The Epidural - How the gift of the few became the curse of the many

In episodes 278 and 279 of the Nourishing The Mother podcast, childbirth educator, birth doula and author Rhea Dempsey explains how epidurals were initially welcomed by the birth community.

To begin with, they were given to women who had very long labours so they could finally get some rest before pushing their babies out.

I know women who have used epidurals as per their original intended usage to great effect. I know women who have understood the risks and benefits and planned for an epidural at a certain time in their labour, and had a very positive experience.

There can however be too much of a good thing, and what was originally a gift for the few has become a curse of the many. As of 2020, 40% of Australian mothers and birth parents received an epidural.

Unfortunately, an incredible number of us have one without a full understanding of what it entails, where it can lead, or proper support to make informed decisions regarding it.

FYI:

1. An epidural involves a local anaesthetic to an area of the back, then another needle and catheter to the spine. Once this is in place, you will also get a urinary catheter to empty your bladder, IV line for fluids to avoid dehydration, and likely another drip line with syntocinon (if you didn’t have one already from an induction) to augment labour keep things progressing (and vaginal/cervical examinations to check that they are).
2. Each of these lines restricts movement, so you are essentially restricted to the bed.
3. You are more likely to be instructed to birth on your back and coached to push, both of which increase rate of episiotomy (a cut through the clitoral tissues to get the baby out), 3rd and 4th degree tear (tearing into or through the anal sphincter muscles) and instrumental (forceps and ventouse) birth. These can be emotionally as well as physically traumatic events.
4. You are more likely to be continuously monitored with technology, which has been shown to increase c-section risk without necessarily improving baby safety.
5. You may get intense headaches during or after the birth, get the shakes or feel nauseous, be temporarily paralysed for days or weeks if it hits the wrong spot, and you and your baby (postbirth) can spike a fever and/or get an infection, leading to antibiotics and potential separation.

This list is not exhaustive, and each of these effects can then flow into another scenario that can alter the birth, feeding, bonding and early newborn period and beyond.

If you are birthing soon, I am not saying to avoid an epidural at all costs!

What I am doing is encouraging you to ask questions of your care providers and yourself ahead of time so you can make a plan you are happy with ahead of time, rather than finding things out in the heat of the moment.

Consider things like:

• Under what conditions would you request or accept an epidural.
• What methods of pain relief will you use first, taking into account the availability of these at your expected place of birth?
  
• How will you cope in the time between the request to when it’s actually administered and then working at full effect 20-30mins after that?
  
• Who you want to administer the epidural - would you be happy to accept it from someone still in training, or prefer to wait for a senior clinician?
  
• Do you want to have an epidural and continue labouring towards vaginal birth, or are you having an epidural as pain relief and requesting a non-emergency, in-labour Caesarean section?
  
• If you want to birth vaginally, will your support people be able to help position you in positions more conducive to birth (e.g. side lying) rather than on your back?
  
• Will you accept or ignore coached pushing directives or episiotomy, and how will your support people help you maintain this informed decision under pressure?
  
• If it all goes to poo and you and your baby need to be separated, who will stay with you and who will stay with your baby?

Even if you’re planning an outside of hospital birth, it is helpful to prepare throughly for a variety of scenarios.

Understanding your options and mapping your birth in all possible directions helps to increase feelings of calm and control as birth unfolds.

As Catherine Bell says, “Birth can be unpredictable, but that doesn’t mean you can’t prepare for it!”

If you’re birthing in 2023, I highly recommend downloading or ordering the Birth Map book here*.

The epidural is just one of multiple key decision points I discuss with expecting parents in individual Birth Mapping sessions. I have availability for these upon my return from maternity leave in mid-March.

Birth mapping session are available with me as a standalone 90 minute call, or as part of a 4 session package including birth mapping, postpartum planning, birth debriefing and transition to motherhood support.

As always, sessions with me are available on a pay as you can basis. The suggested range for this service is $80-200 AUD per session.

You can book a session with me here.

In the meantime, go get Rhea Dempsey’s voice in your ears via the Nourishing The Mother podcast to hear the full story on the Trojan horse that is the epidural. If you get right to the end, I can you promise you the image of the billboard will make much more sense!

*I am an affiliate for the Birth Map book because I love how it enables women and parents to take charge under almost every birth circumstance. This means I receive a small remuneration from each purchase as the referrer, however you can also join the site as a member and access the online version for free! I am proud to be a certified facilitator of birth mapping sessions.