Podcast Episode #71

Pain relief is an independent and individual choice for all pregnant women. Every woman will have an idea or plan on what pain relief options they want to use when going into their birth experience. Whether you’re aiming for a completely non-medical pain relief birth or are certain you want an epidural, there is a spectrum of pain relief options in between that you may not have known about.

In today’s episode, we’re discussing common pain relief options for birth with anaesthetist Dr Gareth Symons. Dr Symons has been a consultant anaesthetist since 2013 and has an anaesthetist practice in both public and private health systems. He is a wealth of information and I’m so grateful to have him in to share his expertise with you. 

Dr Symons talks about a variety of pain relief options including gas, intermuscular injections, and epidurals. There are benefits and risks to all medications and Gareth runs us through each of these thoroughly. He also discusses side effects for both mum and bub, the misconceptions around epidurals, and the impact of Covid on pregnant women giving birth. 

This episode will help you learn more about your pain relief options during birth and empower you to feel confident in your choice. 

Enjoy. 

Episode Links

Resources mentioned: 

Pain relief in Labour and Childbirth: https://ranzcog.edu.au/womens-health/patient-information-resources/pain-relief-in-labour-and-childbirth

Managing pain in Labour: https://www.thewomens.org.au/health-information/pregnancy-and-birth/labour-birth/managing-pain-in-labour

FitNest Mama Pregnancy & Pelvic floor Workshop: https://www.fitnestmama.com/free

Website: https://www.fitnestmama.com/

Instagram: @fitnestmama

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Pain Relief Options during Birth

Transcription

DISCLAIMER:

Please note that this transcription was completed with computer voice recognition software. Quite often unanticipated grammatical, syntax, homophones, and other interpretive errors are inadvertently transcribed by the computer software. Please disregard these errors. Please excuse any errors that have escaped final proofreading.

INTRODUCTION

If you are pregnant or you’ve recently had a baby, this podcast is for you. I am your host Kath Baquie. A physiotherapist working in women’s health and mum of three. Join me each week as we dive into all things pregnancy care, childbirth, and postnatal recovery, helping you have a wonderful pregnancy and afterbirth experience. And don’t forget to hit subscribe so you don’t miss any episodes.

KATH BAQUIE

Well, hello there! Thank you for tuning in to another episode of the FitNest Mama Podcast. Today we are discussing all things, Pain Relief for Birth, and I had the pleasure of today chatting to anesthetist Gareth Symons. So Gareth is a dad of three young girls, and he has been a consultant anesthetist since 2013. Gareth is trained in a variety of Melbourne and regional hospitals. And he’s also been a supervisor of training in public practice, and has an ongoing obstetric anesthetist practice in both public and private health systems amongst the clinical interests.

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So in today’s episode, Gareth talks us through common pain relief options for birth, and we discuss the use of gas, intramuscular injections, including morphine and Pepperdine, as well as epidural. Gareth talks us through the benefits and the risks. And we also discuss the impact that COVID is having on pregnant women giving birth. So I do know that pain relief is a very individual choice. But I do trust that today’s episode will help you to feel more empowered and comfortable by understanding the different choices available to you. No matter what type of birth you decide to have. So do stick around because this is a great episode in which Gareth provides lots of information to really help empower you with this next stage of your pregnancy journey.

Before diving in, I invite you to join us inside FitNest mama. So if you’ve been fat and you are not exercising as much as you’d like to during pregnancy, or after pregnancy, perhaps you’re busy or you’ve lost the motivation to exercise. Or perhaps you’re not sure about how to best be looking after you’re changing body and you’re growing belly. Or you’ve got the pelvic girdle pain and the abdominal muscle separation and you’re not sure about the best exercises for you. Or you’d like to get back into running after birth and you want the best Kickstarter, then FitNest Mama is for you. So join us for these convenient, short, easy workouts that you can do from the comfort of your home. So head to fitnestmama.com. Alright. Let’s dive into this episode.

Thanks, Gareth. Thank you so much for joining me today on the FitNest Mama Podcast. It is great to have you on. We’re chatting all things pain relief for birth. So yeah, thank you for joining me.

