dessi Kassab Easibirthing instructor
"From an Easibirthing point of view - which aims to make labour as calm and natural as possible using relaxation and hypnotherapy techniques - epidurals are a little bit like cheating on the experience, aside from the possible negative side effects. The numbing of the body also means that the mother may not feel the pushing sensation of giving birth to her child, making her more of a passive observer rather than an active participant in her baby's birth. This isn't as empowering as a natural birth can be, and epidurals can also increase the risk of medical interventions - C-sections, use of forceps or a vacuum. And, of course, the bonding with the baby might be delayed as well."
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