​​"Your birth. Your body. Your baby. Your choice. Your way. Even when the shit hits the fan and you have to change your original plans."


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Do you want 1-on-1, 100% focused on YOU support during your pregnancy and birth? Do you want someone willing to listen who really HEARS YOU? How about a source of unbiased up to date information? Someone who doesn’t have a hidden agenda? Who trusts in, and believes, in you? Who doesn't pretend to be someone that they aren't? Someone who will give their all in supporting you to the best of their ability and beyond?
If your answer is a resounding YES!!! and you live on the North Side of Brisbane send a message TODAY to arrange a no obligation interview.​

Anyone who knows me well will know that I am a huge advocate for respectful, evidence based, consensual medical care. You would also know that I am hugely against inadequate medical care when medical care is absolutely necessary and INSANELY AGAINST biased and coercive based medical care.

If you didn’t know any of that, then congratulations! Now you know and I won’t have to say it all again later on.
Before I really get started on what this blog post is about though I’d like you all to picture something in your minds for me:

• A man goes to the emergency department of his local hospital at night for excruciating lower abdominal pain, non-stomach-bug-related vomiting and inability to walk without aid.
  The pain doesn't respond to any of the standard pain relief medication normally given when people present with severe (currently) unexplained pain – paracetamol and ibuprofen doesn’t work, the maximum doses of endone or buprenorphine doesn’t work. Usually when that happens the nurses consult with the on call registrar and stronger pain medications are ordered (morphine, fentanyl etc).
  The man gets to stay in the hospital for a couple of days or so days with regular morphine and/or fentanyl and/or every other strong pain relief available to try and get the pain under control while having in depth investigations to find out exactly what is causing the pain (by in depth I don’t just mean the standard urine and blood tests and maybe an ultrasound – I mean the full kit & caboodle testing to rule out everything from appendicitis to cancer to an obstructed bowel). The man walks out of the hospital with his pain under control and either a diagnosis or a referral to a specialist who can diagnose him.
  
  

Now I ask you to picture this:

• A woman with a pre-existing incurable and generally painful disease goes to the emergency department of her local hospital at night for excruciating lower abdominal pain, non-stomach-bug-related vomiting and inability to walk without aid.
  She is only given one endone every 4 hours and two paracetamol every 6 hours. When she tells the nurse that neither of those pain medications is helping at all she is given a heat pack and told “that will help” (what the nurse hasn’t been told is that the patient spent the previous 6 hours before rocking up at the hospital at home taking the buprenorphine she normally takes for severe pain related to her pre-existing disease with a heat pack so hot that it is burning the skin on her lower abdomen). Only the basic tests (urine, bloods and an ultrasound – a basic one that cannot pick up the disease that she has and has been proven in the past to not show serious things that were happening within her body) – are done and she’s left to suffer and cry alone in her bed on the ward while still in excruciating pain. After about 12-18 hours, and maybe in a rare case after a second overnight stay, she is sent home and told to “wait it out” as it is assumed to just be a 100 times nastier than normal flare up of her incurable condition – no in depth testing has been done, the pain is still not under control and the woman in question can barely walk let alone speak up for herself as she’s pushed out the automatic doors with no real help and told to see her GP in the morning, all so the hospital can make room for someone “who really needs the bed”.
  
  

After visualising both of those scenarios can you see the difference between the two? The differences between the tests that were done and the treatments that were given? In how both patients are cared for and the results that both received? In when and how they went home?

The man received better treatment, his pain with an unknown cause was taken much more seriously and given top priority to find out what was wrong, and he was given adequate pain relief and left the hospital with the pain in control and a plan in place.

The woman wasn’t given adequate treatment, was given inadequate pain relief, was brushed off and mostly ignored, and, potentially even more dangerously, her pain was solely attributed to a pre-existing condition with only minimal investigation done - what if it had been her appendix getting ready to burst? Or what if part of her bowel that wasn’t visible on ultrasound had ruptured? Or what if her fallopian tube and ovary had twisted right behind her uterus where it can’t be seen clearly and had gone into torsion which can result in the loss of an ovary if it isn’t picked up in less than 6 hours of onset and can be deadly if it is left untreated? All of these are valid concerns but sadly a lot of them are brushed off and ignored if there isn’t anything visible on an ultrasound or if the symptoms don’t exactly match what most doctors have been trained to recognise.

If you can’t tell already I’ll explain this now – there is HUGE inequality between how men and women (and this is not even going into how those who don’t associate as either are often treated!) are treated when it comes to the quality of the medical care given to them.