GARETH SYMONS

Oh, no worries. Thank you very much for having me.

KATH BAQUIE

So full disclosure for everyone listening. I have been hounding Gareth for a good few months to have him on the podcast. So he is my brother in law, and it’s great. I think Gareth finally buckled. You can’t say no to family. Right, Gareth?

GARETH SYMONS

Absolutely. But I was very, very happy to do it. Just matter of finding the time. So my holidays is perfect.

KATH BAQUIE

Yeah, absolutely.

So to start off with, what would you say are the most common or popular types of pain relief available for women who are about to give birth?

GARETH SYMONS

Okay, there’s a really wide variety of options for when looking for pain relief in labour. I agree with what you said, right from the outset, which is that it’s a very individual experience, and people will have different ideas about what’s the most appropriate sort of pain relief for them. Obviously, being an anesthetist, I’m used to dealing with some of the medical sort of approaches to pain relief, but there are there are non-medical approaches to pain relief. And what I mean by that are things like relaxation techniques, hate packs, cold packs, water immersion, all sorts of things, which I’m not generally involved with, but which some people find helpful. And then there are they’re sort of the non-medical packs, still, I guess, hospital based kinds of or healthcare based interventions like things like TENS, or water injections that the midwives might offer to patients during labour. From an anesthetic perspective, the things that I guess we sometimes are involved with is providing opiate analgesia so whether that’s Pepperdine or morphine right up to epidurals, which I’m sure we’ll talk about in detail, but what I would say from the outset is that I know that people will have strong ideas about what they would like in terms of like a birth plan and those sorts of things. And I think that’s very reasonable. I do think it’s great that they listen to something like your podcast to get some information about all of that before the day.

KATH BAQUIE

Yes, being pre armed. And it’s amazing that prior knowledge, and it’s something I didn’t do at full disclosure for my first baby, I totally went with the flow, as I say, and I don’t think it was a good idea in hindsight. So in terms of what you were just talking about, with the different pain relief, in your day to day practice, what would be the most common?

GARETH SYMONS

Generally speaking, my involvement would be when a woman’s in labour in significant distress, usually, because that’s what we’re asked to attend to put an epidural in most of the time, most women would be using nitrous oxide at that stage, which is a gas that you can breathe through, breathe through a mouthpiece. And many women will be familiar with that, or when I’ve talked to friends or family that have used that it’s available in pretty much all Australian hospitals sort of settings. And that would be probably the most common form of analgesia, I think, in terms of pros and cons. Nitrous is fast acting, works well, you know, take big breaths, and you’ll quickly get some degree of pain relief with that during contractions. And you can stop breathing in between contractions. So it’s sort of something which works well. And that way you can match it with the contractions. Some women find it really helpful, and women don’t find much help at all. And so again, it’s a really individual kind of thing. And you won’t necessarily know until you try it. The other thing I’d mentioned is that can make you quite sick so stop using it pretty quickly for that reason.

KATH BAQUIE

And is that the main side effect?

GARETH SYMONS

Yeah, I think so. I mean, there’s really no concerns about harm to the baby with nitrous in the big picture to greenhouse gas. And we look at it from that perspective in anesthetic practice, but from a from a labour and woman’s perspective, I think that would be pretty secondary in the middle of their contractions to a labouring woman, I think the main thing would be the nausea, and also just the fact that for a significant proportion of women just won’t be adequate pain relief.

KATH BAQUIE

Is it right that we’re talking about these in terms of levels, in terms of easier to apply? So a guess is at one spectrum, and then if the spine or the epi drills at the other spectrum? Is that right and the gas is the start of the spectrum of pain relief options?

GARETH SYMONS

Yeah. So I mean, from a medical perspective, the least aggressive sort of analgesic options would probably be just some oral analgesia, which could be as simple as paracetamol Panadeine, Pepperdine for those sorts of things. And then those would be rare that that was adequate analgesia for childbirth. And people would generally proceed to nitrous at that stage. So yeah, I would say it is a sort of hierarchy. I mean, practice varies from institution to institution and from different settings that women might be having their baby in. But I would say that that’s the hierarchy. And then generally, most of the time, if a woman has tried nitrous, and has also been offered opiate, so whether that’s Pepperdine or morphine, they might have an intramuscular injection of one of those. If they’re still not comfortable or adequately comfortable, then that might be when they might progress to an epidural.

