Q&A: Epidurals
Email your question for our experts to: sharing@ypbmagazine.com Please note that experts unfortunately cannot respond to each question personally. The answers provided on these pages should not replace the advice of your doctor.
Q I am almost 33 weeks pregnant. I have read so much on the stages of birth and what to expect at each stage. But I would like to know more about epidurals and how and at what stage they are given. Will it be better for me and Baby to give birth naturally without any anaesthetics, or does it not have an effect on Baby? Must I decide beforehand if I want an epidural? Can you please tell me more about this.
A DR PETER KOLL ANSWERS Epidurals are generally regarded as a safe and very effective form of pain relief in labour if administered by an experienced anaesthetist in the appropriate setting and with the proper emergency equipment available. An epidural can be administered at any stage of the labour, but because it takes about half an hour to work, it will not be administered if delivery is imminent. The decision whether to have an epidural or not is, however, an incredibly difficult decision to make before labour. The problem is that labour can be very different in different women. Even in the same woman, your one labour can be very different to the next. You would have also noticed by now that there are no shortage of “experts” and consequently no shortage of advice and opinions when you are pregnant. One person will tell you that they had a magnificent birthing experience with an epidural and that this is the best way to have a baby. Another will tell you that she had the best experience with a water birth and that this is the only way to have a baby. Both of these opinions are correct for the individuals concerned but may not be the best option for you. What we need to determine is what birthing option will be best for you. The good news is that as difficult a decision it is to make before you go into labour, as easy a decision it (usually) is when you’re in labour. You will either cope without it – or you’ll need it, and this will not be a difficult decision in labour.
I have always encouraged my clients to come to the labour ward with an open mind, discuss what options are available with your healthcare professional, and make the decisions in the labour ward. Don’t stress about these decisions antenatally. When you get to the labour ward, play it by ear. If you feel like walking around, then walk around. If you feel like using a birthing ball, use one.
If it feels like a good idea to climb into a bath (and if one is available), get the staff to fill the bath and try it. If you have two contractions in the bath and don’t like it, get out. If you are screaming for an epidural from the parking lot, that’s okay too. The point is that decisions that are impossibly difficult to make before labour are generally quite easy to make when you are in labour. Remember too that your healthcare professionals are there to help and guide you if necessary.
I must add a note on the effect that the COVID pandemic is having on labourward staff and facilities. Most people will arrive in the labour ward with their COVID status unknown and would thus have to be treated as positive. This will inevitably (and necessarily) put restrictions on your movements and options. Discuss this with your healthcare professional before the time. There may also be reduced availability of anaesthetists to do an epidural at short notice. Ask about this when you arrive at the hospital, as this may affect the timing of your decision. ●