In some ways - and some places - we are still very much in the dark ages with how women experiencing reproductive, lower abdominal and pelvic issues are treated in hospital settings. This is not to say that there aren’t some wonderful care providers out there because there are, I’ve personally met some of them, but they are few and far in between and the chances of one of them being on duty when you end up in hospital are really slim.
You may think that these are just random scenarios created in the fertile darkness of my crazy mind but I must sadly inform you right now that this isn’t the case.

These scenarios are both based on very true stories – the inspiration for the man’s scenario came from a combination of my own husband’s experience and the experiences of random men who have shared their stories online, the woman’s scenario actually happened only this past week, and the woman’s scenario is also, I am very sad to report, the real life outcome that happens to hundreds of women every single day all around Australia.

When I randomly questioned a group of women (some who have children and some who don’t have children, some with a painful health condition and some without any known conditions at all) about the two scenarios above the answers were empathetic towards the woman’s scenario and many shared their own experiences.

• W- “It is like you have written the experiences of myself and my husband”
  
  
• Another, Anonymous, responded with – “The world is sexist as if a man says he is in pain he is surrounded by help but a woman has pain she is told to deal with it.”
  
  
• P says – “It's BECAUSE pain associated with women's reproductive organs is accepted as "normal".
  
  
• From B – “I'm a part of a huge Perth group and I honestly just saw a story like this on there, but it was a mental health thing. They kept the person in overnight but then said they assessed her and she wasn't deemed worthy of a bed and was discharged even though she went in with suicidal tenancies - yet someone else (male) posted their experiences with the same hospital in the same mental health unit and couldn't stop praising the hospital saying how great they were for him and how they must have been leaving something out for them to have kicked her out. Yet, when copious amounts of other women came along and said they experienced the same thing, said male 'joked' that men have it harder anyways which is why they're better looked after.
  I know it's not the same thing but in some aspects is because it shows that there are some discrepancies in care.
  I have seen this before myself and been a part of it. A few years ago, I presented to the ED with chest pains and numbness down my arm. I got taken in 2 hours later, put on an ECG machine and monitored for an hour maybe 2 before told I could go home. Given pills for the pain and dizziness I was feeling at the time too. Nothing worked and I felt so horrible and tired that while on the ECG machine, I fell asleep. Next morning, woke up and felt horrible and the pain wasn't gone but dulled down.
  A couple years later, XH goes to hospital with exactly the same as what I was feeling and ended up staying overnight and having all tests run on him under the sun (Luckily they did cause they found gall stones but still) and I remember just saying to him that he was get preferential treatment cause he was a male - little did I know how true it actually felt.”
  
  

Every single day in Australia women are treated as second class patients compared to their male counterparts and have their pain ignored, they are told to “suck it up”, that pain is “normal” (pain is not “normal”, even the scientific literature agrees that pain isn’t “normal” and is a symptom of an underlying issue that needs to be treated) and that we just need to live with it, to go and see a psychologist or therapist because it’s “all in our heads” and if we “fix our heads” the pain will “go away” (it won’t, physical pain can’t just be stopped by a psychologist or therapy, it needs adequate physical medical treatment and pain relief as well and even then it may not be “fixed”).
What can you do to change this? There are several things and I’ll outline them below.

• Contact your local members for parliament. By sending your local members for parliament letters outlining your anger at how women are treated in the healthcare system you can help to promote more awareness by making them aware. Not all of them will respond or take it seriously, but some will take action on it.
  
  
• If you or someone you know has been on the receiving end of this sort of treatment lodge a complaint with your local hospital. While most of the time you’ll only get a generic apology letter it is known that the more times that complaints are made, and the more people who kick up a huge stink about how they have been treated, the more that problems are taken seriously and the better the treatment will be for similar scenarios in the future.
  
  
• If you or someone you know are currently being treated inadequately in a hospital setting and located in QLD you can call 13HEALTH and quote “Ryan’s Rule” (you can find the details of Ryan’s Rule here - https://www.health.qld.gov.au/cairns_hinterland/html/ryan-home)
  
  
• If a specific doctor has treated you or someone you know like this you can lodge a complaint with the Medical Board (http://www.medicalboard.gov.au/~/link.aspx?_id=60F806737FE14B28AF314FB306B4BFBE&_z=z) and also with the Australian Medical Association (https://ama.com.au/tas/health-complaints)
  
  
• Share awareness amongst your friends, family and anyone else who will listen. Many won’t be interested and some may even ridicule you but there will be people who are receptive to what you have to say and will listen and take action themselves.
  
  
• Continue to advocate for yourself and those who rely on you for their care. If you don’t advocate for yourself you can’t change how you are treated. As part of advocating for yourself you can ban any practitioner from treating you or being in charge of your care and can request another practitioner if needed. You have the right to receive the best healthcare and treatment possible (and also to refuse any healthcare that you don’t want to have). The more people who advocate for better healthcare for themselves and others the more that Australia’s care providers will see how much people aren’t willing to put up with substandard treatment.
  