KATH BAQUIE

Okay, so let’s talk about those injections in. Well, first of all, how long would those injections last?

GARETH SYMONS

Well, first of all, I guess onset is going to be half an hour really, to start to generate some decent pain relief. And then in terms of duration, like a few hours is the sort of idea. So obviously, the duration of people’s labour can vary pretty significantly. And so depending on the particular patient, that might be a good option. But if it’s going to be a prolonged labour, then it will wear off again during the labour. And conversely, if it’s going to be a very quick labour, you sort of again, would be a little bit concerned about giving a systemic opiate because there’s the chance that the baby comes out of it sedated with that. So that’s something to consider while planning for the doctors and midwives to consider usually, but yeah.

KATH BAQUIE

Yep. So when is the ideal time, if you’re going to have these options with the intramuscular injection, when is the ideal time for that to happen?

GARETH SYMONS

I would say it would be, you know, once labour has probably commenced, the patients having contractions that are uncomfortable, you don’t really want to do it before that, but early in the labour. So you know, you might be just starting to dilate, or that sort of phase of labour rather than sort of waiting until you’re getting close to delivering.

KATH BAQUIE

Okay, so you saying you don’t want it to be in the system during the pushing phase?

GARETH SYMONS

Not so much that it can’t be in the system, but you wouldn’t want to be administering it close to the end of the end of the labour.

KATH BAQUIE

Okay, and what are the potential side effects?

GARETH SYMONS

So I guess the side effects could be either for the for the mother or for that for the baby. And what I’m most concerned about side effects for the baby in that setting in terms of the baby coming out a bit sleepy, I shall put some context to that if you’re delivering in a healthcare setting, whether a pediatricians and so on available, it’s not a huge concern, but it’s just something to be mindful of and something that we’d be mindful of in the midwives would certainly be mindful of. And then in terms of side effects to mum, again, it’s a little bit like nitrous in that respect. You can get nausea and or vomiting. You can sometimes get itch with it as well. Of course some people have allergies to specific types of opiates like morphine. Some people won’t tolerate very well, but primarily nausea, vomiting, I’d say.

KATH BAQUIE

And how common are they? Are they commonly used?

GARETH SYMONS

Oh, yeah. Yep. Still really commonly used. Yeah. Often women who are requesting an epidural have already had intramuscular opiate before the epidural request.

KATH BAQUIE

Yeah, that makes sense. And do you also, for those women who, for whatever reason are wanting to avoid an epidural? Are they the ones that are more likely to perhaps do those intramuscular injections?

GARETH SYMONS

Yeah, look, I’d say absolutely. But as you know, Kath, like some women will come in with a birth plan, which is really to minimize analgesia absolutely. And that’s, of course, absolutely, they’re called. And maybe try to avoid everything. Someone will come up with a plan where they’re sort of happy to use nitrous, but hoping not to use much more than that. But I do think that some women will be happy to try everything short of an epidural because of concerns they’ve got about an epidural. But once those options have failed, then might progress to requesting an epidural about time. Yeah.

KATH BAQUIE

Okay. Well, that leads us perfectly into the next question, then, epidurals. Because I know it’s a bit divisive. So let’s go for it, Gareth. What are the benefits of an AP journal? And let’s also go through the risks as well.

GARETH SYMONS

Yeah. So I want to acknowledge that there will be plenty of people who don’t want an epidural. And that’s absolutely their call. But I guess I’ll present what I say is the sort of the pros and cons from a medical perspective, epidurals are the most pain relief, the best pain relief that you can have during childbirth, that the most effective interventions that we can provide to relieve pain. And certainly from a doctor’s perspective, it’s a really satisfying thing to help someone with, because you see someone who’s in really significant pain, and achieves really good pain relief, potentially complete pain relief, within the space of sort of 20 minutes to 30 minutes from them from the time they’ve called you to the time that they’re completely comfortable. So the major pro is that that you get excellent pain relief with it most of the time, not all of the time. And then look, there are some other potential pros, there are medical reasons why sometimes your team might recommend that you have an epidural, for example, women with preeclampsia, it may be suggested that they have an epidural, which will help with their pain relief, but also help us manage the different phases of the delivery, including if they were to need to go to cesarean section. It’s a really good way of providing anesthesia for the cesarean section.

