Epidural

My Ob asked me today at my visit if I have decided to have epidural for pain relief for my baby's birth. As this is my first pregnancy, I am so unclear of whether to accept epidural or not. Can anyone give any advice? Also, is there any exercise that I can start doing to minimize the possibility of a tear or to facilitate an easier vaginal birth? I am really excited as my baby's birth is approaching. At the same time, I am really anxious/scared of the whole birth process.

Hey Carmen

There's a great book about practical strategies for pain management during labour called "Birthskills"...It's co-written by a Sydney physiotherapist (Juju Sundin) and Sarah Murdoch.

I've been reading it...and it's just fantastic! The book is about empowering you for birth...helping you to deal with the fear and anxiety in a really realistic way...it's practical and easy to read...my cousin used the techniques in her birth and said they were just brillant! She had a very big baby with no tear whatsoever...despite being initially told that she would definitely tear...

You should be able to get the book from local bookstores...it's about $40 but worth every cent!

Regarding an epidural...you don't have to decide about that now AT ALL! Look into a whole lot of alternatives...be well prepared for labour with a whole lot of pain management strategies and then when it comes to the actual birth...you can decide then!

Hi Carmen, I agree with Monnie (I seem to do that a lot! haha) You don't have to decide on your pain relief right now. Make yourself aware of what's available to you though, and talk to your support person about what you THINK that you might like. Look into a whole lot of alternatives, not just drugs.

I have of about the book that Monnie reccommends and have heard that it is really good. Might be worth a read. You still have a fair bit of time to get your head around all of this.

I personally refuse to have an epidural unless it's completely necessary, as I have had a bad experience in the past with having a spinal anasthetic, and don't want to go through that again. But that is MY personal request. I have made sure that my DH is completely aware of it, and if I ask for one, he is to refuse it. When in labour with DD I begged for one, and I am so glad that he held strong and denied me it, as that is what I asked him to do. He nearly caved, but didn't. And now I know that I can do it without one.

Make sure that your support person/people know about what you decide for all of your requests, as they are the ones who may have to take charge while you are in labour.

As far as tearing is concerned, with my first pregnancy I didn't tear at all, and I put it down to having really good relaxation techniques and strong pelvic floor muscles. When your baby is crowning, and they say "stop pushing" I found that I really had to remove myself from the situation (relaxation and breathing) and just hold the baby where it was (muscle strength). And I'm not going ot lie to you, it hurts!!! Like nothing else that I've ever felt!!! I don't want to scare you, but I can't describe how painful it is. But then once you get through that, that's it. A couple more pushes, and your bub is in your arms.

I practiced yoga and exercised my pelvic floor throughout my last pregnancy, but not so much with this one, so it will be interesting to see how I go. I might have to get ready for stitches.........oh well. It's my own fault.

Good luck with it. I hope that you make decisions that you feel happy with, and don't feel pressured into doing anything that you're not comfortable with. It's YOUR labour, and you do it YOUR way.

Hi Carmen2

I'm a first-timer like you (due in a few days, yikes!) and agree with the others. I think there's way too much emphasis put on what pain relief we may or may not want and nowhere near enough on how we can use different techniques to cope with the pain.

Now as soon as people use words like "techniques to cope with the pain" I imagine aromatherapy burners and CDs with whale music on them which are NOT my cup of tea at all. But I too found Juju Sundin's book really, really useful because there's lots of other stuff in there. You just need to find something that works for you. I was having pre-labour pains yesterday so thought I'd have a bit of a practice so now I know that putting on some music DVDs take my mind off things as I bounce on my fitball pretending I'm a drummer! Whatever works, I reckon!

Bearing in mind that these days a lot of women feel disappointed with their birth especially if they go in intending to go all natural and end up having an epidural/caesarean, she makes the really important point that as long as you belive you've done your best, you can't be disappointed.

So the way I'm approaching it is, I'll give it a red hot go based on her book (and a few other things that I think might help me personally) but if I can't cope then I'll have an epidural without any guilt whatsoever and accept the likelihood of other interventions such as forceps/episiotomy.

You definitely don't need to decide now.

You definitely dont need to decide this early on. Although its a good time to start researching and talking to others about what pain relief worked for them and then pop i down in your birth plan.

My labour was 24hrs and 12hrs was with no pain relief. But i was exhausted and opted for the epidural because I still had a lonnnng road ahead of me with not much progress but i did have contractions building on contractions...anyway for me the epidural was the right choice.

Before that you can try many other options. The TENS machine, the hot shower, bath, gas, pilates ball...the epidural is quick to administer so dont think you have to decide before you get into the delivery room.

I hope you have a wonderful experience.

Ann

Carmen, Monnie has given you good advice - reading as much as you can before birth is a great idea. I also recommend New Active Birth.

