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The hidden truth of epidurals...and strategies to make it work for you.

Epidurals are a common pain relief option during birth. But most people are not given full information about the impact of epidurals on their labour and how accepting one can drastically change their birth experience.

When I chose to have an epidural I had no idea of how it could change things for me and my baby. Nobody told me. Later, as a junior midwife, I've seen the same thing happen many times...but I know better now. So here are some facts for you to feel better informed as you develop your birth plan and prepare to make decisions in labour.

Epidurals are the most effective form of pain relief in labour. They work by injecting a local anaesthetic (cocaine derivative) and an opioid pain killer (heroin derivative) in your spine, in a space near your spinal cord. However, they interfere significantly with the birth process, its hormones, and can compromise birth safety for mum and baby, overall affecting birth satisfaction.

"Epidural analgesia is one of the most striking examples of the medicalisation of birth, transforming a physiological event into a medical procedure” - WHO, 1996

- Epidurals lower your oxytocin in labour and obliterate the peak that happens at birth, the highest in your lifetime, designed to help you and baby fall in love at first sight. Often your contractions will slow down from the epidural and synthetic oxytocin is needed for labour to progress, leading to a new set of risks for you and baby.

- Epidurals reduce your endorphins, limiting your ability to transcend pain and go to the beautiful altered state of consciousness (“labour-land”) which helps us cope and become more instinctual in birth.

- Epidurals double your chances of having an instrumental birth (forceps or vacuum/kiwi). Epidurals paralyse your pelvic floor muscles, making it more difficult for baby to get in the best position and make their exit unassisted. Babies are 4 times more likely to be born back to back with an epidural.

- Epidurals double your chances of excessive bleeding after birth, possibly for the increase in the use of synthetic oxytocin, instrumental births and perineal damage.

So, are epidurals to be avoided at all costs? Not necessarily.

There are situations where they may be helpful, such as when labour has been long and you're very tired, or if you have high blood pressure. There’s no judgement here if you choose to have one, you are the expert and you know what's best for you and baby. But you should definitely know what you’re signing up for before you make your decision, and strategies you can use to minimise the potential impact of an epidural.

Here are my top tips to boss your birth with an epidural:

- Go easy on the top ups

In most hospitals you're given a button to control how much medicine you use. Top up your epidural only when the intensity is getting too much rather than at set intervals (ie. every 20 min). This way you'll get the relief you need without numbing your legs too much so you can still move and feel some sensations, especially helpful during the pushing phase.

- Keep your Oxytocin high

Your environment is paramount here. Low lights, relaxing music/sounds/hypnobirthing MP3s, aromatherapy, privacy and being surrounded by supportive, loving people you feel safe with. Pro tip: Nipple stimulation is very effective in increasing your oxytocin levels. It's natural and on tap!

- Keep moving

Changing positions will help your baby find their way more easily. If your legs are feeling numb ask your midwife to help moving on the bed. There's loads you can do!

- Skin to skin

Having your baby skin to skin immediately after birth and without interruptions will help massively in increasing your Oxytocin levels, bonding and breastfeeding success. Keep your baby skin to skin for as long as you'd like, if you're both well all checks and measurements can wait until you're both ready.

Whatever your choices, t's important you know the full picture, pros, cons and alternatives of any intervention offered. Learning about your options during pregnancy gives you the time to think things through and make the best plan for you and your family. Being prepared also means that if you opt for interventions, you are able to take action and minimise some risks.

Take control of your experience by learning about birth. It doesn't have to be overwhelming when you access the right support, and it's 100% worth it!!


- World Health Organization, Care in Normal Birth: A Practical Guide. Report of a Technical Working Group (Geneva: World Health Organization, 1996): 16.


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