KATH BAQUIE

And can you explain that a little bit more for those listening. So how can an epidural help if you need to have a cesarean?

GARETH SYMONS

Yeah, so if you’re going to have a cesarean section, which is essentially, you know, making a cut in the tummy, like it’s what we would call a laparotomy in medical terms. It’s making a big cut in the tummy to deliver a baby. It’s a big ask, and we need to provide you with really good pain relief to make sure that the woman is able to deliver that baby in comfort. In epidural involves putting a little catheter into this space called the epidural space around the spinal cord. And because we leave a little catheter in there, we can actually use that catheter to provide a stronger form of pain relief, which facilitates during the cesarean section, if it comes to that, that a woman needs a cesarean sectional, that’s absolutely the appropriate way to go. The nice thing about that, as opposed to any of the other forms of pain relief, is that you are ready to go if that was needed. But it certainly doesn’t mean that you’re going to have a cesarean section. And I know that a common misconception that people have is that having an epidural means that you are going to have a cesarean section. From an evidence based perspective, there’s no evidence to suggest that you have an increased risk of a cesarean section if you have an epidural.

KATH BAQUIE

Okay, that’s great to know. So you’re saying if you have an epidural, there’s no increased risk of cesarean birth?

GARETH SYMONS

Correct. But it does mean that if you did need a cesarean section, then you’ve got a way to provide anesthesia for it already ready to go.

KATH BAQUIE

Could you just talk us through, just in very quick, general terms? What is the process of getting an epidural? Like what does the woman have to do?

GARETH SYMONS

So the process of getting an epidural involves an anesthetist attending. So you need a specialist doctor to attend, usually the midwife or nurse looking after you, care looking after you will request the anesthetist to come for you. And things that would need to be done usually involve getting some basic blood tests done, particularly if there’s any concerns medically about how things are going in the labour and also just getting what we call IV access. So putting a cannula into one of the veins in your hand or arm and starting some intravenous fluids through that. And I’ll explain why we do all of that in a moment. Then following that usually the anesthetist would attend hopefully pretty quickly. Usually at that stage, you’d like them to return quickly. And that will explain the epidural to you, the risks and benefits and this is why I think it’s great to go through some of this now, because it’s very difficult to take that in in the moment. And then once the anesthetist has gone through the risks and benefits and explained that to you, they would fairly quickly get things set up. So it’s a technique which we perform as a sterile technique with aseptic sort of practice. So we’re really trying to minimize the risk of any infection in what is a really important part of your body in terms of quote and quote the spinal cord. The anesthetist will unpack the equipment in a sterile way, making sure there’s no contamination of the equipment that get you sitting up on the bed. And the way we actually find the right spot for the epidural to go in is by palpation. So I have a feel of the patient’s hips and their back, put some antiseptic on the skin just to make sure there’s no bacteria remaining there, and then put some local anesthetic in the skin with a small needle to make the skin go numb. And once that skin is gone numb, then we can use a large needle to actually put the epidural catheter in without it causing any sort of pain in the skin.

KATH BAQUIE

Oh, I didn’t realize, of course, that would happen. But I thought that first need it was that was everything happening?

GARETH SYMONS

Yeah, it’s a good point. Because I think sometimes people think that there’s been lots of goes in quotation marks to put the epidural in. But actually, that’s just a part of the process is to numb the skin with local anesthetic first, because the epidural needle. It’s not one I’d advise the woman who’s in labour to turn around and look at. It’s a relatively big nail, but it really doesn’t hurt because the local anesthetic has already numb the skin, which is where all those nerves are they can they can make it uncomfortable.

KATH BAQUIE

Yeah, right. Good to know. So what happens once that bigger needles gone in?

