Official guidelines state that all women in the UK are entitled to opt for an epidural. Yet, the latest report from the Department of Health and Social Care reveals that women being told they cannot have an epidural has become a common occurrence.

Reasons for this include a lack of information, coupled with NHS staff and resource shortages. And, an unfortunate knock-on effect has seen many women experience a traumatic birth, which can lead to issues with post-natal depression and anxiety further down the line.

To avoid this situation and ensure the best possible childbirth experience, it’s essential for expectant mothers to be equipped with the information and knowledge they need to make informed choices when it comes to pregnancy and childbirth.

That’s why here, Lesley Gilchrist, a registered midwife and co-founder of My Expert Midwife, shares her expert advice on epidurals, including the advantages, risks and complexities involved.

What is an epidural?

It’s no secret that delivering a baby can be painful! However, the decision about whether or not to use an epidural is very much a personal one and will depend on the health of your baby and the specifics of your pregnancy labour and delivery. To help inform this choice, it’s essential to first know what the procedure involves.

Apart from spinal anaesthetic which is used in operations, such as caesarean section, an epidural is the only form of pain relief that can completely remove the pain.

The medication is given through a catheter which is run through a large needle inserted into your lower back by an anaesthetist. You will be required to stay very still during most of the procedure and will be sat upright on the bed facing your partner.

The procedure itself takes an average of 15 minutes and you should feel it starting to work after around 20 minutes. Once the plastic tube is in place, it will be taped down and attached to a pump which will deliver a set amount of painkilling drug continuously; it will not run out. You will then sit upright to ensure that the medication is evenly distributed, and your midwife will begin monitoring your blood pressure and your baby’s heart rate.

Occasionally, the medication can cause your blood pressure to drop. If this happens, you will be laid flat and moved onto your left-hand side. You will be given fluid into a needle in the back of your hand and after a few minutes, your blood pressure should normalise.

During that time, it is usual for your baby’s heart rate to drop and this should also recover before six minutes. Providing there were no concerns about your baby’s heart rate before this it shouldn’t cause great concern.

For one in 10 women, the epidural is only partially effective or not at all. In these cases, you may be given a higher dose of medication or the anaesthetist will either move or reinsert the plastic tube in your back.

While the epidural is working your midwife will keep a close eye on your blood pressure and monitor your baby’s heart rate. If your labour is still classed as low risk, then you will not normally require a continuous heart rate trace. Some labour wards offer mobile epidurals while others feel that in order to have a proper effect, they require higher doses of medication which leaves you less mobile.

The advantages of an epidural

Before agreeing to an epidural, ensuring that you fully understand the pros and cons of having one is key, as this will empower you to feel like you’re able to make the best decision for both you and your baby.

The primary advantage of having an epidural is the quick and effective pain relief it can offer during childbirth. It can also help you to relax and get more rest, which can be beneficial if you have a long labour and may provide a more positive birth experience.

It may also help you stay alert during labour so that you can take an active part in the birthing experience and can spare you discomfort if forceps or a vacuum are needed to help get your baby out.

In addition, if you need to deliver by C-section and an epidural is already sited, this can be topped up, reducing the need for a general anaesthetic. An epidural allows you to stay awake during the procedure and provides pain relief during your recovery.

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Epidurals and the associated risks

That said, when it comes to epidurals there are of course some associated risks, including a higher rate of assisted birth, such as the use of forceps or Ventouse for the birth. This is partly due to the effect that it has on slackening your pelvic floor, on the inability of knowing exactly where to push and that you are lying down in bed to push.  However, some midwives will offer to stop the epidural before you begin to push, which may allow you to have more sensation of where to push. Your contractions may also become less frequent and this can mean that you will need a drug to build their strength and frequency back up.

Other side effects can include nausea, low blood pressure, itchy skin and a temporary loss of bladder control. You may also develop a severe headache sometime after the procedure which may require treatment with something known as a ‘blood patch’.

The importance of making an informed decision

Whether or not you choose an epidural as a form of pain relief during childbirth is up to you and no one should influence that decision. All expectant mothers should be able to make an informed choice that’s right for them, to know this decision will be fully respected and to have the freedom to change their minds.

However, unfortunately in the present reality, this is not always possible. For instance, current resource challenges dictate that there may be times when anaesthetists are not available to perform the procedure, which poses real challenges for midwives seeking the best experience for women in labour.  In addition, due to funding shortages, the NHS has withdrawn many free antenatal classes and as a result, lots of women are missing out on important information about epidurals and pain relief.

As a consequence (whether direct or indirect), many women in the UK have experienced a traumatic birth. In fact, a recent study estimated that as many as 30,000 women in the UK suffer from the effects of birth trauma and PTSD each year, which can be hugely debilitating and can impact enormously on what should be a happy time after your baby’s birth.

However, it’s worth noting that often post-traumatic stress disorder doesn’t stem from being refused the analgesia but maybe because the birth didn’t go as planned or because the expectant mother was not adequately informed and involved in the decision-making process, either during pregnancy or during care in labour. This is again due to an overstretched system, which is currently at breaking point.

There are also certain circumstances when an epidural is not suitable or may be detrimental to a woman’s labour, such as pre-existing medical conditions. In addition, it can be bad practice to issue an epidural too early in labour as this could lead to unnecessary interventions, all of which come with risk factors to both the woman and her baby. However, if an expectant mother hasn’t had adequate antenatal education, she may not understand this rationale and potentially interpret it as a denial of pain relief.

Deciding what’s right for you

Ultimately, every pregnant woman is an individual and what’s right or acceptable to one woman when it comes to childbirth and pain relief, may not be the same for another.

If you are unsure what’s best for you and your baby, do as much research as possible, weigh up the advantages and disadvantages of what is being offered to you and discuss the available options with a midwife or doctor, who can provide further information and advice to help you take control.

Remember, you do not need to have a natural birth without any pain relief to feel strong and empowered during your pregnancy and labour. It is about choice and feeling as though you have made the decisions that were the right ones for you and that you have been listened to by your care providers during your journey through the maternity care system.

Always know that it is your body, your baby and your decision, and so the most important thing is to make the choice that is right for you – not for anyone else.

Article by Lesley Gilchrist, a registered midwife and co-founder of My Expert Midwife

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