  

Lastly I want to say this – in order for the treatment of women in the healthcare system to be improved those who are in charge of our care need to be taught that we women are equal to and just as deserving of high quality medical treatment as our male counterparts who are also patients. They need to learn that our pain is real, that it exists physically and that a lack of adequate treatment is not only detrimental to our health and well-being (as women) but also to that of our families and friends too. Care providers need to take our pain seriously and provide adequate pain relief (not just minimal pain relief) and need to be educated on the various diseases and conditions that can cause it – not just the basic information from one paragraph in a medical text book but actual first hand information provided by a specialist in that particular field. They also need to respect us not only as fellow human beings but also as people who are intelligent, educated, able to recognise when something is wrong with our own bodies (it is our body after all and no one knows it better than ourselves) and able to make informed, intelligent and needed decisions for ourselves without being coerced, manipulated, forced or scared through fear mongering into making a decision that we otherwise wouldn’t make.

Today I took part in a discussion about obstetric violence and the doulas role when witnessing obstetric violence. It was very interesting and also sad, frustrating and made me a bit angry reading the personal experiences of going through obstetric violence from some of my fellow doulas, as well as the first hand witness accounts from those who has seen it done to their clients.
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Obstetric abuse is not new to me; I have been through it myself and know many others who have also been through it. Seeing it discussed openly and respectfully with suggestions of things that we (doulas) can do to help any of our clients who may be on the receiving end of it and hearing about the different ways that obstetric violence can be presented was very helpful and I know that I will be taking away much of what I have read and using it to help any of my future clients who may experience obstetric violence (I bloody well hope that none of them do!)

The biggest issue discussed was about many of those who experience obstetric violence AND have a doula supporting them while it is happening – specifically about the client blaming the doula for not stopping what happened and what we, as doulas who may be witness to this awful practice in the future, could potentially do to not only stop it from happening but also to potentially prevent it from happening at all. The one thing that I noticed most about this part of the discussion (and from a documentary that discussed women’s experiences of obstetric violence) was that the doula was often blamed for not stopping it, not preventing it, not fixing the problem.

Having personally experienced "birth rape" during the birth of my youngest child - I didn't have a doula during that birth and I did blame my husband for a LONG time afterwards (and still have some residual anger towards him that I have not yet been able to release, it has been nearly 6 years now and the long term negative effects of that experience still affect me to this day - I have forgiven my husband however, and I have no doubt at all that had I had a doula I would have blamed him/her for not protecting me instead of my husband) for not doing anything to stop what was being done to me (in his defence he truthfully had no idea what was going on and was focused on our baby who wasn't breathing yet and needed resuscitation). I blamed the person that I trusted the most during the most vulnerable moment of my life for not protecting ME, for not SAVING ME, for not ripping that fucking obstetric registrar away from me and ripping his damn head off. I still blamed the registrar for his actions, but most of my blame went to the person who was supposed to be my protector.

We as women who have experienced obstetric abuse still blame our care provider for what happened - that's obvious - but we also blame the person that we trusted most to protect us, either our partner, a family member/friend  or our doula (if we have one), because in our eyes they DID NOT protect us and they were supposed to.

Blame, choosing one person to blame for what happened, is (unfortunately for us) normal and is part of the grieving process, it's awful for us who are on the receiving end. And we are grieving after what happened to us – we are grieving for what should have been, grieving for the pain we have experienced that we shouldn’t have had to experience, grieving for everything that should have been perfect and right and instead went so very very fucking wrong.

WE the doulas become the scapegoats instead of the other support person (if there was one) just because of our presence in that room, WE become the ones who SHOULD have done more, SHOULD have been better, SHOULD have been able to FIX whatever was happening, SHOULD SHOULD SHOULD have done SOMETHING, ANYTHING to stop what was happening from happening in the first place. WE doulas are the ones who are trusted to protect our client, to keep our client safe, to tell our client what is happening and when. WE doulas are often expected to do more and be more than we actually are – like that old blog post about airy fairy doulas full of unicorns and rainbows from way back in 2014.

All that we as doulas are physically able to do in the birthing room is to tell our clients what is happening, speak up (out loud so that everyone present is aware of what we are saying) and ask our clients if they are ok with what is happening or if they wish for it to be stopped.

We cannot control what their care providers do.