As someone who has had an epidural with one birth, and just gas with the other, I can only tell you if I was to have another baby, I would go for just gas or no pain relief again. With an epidural you are confined to bed. It increases the risk of intervention and this happened in my case, Jack ended up in foetal distress and forceps were used which then led to a tear which then led to an episiotomy. Also, you have to have a catheter and are immobile for some time after the birth. I was quite ill with gastro prior to Tom's birth, yet I felt so much better after his birth than Jack's. I didn't have drugs in my system and I could get up straight away and have a shower and walk around. I can't tell you what a difference it made.

So my advice, is to plan for no epidural. It might happen that you have a back labour, or a very long labour, or you just find you aren't coping with the pain and need something. If this happens, that's fine, you go to plan b and have an epidural. But if you do manage not to need one, you will feel so much better for it. And it's also very empowering to give birth without pain relief, it truly is an amazing feeling.

Unfortunately I think the rate of epidurals is too high and it is this way because we don't trust our bodies to do what they are designed to do, and we fear the pain. If you can believe that you can do it you have a great chance of doing it. This is also why the reading is so important.

I wish you all the very best with your preparation and your labour and I know you will do a great job.

As all the previous posters have said, you definitely don't need to decide on your pain relief now, but it is good to have an understanding of what is available before you go into labour. For next time I'm going to have a birthplan of what I'd ideally like to happen.
If you do decide to have an epidural make sure the midwife checks to see how far dilated you are before you have one! I went in to be induced at 41 weeks and the midwives thought I'd be there for hours so were telling me that the contractions I was feeling was just the begining (they hadn't checked me at all till after I'd had the epidural) so I decided to have the epidural, and when they checked the cervix moments after the epidural I was fully dilated already, so they turned the epidural right back so I could feel the contractions and when to push, but there was no pain and I didn't need any further intervention and only had a couple of stitches - I was a bit disappointed about having it considering I'd come so far without it, but the end result is worth it!

Think about what you want to use and dont be pressured by OB into anything!!

options are water (shower and or bath), heat packs, massage,counter pressure, aromatherpay, music, hypnotherapy/hypnobirthing, position changes (especially standing, all 4rs, sittinng on toilet, sitting on bath. and more

ot nitrous oxide gas

tens machines are great!! physios hire them out

sterile water injections (if hospital offers them)
Pethidine

and then epidural!!

You are better to discuss with partner what you do and dont want and remmeber to be active in your labour move around as much as you can and be as upright as you can!!

good luck

I agree with Monnie too!

I think you need to inform yourself as much as possible about the affects of epidural and other forms of pain relief. It's really important to make an informed and empowered decision. You may read about the pros and cons and decide to go with it. But, I urge you to read read read and that way you will feeel really comfortable with your decision.

Pain relief in labour is something that's really important to think about. I had an epidural with my first child and I had a really bad experience. I had transferred from home to hospital and my baby was posterior. I made the choice to have an epidural. It's important to rmember that often epidural will limit yur mobility.

With my others I had birth centre births and I used water immersion, massage, labour support, showers, squatting, hanging (holding on above my head and dangling (off the door!) it was fabulous!

The unmedicated labours were far better for me than the epidural labour. (my epidural didn't "take" and I ended up with a dural tap - when cerebro spinal fluid escapes causing a massive and debilitating headache.) Whilst this is a rare side affect it does happen and it is hideous!

ONe of the best ways of minimising the need for medicated pain relief is having good birth support. Having a midwife you have got to know and trust with you, a woman friend who has birth beliefs congruent with your own, a doula.

Wishing you a wonderful birth!

If you want to minimise your chance of tearing, then avoid the epidural.

Arm yourself with pain management strategies and consider other pain relief options first. I don't think you need to make a decision about an epidural now.

Good advice everyone :)

Flowerchild...hanging off the door...sounds amazing...I'll have to keep it in mind!

Oh Monnie it truly is. In some indigenous cultures women hang from ropes (aaahm you know what I mean - pull down on them!!!!) The reaching up and pulling down helps gravity, and it truly is wonderful in labour. I see a future where ropes are hanging from birthing centre ceilings!
I hung off the wardrobe doors as my husband pushed on the cupboard so I didn't pull it on top of me! Also holding onto the handles in the showers and squatting down. So, I still got that feeling in the birth centre but not to the same degree.
It's certainly one to try!
Remembering we all have different positions that are great for us. I personally can't stand to be still. The idea of a fit ball sends me into conniptions! I need to be up, squatting, rocking my hips. Even in the water I do this. Other women love the fit ball. Or birthing stool. It's a case of trial and error!

Good luck with all of your up coming births... :hug:

I'm imagining birthing suites with trapezes in them :lol::lol: They'd be easier to hold on to than the door frame.
It sounds interesting though. I might have to give that one a go.
I found that moving around helped me out too last time. Definitley rocking my hips and stuff - can't just sit there.

We are not meant to sit or lie or be in stirrups. That's why it all feels so "Normal" when we move about.

Birthing places with trapezes! mmmm I am imagining all types of things there!

I was at a birth once where the woman actually pulled the handle out of the wall she was pulling down so hard!

