Epidurals

By Sarah Vine

When offering a woman an epidural at childbirth, in my experience, midwives and anesthesiologists rarely explain all the side effects that accompany this form of pain relief. I feel this is very wrong, if women are purported to have ‘free choice’ for childbirth! That is why I am including this information on epidurals.

The main reason I try to avoid epidurals because of the increase likely hood of other interventions that may follow: epidurals commonly cause blood pressure to go down, so a saline IV is introduced. Another side effect is that contractions may then tail off, so pitocin (a synthetic hormone that stimulates contractions) is added. Contractions suddenly get very strong with pitocin use, which may cause the baby’s heart rate to drop…. etc. I have met midwives who believe that the epidural can help a woman who is fighting contractions relax, and allow the dilation to take place, and in some cases this might be true. In preparation to allow this to happen without resorting to drugs, you can practice pregnancy yoga, and/or look into hypnobirthing techniques to help yourself relax and let go.

Epidurals also stop the release of oxytocin by your brain – oxytocin is the body’s natural pain relief. (I wish it were stronger too!) As pain increases, oxytocin levels increase too. As soon as pain goes up a notch, you may start to panic that you can’t cope, but if you can mentally get on top of the panic, you may find yourself coping better again in a few minutes as the oxytocin levels increase in response. It is also an important hormone for bonding with the baby, and for breastfeeding. It doesn’t mean you can’t bond or breastfeed after an epidural birth, but the intuitive response, from my experience, sometimes seems lower. I have had both kinds of births, and the cocktail of hormones and joy make one so high for weeks after a natural birth, as opposed to a birth with lots of interventions which leaves you feeling like a train has run over you, and instead of positive hormones your body has drugs to flush out.

It is rare, but things do go wrong with epidurals. The placement of the IV is in the space just before entering the dura, the which protects the center of your spine where spinal fluid flows up to the brain. If the placement is wrong and the dura is punctured, spinal fluid leaks out and the result is an excruciating headache that may last for days or even weeks – severely interrupting the crucial period for bonding and learning breastfeeding techniques. (Dura puncture rate between 1 and 5 cases out of 100. See below for source.) Another rare occurrence is when the epidural is only partially effective, meaning one half of the body is pain free while the other half feels everything. Sometimes it’s only a small patch of stomach that can still feel pain – but unfortunately, since the oxytocin (natural pain reliever) in the brain has been switched off, the pain in that one spot is even MORE excruciating than before, which can be very distressing for the mother, especially since she has been looking forward to being pain free. The NHS suggests that 1 of 6 epidurals is unsatisfactory.

Now, if you do decide to have an epidural, you can rest assured that you know all the side effects and that you are going into this with eyes wide open. Whatever you do, do NOT feel guilty or like a failure. Every woman’s pain is different, and modern medicine does have huge benefits when properly used. You have a free choice, you do not need anyone’s permission or approval here.If an epidural is what you need to give birth without fear, and welcome your child with joy, then take it. It is important not to bear guilt afterwards.

The ultimate goal is to be able to give birth in full knowledge of the miracle, the holy moment when the breath of life enters your child’s body and you gaze at each other, eye to eye. Embrace the experience!

Management of Accidental Dural Puncture and Subsequent Headache
By Stephanie Goodman, M .D. , Associate Clinical Professor of Anesthesiology, Department of
Anesthesia, Colum bia Presbyterian Medical Center, New York, New York

Epidural analgesia in labour St Mary’s NHS Trust