We cannot physically stop their care providers without risking being charged with assault ourselves and as a result leaving our client alone, vulnerable and still in the hands of that care provider (here in Queensland, Australia we are now not "allowed" to even raise our voice in anger or frustration at a care providers actions, regardless of if we are in our role as a doula, as a patient or as the support person/advocate of a family member, without risking being potentially charged with abuse against that care provider ~ carries the risk of spending up to 14 years in jail if we are charged), we can do what we can within the limits of the current system wherever we are but we alone cannot change it, we can only create awareness and make sure that our clients know all of their options.

The harsh reality is that there isn't all that much that we doulas are able to do in the moment and we cannot stop all of it from happening. All we can do is support our client, inform them and their other support people, tell our clients if we see that something is being done without their consent and remind them that they can say NO and STOP and can kick their care provider out of their room if they don't stop what they are doing.

After the birth we can register complaints with the hospital and the relevant medical authority as witnesses of what occurred and we can provide a witness statement that our client can use for what we saw happen. We can support our client physically and mentally/emotionally and we can find suitable resources for our client so that our client can hopefully begin the process of healing, if not physically then at least mentally/emotionally.

It kills me inside that I cannot do more. I wish I could do more. I wish that I could save every single woman from experiencing anything like what I went through – I know that I can’t but the wish is still there – and all I want, more than anything else in this world, is to see those care providers who practice obstetric violence be appropriately punished for their actions and for all of the damage, pain and heartbreak that they have left in their wakes.

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Just a little end note:

-  If you or someone you know has experienced obstetric violence please lodge a complaint against the person who perpetrated that violence with both the hospital that it occurred in and also with the relevant regulatory authority for that persons profession.
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- If you or someone you know has experienced obstetric violence and is struggling mentally/emotionally please encourage them to seek help from a maternal mental health counsellor/psychologist with experience in treating complex PTSD caused by obstetric violence/birth trauma.

Recently I saw a question on a pregnancy and parenting page asking about being induced at 37 weeks for a “Big Baby” (estimated to be around 9ish pounds/4-4.5kg by 40 weeks). This particular mum-to-be didn’t feel comfortable with being induced then, and did say that, but was seeking advice and support that it was the right thing to do.
I did what I usually do, I advised of the risks, the benefits, that the estimated weight was not “Big” at all and many women birth babies even bigger than that vaginally and after spontaneous labour with no issues at all, and reassured the mum-to-be to follow her heart – in that if it didn’t feel right then tell her doctor that she didn’t want to be induced and would wait until baby decided to arrive on his/her own.

This kind of question is becoming more and more common these days, women being told they are having “Big Babies” estimated to be between 9 and 10pd (which isn’t “big” as such, it is just another variation of normal size) and will be induced between 37 and 38 weeks gestation because of that. These women are apparently not being given any choice in the matter, they are being told it WILL happen, that they NEED to be induced as if they don’t their baby will get stuck (shoulder dystocia) and die because it is too big to be born vaginally.

For the record, this is not evidence based medical practice, this is fear mongering and scare tactics and outright lying by medical professionals in order to get an expectant mother to do what THEY want her to do. A 9-10pd baby is not big, 11+ pounds is “big”. 9-13pd babies are born all around the world all the time without any issues when the mother is able to move around in whatever way she finds comfortable and as a result assist the baby in manoeuvring through the birth canal. In these cases there is no respect for a mother’s decision making, no allowing the woman’s body to do what it was made to do, preventing the natural physiological process of birth from occurring when the time is truly right and making women around the world afraid of a natural body process. To add to this a small baby is just as likely to get stuck as a larger baby if baby’s position and mothers position while birthing are not ideal. There are ways to prevent it and to reduce the chances of it happening, and early induction is not one of them and has a higher chance of shoulder dystocia by preventing the mother from adopting natural birthing positions due to the CTG monitoring and in many cases an epidural as well when the induced contractions become too much for the mother to bare and increasing the chances of baby being malpositioned when artificial rupture of the membranes (amniotic sac) is done as part of the standard practice of induction, traumatic physical and emotional intervention with the use of ventouse (vacuum), episiotomy, forceps and physical pressure on the mothers abdomen, and fetal distress from the induction itself resulting in either the above mentioned interventions or an emergency cesarean occurring.

But what I've mentioned just above is not what prompted this blog post. What prompted this is the lack of up to date knowledge in obstetricians and other mothers who were “fans” of this particular page and answered this particular question.
These “fans” were promoting induction at 37 weeks with no major risk factors or true need, stating that it was “term” and “baby would be fine”. This information is incorrect, not only have the WHO and ACoG, within the last 12 months, updated their guidelines of when “term”, “full term” and “post dates” are, but an induction at 37 weeks for no reason other than an ultrasound weight estimate (proven to be inaccurate in the majority of cases) shows that baby is measuring larger than average. The new guidelines state that “term” is now from 39 weeks to 39+6 weeks after recent research showing that a lot of important brain development occurs in-utero between 37 and 39 weeks and babies who stay in longer have less physical issues than babies born before 39 weeks gestations (eg feeding issues, regulating of body temperature issues etc), “full term” is now from 40 weeks to 42 weeks gestation, and “post dates” is now from 42+1 weeks onwards.