That hanging dangling, pulling down feeling is really good - I hope you can try it!

Thank you all for the wonderful advices. I will definitely read as much as I can especially now I still have got some time before I need to decide whether or not to have an epidural. Every visit, my Ob kept on suggesting that I have an epidural as "this is my first child, and the pain can be quite bothersome". I still haven't given her an answer yet, but after having read all the posts, I think I would rather go without the epidural. That way, there's less complications such as immobility, fetal distress, and etc. Unfortunately, where I am (Canada), epidural is favored by most Ob unless health issues contraindicate, but I will definitely let my support people know my plan especially when I go into labour. When I'm in labour, I think my mind will be off in wait of my bub's arrival, so my support people can speak for me!

Honestly, I am so grateful to have found all the support I need from BB. My mom had me by C section, so it's a little hard asking her what it feels like when in labour! Fortunately, I still have a little less than 3 months to prepare and read up as much as info I could about labour/delivery/breastfeeding/care of the newborn... There's a lot for me to absorb. I have to admit that as the days are approaching, my fears began to sink in. It just feels like I am not prepared enough!? I guess I could say I am experiencing some kind of prenatal anxiety. LOL... So glad to have found support here! I have to say that without BB, I wouldn't be able to go through my first trimester in ease! DH is so glad that I found this forum on the internet because otherwise, I would have been calling him up every second freaking out at every discomfort I was feeling!

This week, I will definitely run down to the book store and get the books that Monnie suggested. In addition, I think it might be good if I also buy some books on alternative pain management therapies... Thanks a million to all the girls for your support!

Ah, so you're in Canada.....
I always wonder about Canada and the USA and epidurals. Every baby and maternity show that I have watched from either place seems to see an epidural as the 'first choice' in pain relief, and I've always wondered why.
Any other pain relief is seen as 'alternative'.
Is anyone able to shed light on this?

Hi Carmen,

That's great your goal is a vaginal birth and you're thinking of ways to get through it with an intact perineum.

I'll tell you my honest view of epidurals. I think they've become an accepted, sometimes even routine part of birth in many cultures. As Kirst observed, it's even considered the "first choice" in pain relief. This is not without a down-side tho. With an epidural, you often lose some of your best allies for an easier birth - gravity, mobility, privacy and the chance to get into a birth pool. So when it comes to pushing the baby out, you may end up unable to push very effectively, and less able to get into active, gravity-positive positions to push. This can lead to the need for a ventouse or forceps delivery, which can be quite damaging to the perineum through tearing or episiotomy; or caesarian. So the pros and cons need to be weighed carefully.

That's the advantage of other pain-management strategies in labour - if you can find other methods to get you through the toughest contractions of late first stage, you may be able to avoid the "cascade of interventions" which can leave you with damage to your body.

I do think that there are times when the judicious use of an epidural might just help a mother to avoid a caesarian, such as when the baby is in a tricky position. I'm not saying avoid epidurals no matter what. It's just that, as I once heard a wise Obstetrician say, "everything we do has side-effects - there's a down-side to every intervention". No intervention is always going to be superior to intervention, so it's best to use it wisely as a last resort after less invasive techniques have been tried for a while and given a chance to work.

I think also there's a cultural concept of avoiding pain. In most parts of our lives, avoiding pain & discomfort of any kind is desirable. Pain means something is wrong and it should be numbed and eradicated as much as possible. I think this approach is counter-productive when we take into birth, though. That's because if we try to eradicate or numb labour pain (which is a positive, healthy pain), the pay-off may be even more painful when we're recovering from a surgical birth. Some women even have lasting pain from the needle insertion site in their spine. So another possible approach, rather than seek to avoid labour pain, is to embrace it and go with it - as athletes too - they say, "no pain, no gain" and the pain is associated with effort, exertion and excellent performance. I think labour pain is the same - your body is working supremely well, and if you can go with it like a runner does, rather than try to numb it, stop it or avoid it, by doing the hard yards with that you may be able to damage that might cause you more pain and discomfort when you are recovering.

I think it would be more encouraging for you if your Ob was saying, "You are a strong healthy woman and you are capable of birthing your baby under your own power - we'll be there only if you really need us" rather than, "you'll probably need an epidural, the pain can be quite bothersome". I think she'd be givng you a clearer picture if she also added that the side-effects of an epidural can also be pretty bothersome for many women. I don't know too many cases where a woman went on to have a normal vaginal birth with an intact perineum after an epidural. For that, an un-numbed body and the ability to choose gravity-positive positions as your instinct guides you, may well be more conducive to your goals.

There are some awesome doulas (birth attendants) in Canada, I wonder if there are any in your area? They can be a good resource to have with you in the birth room.

One more thought - many women find giving birth in a pool of water is helpful for avoiding perineal tears.

I hope all goes really well for you Carmen. It's great that you are arming yourself with knowledge and making plans. Let us know how it all goes. Take care, hun.