EPIDURAL OR NOT? What you need to know

For many expecting parents, the epidural can feel like a confusing topic. There is a lot of information out there, and sometimes very strong opinions too. Some people talk about it as something every women should have, while others see it as something to avoid. This can make this decision feel heavier or more pressuring that it has to be.

As a doula, I dont see the epidural as good or bad. I see it as one of the many tools a woman can choose from when preparing for her birth.

Understanding what an epidural is, how it works, and the pros and cons can help bring more clarity when preparing for birth. Let’s take a closer look to help you make a decision.

What is an epidural?

An epidural is a form of pain relief given during labor. An anesthesiologist inserts a small catheter into the lower back, just outside the spinal cord, through which medication is delivered continuously. The medicine

can feel cold as it travels down your leg, and takes about 15 minutes to start working. This medication numbs the nerve that carry pain signals from the uterus and birth canal, providing significant pain relief. It then removes all sensations from the rib cage to the feet.

The Pros

• Effective pain relief. An epidural is the most effective form of medical pain-relief available in labor.

• Helps with exhaustion. If labor is long or intense, the epidural can give you the chance to rest and rebuild energy for birth

• Keeps you awake and present. Unlike general anesthesia, an epidural allows you to stay fully conscious and experience the birth

• Helpful for certain medical situations. High blood pressure, long labor, interventions may be easier or safer when pain is managed with epidural

The Cons

• Restricted movement. Once the epidural is placed, walking and moving around is not possible. Walking epidural are available in some hospital, unfortunately not in Phnom Penh at the moment.

• May slow things down. ( although sometimes it can also speed up labor, or labor stays at a steady pace). For some women, contractions become less effective after the epidural, and labor may need support from synthetic oxytocin

• Other medical things come into play. You will need IV fluids, your blood pressure (BP) will be checked regularly, you will have fetal monitoring to check your baby’s heart rate and your contractions, and have a urinary catheter, and possibly a pulse oximeter (measures your blood oxygen levels)

• Potential side effects; Shivering, itching, drop of blood pressure, nausea or vomiting can happen. Sometimes, there can be headaches or uneven pain relief. Meaning you will still feel the sensation on one’s side, or have a spot where the epidural doesn’t work

• Pushing can feel different. As women feel no sensation and urge to push, which can make pushing harder. Doctors and midwife will guide to push when a contraction comes.

Common questions about Epidural:

• Does it hurt to have the epidural placed? Getting an epidural usually involves some mild discomfort rather than severe pain. First, the anesthesiologist injects a local numbing medicine, which may feel like a quick pinch or sting. Then, a thin needle is inserted into the epidural space in your back, and you might feel pressure, pushing, or a brief sharp sensation, but most people describe it as tolerable

  
  

• When can I have an epidural? Most hospital recommend women to have an epidural anytime after active labor starts ( 5/6 cm dilated).Reason being there is a greater chance of your labor slowing down when the epidural is placed earlier than that. However you can ask for an epidural anytime, and it is almost never too late to have one, unless the head of the baby is visible. Similarly, it s almost never too early to ask for one. You can request an epidural at any point, form the beginning of labor right up to when baby is crowing. The best time is when you feel ready for it.

• Will the epidural affect my baby? Epidurals use low-dose local anaesthetics, and sometimes small amounts of opioids, which mostly stay in the mother’s bloodstream and do not reach the baby in harmful amounts. Research shows that babies exposed to epidurals are not at higher risk of birth defects or long-term health problems. Occasionally, a baby may have a slightly slower heart rate or appear mildly drowsy right after birth, but this is usually temporary and carefully monitored by the medical team.

  
  

• Can the dosage be adapted? Yes. The anesthesiologist can adjust the dose and rate of medication to give enough pain relief without causing complete numbness. Some hospitals allow you to control small doses yourself (patient-controlled epidural). Dosage can be increased if you need more relief or reduced if you feel too numb.

  
  

• How long does it wear off? After the epidural is stopped, numbness gradually fades over 1–3 hours. Walking may be possible once leg strength returns. The exact timing depends on the type and amount of medication used.

  
  

Having a doula during an epidural

A a doula, my role is not to steer a woman away form a epidural or toward one.

My role is to:

• Give her clear, unbiased information

• Help her understand what to expect

• Support her in listening to her body

• Help her and partner to advocate for their preferences

• Stay by her side, whether she births with or without epidural

My doula tips when having an epidural

During the procedure:Communicate with your anaesthesiologist. Let them know if you feel anxious, uncomfortable, or if holding the position is difficult. They can adjust what they’re doing or offer extra support.Use your breathing to stay calm. Slow breaths, gentle counting, or visualizing a peaceful place can help you manage the pressure or sensations you may feel while the epidural is being placed.

Once it’s in place:Keep changing positions and moving in bed. Having an epidural doesn’t mean you must stay still—you can lie on your side, sit semi-upright, or even lean forward on hands and knees with support. Movement helps keep you comfortable and supports labor progress.Stay in your “labor land.” Even when sensations are reduced, staying connected to your body and the rhythm of your labor helps your hormones continue to flow and keeps you grounded in the birthing process.

Choosing an epidural is a personal decision, and it’s important to have clear, evidence-based information so you can make the choice that feels right for you. It’s also important to know that your choice isn’t set in stone. You can change your mind during labor: ask for an epidural even if it wasn’t part of your original plan, or decide to go without even if you initially thought you would have one.