What does this mean for pregnancy and birth and going past 41 weeks gestation? Well frankly it means that every woman should now have a much higher chance of being able to go into labour naturally when their baby and body are really ready without the need to be induced, whether it is at 37 weeks that their baby decides that he or she is ready, or at 43 weeks, AS LONG AS all obstetricians and doctors follow the ACoG and WHO guidelines, which unfortunately for all of us women is not the case. Sadly most obstetricians and doctors do not follow these guidelines, they follow their own guidelines and the hospitals outdated policies on “management” of pregnancy and labour. And “management” it is, they are “managing” us like animals, inducing when they want, cutting us open when they want, giving us medication when they want, telling us what we can and can’t do, scaring us and putting the fear of death into us, only telling us what they want us to know and not what we need to know, essentially taking away our basic human rights and preventing us from making our own truly informed choices and decisions by not providing all of the information and only telling us what they want us to hear.
There are of course exceptions to this, there are some wonderful and truly amazing obstetricians and doctors out there who treat women with respect and dignity that they deserve and do everything that they can to inform women of ALL of the risks and benefits, accept a woman’s choices without trying to change her mind, support her unconditionally in those choices and go out of their way to try and give the woman the birth that she desires. They are few and far between, a dozen or so in every state, a few hundred or so in every country out of a hundred thousand or more obstetricians and doctors around the world that are trained in high risk pregnancy and birth.

“So what?” You might say, “They are trained in pregnancy and birth, they know what they are doing.” Yes, they are trained, in “HIGH RISK” pregnancy and birth, the types of pregnancies that might be dangerous for mum and/or baby. They are NOT trained in natural physiological childbirth, they are not trained in the kind of birth that does not need drugs to make it start, that does not need intervention or constant monitoring, that does not result in a mother on her back in a bed unable or "not allowed" to get up and move around and physically help her baby to get into a better position for birth, they are not trained in allowing a woman’s body to do what it was made to do and treat every woman the same as if they have the same risks as every other woman. Every woman, every body and every baby are different with different risks and different needs, we do not all fit into same mold (eg not everyone has a 12 hour or less labour just as not every woman has a very long 55+ hour labour), but obstetricians and doctors are trained to fit everyone into the same mold with the same risks regardless our own individual risk factors, body shapes, histories, abilities and needs.

How can we change this? How can we make pregnancy and birth an individual thing again? How can we make obstetricians treat us with the respect and dignity that we deserve? How can we make them respect our decisions and choices without trying to scare us or bully us into what they want us to do? The answer is that every woman and every man must make the decision to stand up for themselves and their partner, to say NO, to make obstetricians and doctors understand that it is NOT a medical professionals or hospitals decision to make on when a baby comes into the world, to make obstetricians and doctors stop scaring women with generalised risks and outright lies, to make the maternity system in whatever country you live in stop and listen and change its policies for the benefit of ALL women, to make pregnancy and birth about the woman once again and not about the medical side of things. Women everywhere need to take their bodies back, to make sure that everyone knows that SHE makes the decisions regarding HER body and HER baby, and that hospitals, obstetricians and doctors are NOT the ones to make the decisions. Even in a life or death situation the mother has the right to decide what is to be done and should be given the chance to do so, even if there is only a minute available for her to make that decision that will affect her and her family for the rest of their lives, she should be the one to decide, not someone else who doesn’t have to live with the consequences.

So there you have it. We live in a medicalised world that is slowly trying to remove all natural bodily autonomy from women, that is trying to stop women from being able to choose if she has an induction or cesarean or waits until her baby and body decide that it is the right time, a world where women are being scared and bullied into inductions and cesareans instead of being given the right information and support to make a truly informed decision over their bodies and method of birth, a world where women are ridiculed for their decisions, denied good care, denied the right support that they need and are traumatised on a regular basis when they are in the most vulnerable state and position.

Can you imagine a world where women are supported personally in a way that fits their individual needs and wants and are empowered in the process? Can you see a world where a woman is able to choose whenever she wants if she has a home birth, an unassisted birth, a hospital birth, an induction or a cesarean without being judged, ridiculed or traumatised in the process? Where she is truly informed about the risks and benefits of every procedure instead of only informed that  the medical professional feels is all she needs to know? Where she can birth however she wants without being lied to or scared by medical professionals? Where she can trust those who are caring for her and supporting her to give her the power to make her own decisions regardless of where she lives, her body shape, her previous history, or what she looks like? I can, I can see that world, our world can become that world. If we all worked together to make changes, if we all supported one another in our individual decisions regardless of what they are, we can create that world and make it ours.

