Epidurals: the pros and cons

By Dr Tim Ross, National Medical Director and GP, Bupa

Dr Tim Ross is the National Medical Director and GP with Bupa. In this article Dr Ross talks through what an epidural is, how they work, the pros, the cons and making a birth plan.

What’s an epidural?

An epidural is an anaesthetic injection given next to the spinal cord, which ‘puts it to sleep’ by numbing it from the uterus down, to relieve the pain of labour.

How does it work?

An anaesthetist performs an epidural using a needle to insert a fine plastic tube into the small of your back to deliver pain-relieving drugs during labour.

These drugs (a local anaesthetic and other pain relief medication) help to block the pain signal going to the brain, so you either don’t feel anything or your pain is greatly reduced.

Labour is an involuntary muscular action, it happens automatically and is not something you can control. The epidural doesn’t stop the contractions so you continue to go through labour with much less or no pain.

The pros of having an epidural

An epidural is the most effective form of pain relief during childbirth. I’ve actually seen some women sleep while they’re having contractions after an epidural, which can be helpful for women battling exhaustion during a long labour. An epidural is considered to be a very safe form of pain relief. It’s fast acting, you can be fully conscious and it allows you to keep a clear mind during labour.

The cons of having an epidural

One of the side effects is that an epidural tends to numb everything from the uterus down, and it also paralyses you for a short time. You will not be able to feel or move your legs. Until the drugs wear off you’ll be stuck in bed for a little while.

It’s uncommon, but some women can experience headaches, known as postdural puncture headache, which can be relieved by taking paracetamol and if necessary ibuprofen. If you are a private patient there’s a cost involved in having an epidural.

In very rare cases, a neurological (nervous system) injury can occur which in extreme cases can result in paralysis. A large scale audit published in the British Journal of Anaesthesia measured the risk of any permanent neurological injury (including altered sensation, motor impairment or paralysis) at 0.6 per 100 000 women.

Making a birth plan

The delivery of a baby is one of the more unpredictable experiences that you will have. While it’s good to have clear ideas of what you may or may not prefer, it’s important to keep a very open mind as to what may actually happen.

Some women would prefer to not use drugs and that’s their choice, but they might go on to find they’re in agony and can’t actually cope with the pain of delivery. On the other hand there are women who say I want an epidural ASAP but they might find that they have a very fast delivery time and can get by without it.

If you want to make a birth plan don’t be too set on one particular path. It should express your preferences rather than being black and white. You’ve got to be open to being dynamic and going with what’s happening at the time.

An epidural is one of a number of tools that can help you get through your labour. But it’s absolutely your choice as to how you want to manage the pain.

Note: The views and advice expressed on this blog post are those of the author and are not representative of the Pregnancy Babies & Children's Expo.

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