Women and pregnancy: What to know if you opt for an epidural as pain relief when giving birth

When his wife and his sister-in-law were each pregnant and about to give birth, Dr Christopher Chong advised them to consider an epidural. This would give them pain relief during labour, the obstetrician and gynaecologist from Gleneagles Hospital said.

However, both women wanted a “fully natural birth” that required no medication, so they decided not to opt for an epidural.

Dr Chong’s wife successfully had a medication-free birth, so no epidural. His sister-in-law, on the other hand, asked for an epidural an hour into her contractions to cope with the intense pain.  

An epidural involves injecting anaesthetic into the space around the spinal nerves in your lower back, to alleviate the pain from birth contractions. It is administered by an anaesthetist at the initial stages of labour.

“I always share this anecdote because each woman’s birth and pain experience will be different, even if they are sisters, and no two births even from the same woman are completely the same,” said Dr Chong. 

“While it is ultimately up to the mother, I recommend every woman to consider an epidural because opting for less pain is better than taking the risk of having a very painful and difficult birth.”

THE BENEFITS OF GETTING AN EPIDURAL  

“An epidural is one of the most safe, effective and reliable ways of relieving labour pain,” said Associate Professor Sng Ban Leong, a senior consultant and the head of the department of women’s anaesthesia at KK Women's and Children's Hospital (KKH).

“Every woman has a different pain threshold, and the labour process can be dynamic,” the anaesthetist added. “Good pain relief can make the whole experience easier.” 

He pointed out other benefits, such as improved blood circulation for the placenta and the baby, both during and between contractions, as well as reduced stress-related reactions to pain. This latter benefit is particularly valuable for women who have high blood pressure, diabetes and heart conditions.

Pain relief from an epidural also helps the woman conserve her energy to push, Dr Chong said. 

Using an analogy, he said that a birth is dependent on three things. The first is Passage, or the mother’s body and bone structure, which can’t be changed immediately. Secondly, Passenger, which is the baby and its position through the passage. 

And finally, Power, which refers to the woman’s strength, This, he said, “can be controlled slightly with medication”.

Dr Chong explained: “When the mum exerts too much power without any pain relief, it can be draining and painful especially towards the later stages of labour, demoralising her throughout the process as she may feel her efforts are fruitless.”

THE SIDE EFFECTS AND RISKS OF AN EPIDURAL

Though they’re not typically a cause for concern, Assoc Prof Sng said a woman may feel some immediate side effects after receiving an epidural:

• Bruising and backaches: Due to the injection in the lower back, bruises may form at the injection site and a mother may experience backache right after. “Both are usually temporary and will go away in a few days,” Assoc Prof Sng said.
• Loss of feeling or numbness: On rare occasions, some women may encounter numbness in their legs and lower body while giving birth. Assoc Prof Sng added that numbness can affect bladder sensation and may result in a lack of urge to urinate, but this can be resolved by draining the urine.
• Muscle weakness: Some women may experience weakness in their legs, post-delivery but Assoc Prof Sng said it’s usually not severe and should wear off when the anaesthesia wears off.
• An effect on the baby: An epidural does not harm the baby, Assoc Prof Sng said, but if the mother’s blood pressure drops during labour after receiving pain relief, it may temporarily affect the baby’s heart rate. This can be averted with proper positioning of the mum’s body and giving her blood pressure-raising medication during delivery.

If you had earlier decided to try for a medication-free delivery, but like Dr Chong’s sister-in-law, realise that you do need pain relief during labour, know this: While there’s no specific “too late” moment for women to ask for an epidural, receiving one late in labour can be dangerous for both the mother and the baby.

“When the baby is close to your rectum, its head will already be pressing down on your back and it will be tough to block any pain,” Dr Chong said. “And when you’re in distress, you also wouldn’t be in a position good enough for the anaesthetist to administer the epidural.”

In this case – and in other situations where labour progresses very quickly and there isn’t time to provide an epidural – the healthcare team will assess your situation and make a decision, Assoc Prof Sng said. 

At KKH, this team consists of nurses, anaesthetists and obstetricians, who can provide alternative pain relief like Entonox (nitrous oxide, also called laughing gas) or pethidine, a pain-relief injection in the thigh.

THE MYTHS SURROUNDING EPIDURALS

Some supposed side effects of epidurals are just myths, said Dr Chong. 

The first myth: An epidural hinders a woman’s ability to push effectively while in labour, leading to an unplanned or emergency caesarian section.

Dr Chong clarified that epidurals help to relieve the pain from contractions. The amount of anaesthesia can be adjusted, and while the medication provides pain relief, the primary pushing power still comes from the mother. 

“An unplanned or emergency C-section will take place only when it is necessary for the well-being of both the mum and her baby,” he added. 

This may be necessary if the baby’s head is too big for the mum’s pelvis, the baby is in an unfavourable position, the mum’s contractions are weak, or her cervix hasn’t opened enough.

The second myth: Epidurals lead to chronic and long-term backache after giving birth. 

“Backaches caused directly by an epidural are usually temporary,” Dr Chong said. “They are also common for women during and after pregnancy, with or without an epidural, and there has been no evidence to suggest that (an epidural) causes long-term backache in women.”

The third myth: Epidurals affect a woman’s future births. Dr Chong said that since a woman’s childbirth experience depends on factors like power, passage and passenger, having an epidural at one birth does not impact future births. 

“The epidural only influences the ‘power’, or mother’s pushing ability, during the specific birth in which it was administered,” he added.

This next myth is not even particularly medical, as it’s related to a social perception that women who opt for an epidural are considered “weak”, “not strong enough” and did not experience a “proper birth”. 

Dr Chong rejects the notion, emphasising that every woman’s situation is unique – and the method of giving birth should not diminish the authenticity of the experience. 

“Using pain relief to make childbirth more comfortable and beautiful doesn’t make a woman weaker or diminish the genuine nature of her birth experience,” he said.

DISCUSSING PAIN RELIEF OPTIONS WITH YOUR OB-GYN

Though Dr Chong highly recommends an epidural, he recognises that it’s not for everyone, particularly for women who have a history of spinal surgery, severe spinal curvature, or spinal trauma, which can make an epidural difficult to administer.

Being aware of your pain relief options is helpful as circumstances differ for every woman, added Assoc Prof Sng. You can get information via your birthing hospital’s antenatal programme or by discussing it with your obstetrician during your clinic consultations. 

“When you know all your options, you can make an early informed decision about your birth experience and increase your chances of having a smoother delivery,” he said.