Jenna Edgley
Student Birth Doula
Placenta Encapsulator
FOOTPRINTS & RAINBOWS

By Jenna Edgley, Student Doula, FOOTPRINTS & RAINBOWS

A big thank you to Janelle Durham for compiling the results of so many studies in one place.

How many of you know all about epidurals? Do you know all of the possible side effects? Do you know what good things that they can do? Do you know what can happen when things do go bad? And do you know the medical interventions that they can cause? Do you know when they are truly needed or when they aren’t actually needed and can be detrimental to your labour?

In this blog post I will be addressing all of these questions and more and supplying the most current (at the time of writing this) risk percentages in easy to understand explanations without all of the medical jargon (apart from the actual name of things like artificial rupture of membranes, where I also supply an explanation in layman’s terms).

What is an epidural and what does it do?

Epidural anaesthesia is a form of anaesthesia that blocks pain in a particular region of the body. The goal of an epidural is to provide pain relief rather than anaesthesia which leads to total lack of feeling, however many epidurals end up being quite strong and take all feeling away. Epidurals block the nerve impulses from the lower spinal segments which results in a decreased or completely numbed sensation in the lower half of the body. Epidural medications fall into a class of drugs called local anaesthetics. They are often delivered in combination with opioids or narcotics in order to decrease the required dose of local anaesthetic. This produces pain relief with minimal effects. These medications may be used in combination with other drugs to prolong the epidural’s effect or to stabilize the mother’s blood pressure. There are two types of epidural – the “numbing” epidural that numbs the lower half of your body, and the “walking” epidural, where after the initial dose only 1 of the drugs used in an epidural is administered, which reduces the amount of sensation to the lower half of the body while still allowing movement and the ability to feel contractions (in effect it takes the edge off the pain so that you can manage it successfully).

Will an epidural affect my baby?

Yes it will. The drugs used in an epidural travel through the blood stream, go through the placenta and go into your baby’s blood stream. In some cases the drugs used in the epidural can make the baby very sleepy after birth which can impact latching and sucking (if you are breastfeeding) and affect how much of the bottle the baby drinks and how well it sucks (if you are formula feeding). Sometimes the epidural drugs can make your babies heart rate go up really high (180 beats per minute or higher) or really low (under 90 beats per minute), this is classed as distress and in the majority of cases a cesarean is needed quite quickly to get the baby out safely.

What are the side effects of having an epidural and how common are they?

An epidural can lower your blood pressure which in turn can reduce your baby’s heart rate and reduce the amount of oxygen that baby gets. You are approximately 74.2 times more likely to have this happen than someone who does not have an epidural (depending on which study you read you have up to a 50% risk of this happening with an epidural).

An epidural can cause you to develop a fever (raised temperature above 38 degrees Celsius). You are 5.6 times more likely to develop a fever than someone who doesn’t have an epidural (depending on which study you read you have a 4%-24% risk of this happening with an epidural, some studies showed that 95% of those with epidurals developed a fever).

An epidural may cause uncontrollable itching, especially when an opioid (a drug made from opiates and their derivatives for example anything with morphine or codeine in it) was included in the medication. An average of 62% of women with an epidural with opioid medication included experienced itching of various intensities. Without the opioid only up to 4% of women experienced itching with most cases appearing to be mild and very few mums requesting treatment for the itching.

An epidural can cause sedation or drowsiness. The Mayberry study showed that an average of 21% of women with an epidural experienced this.

You may need augmentation with pitocin or similar induction drugs if you have an epidural. The Mayberry study showed that women with an epidural were 2.8 times more likely to need augmentation of their labours if they had an epidural.

If you have an epidural you will be more likely to need an assisted delivery (ventouse/vacuum or forceps delivery). In the Lieberman compilation of 16 individual studies it showed that an average of over 50% of women with an epidural were unable to push their babies out without the assistance of the ventouse (vacuum extraction) or forceps.

According to Thorp’s study of 93 women (only 1 woman in the non-epidural control group opted for an epidural) you are 11 times more likely to end up with a caesarean section with an epidural than a woman without an epidural. Lieberman et al (1996), found that there was a 17% risk of caesarean from an epidural.

An epidural may increase your risk of having a post partum haemorrhage, the Lieberman study showed that women who had an epidural where twice as likely to have a post partum haemorrhage than women who didn’t have an epidural (10% with epidural compared to only 5% without an epidural).

