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Epidurals - The Risks & Benefits

It's often one of the first questions you are asked after having a baby, "So, did you have an epidural?" Why we are so fascinated with this answer, I'm still not sure, but it IS a big decision, and one we think about well before experiencing labour.

An epidural is a medical pain relief option commonly used by labouring mothers to help reduce the pain associated with contractions. It is an anesthetic that produces the loss of sensation below the waist. Of course it comes with it's fair share of potential side effects and risks but first, lets talk about how incredible it can be for some women.

I recently attended a birth with a mother who chose to get an epidural. She had been labouring for 8+ hours and had always been open to the idea of getting an epidural if she felt she needed it. When the pain of her contractions started to ramp up she made the final decision and never looked back. At this time she was 4 cm dilated and wasn't progressing very quickly. She was in a lot of pain, her body tense, her mind foggy. After receiving her epidural, she dilated from 4cm to10cm in just 4 HOURS. A perfect example of an epidural working its magic. You see, contractions are caused when our body releases a hormone called OXYTOCIN. This love molecule is released when we feel good and blocked when we are tense, anxious and in pain. As soon as her body was able to relax, oxytocin was released naturally and, well, the rest is history.

Here is what I LOVE about epidurals; we get to have some control over it! You see, after the epidural is placed, there is a continuous stream of the anesthetic administered which blocks nerve impulses in the lower spinal segments. But! Its not a one size fits all type of pain relief - in fact, the women gets to decide just how much she is receiving. This is particularly important for women who still want to feel some of the contractions and the urge to push when the time comes.

There is of course the disappointment that sometimes follows if a mother had wanted an unmedicated birth. In these instances, I like to talk about the difference between pain and suffering. Having a baby is painful, bottom line. That being said, it is very powerful to see a women take that pain into her own hands and make an informed decision to ease her suffering.

So, what are the risks?

Well, the mother's ability to push can be impaired in the sense that she may not have the "urge to push." This is due to the numbing sensation but can be corrected by turning the epidural "down" or off until the urge to bear down is felt. Conversely, the mother can be coached as to when and how long to push. This is typically done by the nursing staff, OBGYN or midwife.

Other risks include:

- inadequate pain relief (no pain relief at all or pain relief on one side only can often be corrected by changing position or correcting the epidural placement)

- slows down labour (due to lack of movement)

- spinal headache (1% of women may experience this caused by leakage of the spinal fluid)

- fever, body temperature elevation

- shivering, backache, ringing of the ears, difficulty urinating, nausea

It is important to note that there is often a wait (sometimes 45 min-60 min) to receive an epidural once you decide that you want one. This can often feel like an ETERNITY because your pain tolerance greatly decreases once you have made that choice. Be prepared by having some additional coping techniques to use such as deep breathing, counter pressure, hip squeeze and vocalization.

The great thing about being a doula is that I get to support women regardless of their birth choices. More importantly, I get to help them process these changes to their birth plans by helping them stay connected to their labour, even when the pain has subsided due to medical intervention. Choice is a beautiful gift and I am so honoured that I get to see women make the decisions based on what they feel is best for their bodies and their baby.

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