I believe that every woman is different and that there is no one size fits all for a birth plan. A friend of mine has asked me to cover the pros and cons of epidural to help other women when they make their birth plan with their doctor or midwife. In this blog, I am mainly concentrating on epidural. In the future, I will cover other options for pain relief.
It’s your choice….
Importantly in the UK the National Institute for Clinical Effectiveness (NICE) advises healthcare professionals to be self-aware of their own values and beliefs to ensure they are not influencing or judging their patient’s choices. They advise them to ensure that the care they offer supports the woman’s own choices.
An epidural is less commonly used in early labour but is still used and you must not be afraid to ask for it, during this phase, if you would like it. Other options that are effective during this stage include: breathing exercises, immersion in water and/or massage.
This is the point where women more commonly request an epidural. It is important you have had the chance to chat through the pros and cons, with your healthcare professional, before your labour. But, it is also important to recognise that you can change your mind during labour. However, just so you know, in the UK, you can only have an epidural in an obstetric unit (i.e. where there are obstetric doctors). You cannot currently have them in midwife led units or home births.
Therefore, if you are at home or in a midwife led unit and change your mind about having an epidural you will have to physically move to an obstetric unit. This can sometimes be difficult and so is worth understanding when you make your choices about your location of your labour.
The reason you can only have them in an obstetrician led unit is you will require special monitoring (e.g. cardiotocography (CTG) which monitors the babies heart beat) and your mobility will be reduced. Also, you will need intravenous access, which is where a small needle is put into the back of your hand, or near your elbow, leaving a small tube in place, which can be used to give you medications or fluids.
Also, having an epidural is associated with a longer second stage of labour and increases your chance of requiring a vaginal instrumental birth (i.e. forceps or ventouse). The second stage of labour has two parts. The passive stage is when your cervix is fully dilated but expulsive contractions have not begun. The active stage is when your cervix is fully dilated and either you have expulsive contractions or when you are actively pushing your baby out.
On a positive note, epidural is a very effective method of pain relief, better than opioids (e.g. pethidine) and it is not associated with a longer first stage of labour or an increased chance of caesarean birth. The first stage of labour is the part where your cervix is slowly dilating and you have painful contractions.
Epidural is also not associated with long-term backache. You can still move around during labour, with an epidural, but it can be a bit trickier as sometimes your legs feel numb, at times you will have the CTG attached and, sometimes, you may have a drip attached. You will require the CTG on for 30mins after the epidural is established and for 30mins after each top up of the epidural is given and sometimes more if the midwife has concerns.
Either you will have control of when your epidural is topped up, by pressing a button, which the anaesthetist or your midwife will show you, or a healthcare professional will top it up for you. You can discuss which option you will have with your healthcare professional.
Induction of Labour
Some women have their labour induced. Usually this is because their pregnancy is prolonged or because their waters break but their labour does not start spontaneously. In the UK the National Institute for Clinical Effectiveness (NICE) outlines a few others. Inducted labours tend to be more painful than spontaneous labour and its important women are made aware of this. It might make them alter their choice of pain relief knowing this. However, they do not have to have an epidural just because their labour is being induced.
I hope these facts, based on evidence collected by NICE, make it easier for you to discuss your birth plan with your healthcare professional.
Any questions or comments do get in touch @PregnaPouch or PregnaPouch@gmail.com.
Best wishes and Good Luck
The PregnaPouch team
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