You may experience a severe headache after birth. These can last for as little as 8 weeks, or as long as 8 years after birth. This is caused by a small leak of spinal fluid into your blood (also called a dural puncture) and can be fixed with a blood patch where a small amount of your own blood is injected into the epidural space and can relieve the headache.

You may develop a back ache on the first day after your epidural is removed. The few studies on this have shown no noticeable percentages in further abnormal headaches at 1 week and 7 weeks post partum, but there could always be exceptions.

What is good about having an epidural?

An epidural can block or reduce the pain from contractions.

An epidural can help you to rest and recover your energy during a long labour or a very painful labour (an induced labour involving pitocin or similar inducing drugs can be more painful than a “natural” labour so an epidural can be helpful in inductions).

It can lower your blood pressure (this doesn’t happen to everyone and is extended upon in another answer below).

It can help you to relax if you are “tensed up”.

Some women have a more positive birth experience with an epidural.

If I have an epidural what are the most common interventions that can occur as a result?

The most common interventions are:

1 – Artificial rupture of membranes (if they haven’t already broken) where the Midwife/Nurse/ObGyn breaks the amniotic sac.

2 – Pitocin/Syntocinon, an artificial oxytocin drug that is used to induce or augment labour and is used by many obstetricians to make labours go faster than they would normally may be started if the epidural causes your labour to slow down or stop. Pitocin/Syntocinon has its own risks that could be detrimental to labour and babies health as well.

3 – A caesarean section (c-sec) where the baby is cut out of your uterus. This is major abdominal surgery and in the average woman who has no complications as a result of the surgery is not fully healed until around 6 months after it occurs.

4 – Consistent Electro- Foetal Monitoring (CFM), where special pads are placed against the mothers skin to pick up the babies heart rate and another pad that picks up the contractions, these are often held in place by stretchy straps (that appear similar to seat belts), or in some hospitals this is done with the use of sticky pads similar to what is used to monitor your heart in an echocardiogram or a it can be done with a clip that is placed on the baby’s skull. This can be very uncomfortable for many mums and usually means that the mum has to remain on her back on the bed as movement can make the baby move away from the pad picking up the baby’s heart beat.

5 – A urinary catheter. Basically when you have a run of the mill (or full) epidural, and even quite often with a walking epidural, you can no longer feel when you need to do a wee. A urinary catheter is placed, with a small medical balloon attached to the end of it which is inside your bladder which is inflated to hold the catheter in place, and has a collection bag attached to it to collect the urine so that the urine doesn’t build up in the bladder. The side effects of this are discomfort for a few weeks afterwards, urinary tract infections (these don’t always happen but have been reported as a common occurrence by many mums) and the possibility of receiving a diagnosis of “obstructed labour” if the urine starts to get a rose coloured tint to it (this can sometimes be caused by baby’s head pressing on the bladder as he/she descends into the birth canal and the balloon from the catheter can cause baby to get stuck and not descend any further – in this instance deflating the balloon and repositioning it further into the bladder can help a lot – rather than being a genuinely obstructed – read stuck – baby), and incontinence. A not very common complication of having a urinary catheter is scarring and bladder damage.

When is an epidural really needed?

There are several things that could suggest that you may need an epidural.

The most common of these is exhaustion, when you are extremely tired and have been labouring for over 24 hours without sleep an epidural can be placed to allow you to “have a break” from the contractions and enable you to get some decent sleep before the big show starts.

Another time an epidural may be needed is if your blood pressure is steadily rising during labour and is getting close to dangerously high levels. One of the side effects of an epidural is lowered blood pressure, and in this instance an epidural can be very helpful. This doesn’t always work for everyone however, and in some cases it can do the opposite and make a woman’s blood pressure go even higher. No one can predict who this will work for, and sometimes it can work for one labour and not for the next labour and vice versa, so it really is a “see as you go” scenario.

Epidurals can also be easily turned into spinal blocks, so if you are attempting to have a “Natural Caesarean with trial of labour beforehand” then an epidural can work really well in helping you to avoid the pain caused by contractions to begin and making it easier for you to get a spinal block when you do go to theatre. The down side of this is that labour can stop shortly after an epidural is placed which may mean that your body doesn’t get the full effects of natural oxytocins, or it can drop your blood pressure so low that you don’t get to experience your “Natural Caesarean” in the way that you wanted to.

If you are “tensed up” from the pain then that can slow your labour down and make it last longer than it normally would. In this instance there is around a 50/50 chance that having an epidural placed can allow you to relax enough to dilate quicker than you previously were and enable your baby to be born sooner.