GARETH SYMONS

Once that needle is in the right spot, we then feed a little catheter through it, and that catheter sits in the epidural space, and we’ve been able to load that up with local anesthetic to block the nerves that are supplying that part of the tummy where the uterus is and where all the pain is coming from during childbirth.

KATH BAQUIE

Yeah, great. And you mentioned that takes about, so once the needles gone in, how long until the pain relief starts to kick in?

GARETH SYMONS

The pain relief starts nearly with the next contraction, but for to really achieve effective pain relief, it probably takes, you know, three, four or five contractions. And so that might be 10 or 15 minutes for it to be complete sort of pain relief. And I should say it doesn’t work perfectly for everyone. Not every epidural that goes in works really, really well. But they probably do roughly sort of eight or nine times out of 10 work very effectively. And when they do it’s it can be complete pain relief.

KATH BAQUIE

And what about those one or two out of 10 when it doesn’t work?

GARETH SYMONS

Yeah. It’s not uncommon for example, to get a block on one side but not on the other. So you might have a block on the left side of the tummy but not on the right side of the tummy. Sometimes if the baby’s not in the optimum sort of lie, you might still have some sort of breakthrough pain in the back. Or certainly, as the labour progresses and the baby’s getting close to being delivered. There might be some perineal and sort of vaginal pain or breakthrough the epidural as well, because there’s a number of different sorts of nerves, which you need to know at different stages of that labour.

KATH BAQUIE

Yeah. Okay. So, Gareth, I would like to also ask you about the different types of blocks because I have heard a few women recently who they had an epidural, but they still had quite a bit of sensation when it came to and that’s what they requested, they wanted to still have quite a bit of sensation when it came to giving birth.

GARETH SYMONS

Yes, absolutely. So I think epidurals have changed over the years, and certainly historically, people used to take a bit of a sledgehammer approach to it and use a really high concentration of local anesthetic in an effort to really completely achieve complete pain relief. And it was probably quite effective at that, but added costs of potentially increasing the risk of instrumental delivery, and also causing really significant motor blocks. So the legs of the mum really can’t move at all. And then it might be really difficult to feel any contractions whatsoever, historically, so over time, that’s changed and people use a lower concentration of local anesthetic generally now than was done in the past. There probably are some differences between individual practitioners exactly how they do the epidural these days. And I think there is room for a labouring woman to ask the anesthetist if they can go slowly with the epidural, for example, and not sort of load it up too aggressively. If they’re sort of hoping to get pain relief without a really profound block. That said, I’ve sort of heard of people advocating walking epidurals, things like that. Personally, I don’t think it’s a great idea. I think if you’ve got abnormal sensation and your feet and your legs and you may have some weakness in your legs, that sort of puts you in a position where you might not be very safe. And the other thing which we haven’t mentioned, I should have mentioned this, that usually, and certainly at institutions where I’ve worked, a woman would have a urinary catheter put in when they have an epidural put in because they won’t be able to feel the sensation of their bladder feeling the way they usually would. And that just allows the bladder just to empty and not have any trouble from that.

KATH BAQUIE

Okay, so to just back up and dive into what you’re talking about the walking epidural, are you referring to when it’s not so much pain relief that a woman can still move her legs and still walk?

GARETH SYMONS

Yeah, so because we use much lower concentrations of local anesthetic than we used to, there’s a really good proportion of women who can still move their legs pretty well, even once the epidurals on board and they may be getting pretty good pain relief. But in my mind, that doesn’t mean that you should be walking at that point, once that load, and load in sensations not going to be normal in your lower limbs. And it’s hard to assess whether you’ve got a small degree of motor block, you’re not sure about. You haven’t really detected and might not be very safe to get up and walk around.

KATH BAQUIE

Yeah, okay. But to clarify the different names just so that if a woman’s talking about one, you know, concentration, epidural versus another apart from walking, epidural is a name that is used?

GARETH SYMONS

Well I’ve heard anecdotally friends talking about, light epidurals and things like that, from an anesthetist perspective, no, we don’t we don’t have as sort of a variety of epidurals that we put in, we basically put in, well, certainly in my practice, and put in the same epidural for anybody. At times might load it up slower. If someone tells me that they’re really keen to, to just get a degree of pain relief, and that they really want to try and make sure they can still feel the contractions really well. And I’m happy to go slower if that’s what someone wants. But there’s not really different types of epidurals that an anesthetist would identify as different.