When isn’t an epidural needed?
1 - An epidural isn’t needed as soon as you arrive at the hospital if you and baby are happy and you are not exhausted.
2 - An epidural isn’t needed before you reach 4cm dilated.
3 - An epidural shouldn’t be placed after you reach 8-9cm dilated.
4 - An epidural should not be placed if your blood pressure is already lower than normal. It may make it drop even lower which will not be good for you and can negatively affect your baby.
5 - If you are in transition and start demanding an epidural (which happens more often than you would think even in mums who are labouring drug and intervention free by their own choice) an epidural should not be given. Not only will it most likely not start to work on time, but if there is enough time for it to work it can make pushing very hard and even make your pushing not be effective enough to get the baby out.
6 - If you use blood thinners then you should not have an epidural.
7 - If your platelet counts are low then you should not have an epidural.
8 - If you are hemoraghing or in shock you should not have an epidural.
9 - If you have an infection in your back then you should not have an epidural.
10 - If you have a blood infection then you shouldn’t have an epidural.
11 - An epidural should not be done if the epidural space cannot be located by the anaesthetist.
12 - If labour is progressing too fast and there is not enough time to administer the drug (mentioned in #'s 3 and 5 of this section).

Why do some doctors insist on epidurals as soon as a woman gets to hospital while in labour?

Training, hospital policy and personal beliefs. Many older doctors were trained when epidurals were considered to be “the next best thing to chloroform” (chloroform, amongst other drugs that are now not used, was used extensively in the 50’s and 60’s to effectively “knock women out” so that they wouldn’t have to be in pain or make a sound during labour and birth) and they see it as an “aid for labouring women” in a misguided belief that no woman should go through that kind of “pain”. Many also feel that women should not make a sound during labour or pushing and a full epidural is the best way to achieve that in lieu of performing a caesarean section. Newer doctors are trained differently but their personal beliefs and desire to prevent what they see as “unnecessary pain” can make them think that epidurals should be given to everyone.

I must point out that not all doctors are like this, there are many who prefer to avoid the use of an epidural if they can, and many who prefer for the woman to decide if she has one or not rather than forcing it on her.

Some hospitals have a policy of making every woman who arrives in labour between 4cm and 8cm have an epidural placed. This is not evidence based and can be detrimental to a woman’s labour and birthing experience. Hospital policy is not law however, and you always have the right to refuse if you wish to. If anyone tells you otherwise then they are not supportive of you and you can request someone else to look after you.

What can I do to reduce my risks of further intervention or any damage to my spine if I choose to get an epidural?

Have a very experienced anaesthetist administer your epidural, and ensure that the cords are placed somewhere where they won’t be underfoot. Also if you already have spine issues (bulging/compressed disks and spine damage) then it might be best to avoid an epidural altogether.

To avoid further intervention get a “walking” epidural, which only has one of the 2 epidural drugs administered to you. This way you can stay active and “feel” the contractions without feeling all of the “pain” as well. This kind of epidural is beneficial for pushing as you can still feel the surges and the pressure and can push more effectively.



Study Sources:
Lieberman E, O’Donoghue C. Unintended effects of epidural anaesthesia during labor: A systematic review. Am J Obstet Gynecol 2002; 186:S31-68. A total of 1900 articles were examined, and evaluated for inclusion in the review based on the authors’ criteria. They limited their review to original reports in English, in peer review journals since 1980; they included both randomized trials and observational studies; they excluded studies with no control group, studies that evaluate specific drug regimens, studies that examine epidurals for anaesthesia during cesareans, studies conducted exclusively on high-risk populations, studies where population selection renders results uninformative, studies with analytic choices that make results impossible to interpret, and studies that examine outcomes only for the overall population of delivering women.

Mayberry LJ, Clemmens D, De A. Epidural analgesia side effects, co-interventions, and care of women during childbirth: A systematic review. Am J Obstet Gynecol 2002; 186:S81-93. More than 700 publications were identified; they narrowed that down to 150 studies that addressed one or more of the common side effects and co-interventions, plus 75 articles addressing relevant clinical or nursing care information related to unintended effects of epidurals. They only included prospective, randomized, controlled trials published between 1990 and 2000. These studies were then further limited by pre-established criteria: evidence of little or no crossover effect, minimal loss of subjects after random allocation to comparison groups, and satisfactory description of the randomization procedures. In the final review, they included 19 studies, with a total sample size of 2708 women.

Thorp JA, Hu DH, Albin RM, McNitt J, Meyer BA, Cohen GR, et al. The effect of intrapartum epidural analgesia on nulliparous labor: a randomized, controlled, prospective trial. Am J Obstet Gynecol 1993; 851-8.

Other Sources
http://americanpregnancy.org/labornbirth/ (under the section on Epidurals)