KATH BAQUIE

Okay, yeah, that’s good to know. So, I’d love to ask, because I know this is a question that comes up a lot with the women I work with is, do you have to birth on your back if you have an epidural? Or what are some other options available in terms of positioning for a woman? If they have an epidural? Or can they be on their side? For example, with the use of pillow, a pillow under their leg?

GARETH SYMONS

Yeah. I think that’s a really good question. And, and to be honest, I’m not usually there at that part. But from a technical perspective, there are some challenges, the local anesthetic will tend to be distributed to where gravity distributed. And that means that immediately after we put an epidural in and loaded it with local anesthetic, we would want a woman to be relatively flat. Just to ensure that you get pain relief on both sides of her body. Once you’ve sort of achieved good pain relief, then there’s no reason why she can’t go on aside, absolutely not a problem at all. The only downside that I can conceive of is that the more moving around that you’re doing change the positions that you do, the more likely the epidural catheter will be pulled out. And it does happen from time to time, but we’re certainly aware of that risk. And we take them in pretty securely knowing that there’s a chance that might get pulled out. And so no, there’s no reason you can’t move around, no. In the bed.

KATH BAQUIE

Yeah. Interesting. Okay, well, that takes us beautifully on to risks. So one of the risks of an epidural to both the woman and her baby?

GARETH SYMONS

Yeah, so the way I frame this discussion is common sorts of things that can happen. And then the really rare sorts of things that can happen. So, so common sort of issues. We mentioned before that some epidurals when they go in just don’t work as well as we would like them to. And that may be as much as 10, or 20% of epidurals that go in to some extent don’t provide the adequate degree of pain relief, we would like. Other things that can happen relatively commonly or sort of drop in blood pressure. And that’s one of the reasons that we have that fluid running through an intravenous cannula before we even put the epidural in. And it means that we can give medications if we need to normalize that blood pressure really quickly. And you would notice the midwife looking after you and will be checking your blood pressure really frequently after an epidural is inserted for that reason that we know that that’s a possibility. And then the other relatively common comments about a 1% risk is it is a postural puncture headache. So that’s something which doesn’t usually occur during the during the labour. But in the days afterwards, sometimes women develop a postural headache, which can be quite severe, and can sort of require intervention to sort of sort out in the days after the child’s after the baby’s been born. So that’s a, I guess, uncommon, you’re 99 times out of 100 of not getting it. But still, you know, we see quite a lot of people with that just because of the huge numbers of people having babies.

KATH BAQUIE

Yeah. And does that tend to disappear by itself after a few days or?

GARETH SYMONS

Yeah.

KATH BAQUIE

Is there any special monitoring that needs to happen?

GARETH SYMONS

Not monitoring. And we want to table clinically, I guess we talked to them and see how they’re going. And we would offer sort of simple pain relief. We’d offer caffeine which is a relatively effective treatment for postural, puncture headache. There is some procedural things which can be done. And if none of those simple sort of things work, then you can be offered what’s called a blood patch, which is where an anesthetist would take some blood, you know, in a really clean fashion from your arm and then inject that actually into the epidural space. The same spot where they did the epidural in the first place, and it just seals up the leak of CSF, which is the fluid causing the headache that or the leak of that fluid is causing the headache. And that’s really effective. But if we do need to do that, obviously there’s a reason why the person had a Dural puncture in the first place. Sometimes it’s because was quite difficult to put it in. And also there is a risk of recurrence of the headache recurring even after that blood patch. So most of the time, we would try and manage it, as you sort of suggested we give them some pain relief and hope that it resolves. And often it would. Yeah.

KATH BAQUIE

Yeah. Okay, good to know. When you mentioned before, there is a risk if you keep moving around the bed that your what you call the needle? falls out?

GARETH SYMONS

Catheter? Yeah, the catheter?

KATH BAQUIE

Epidural catheter, yeah. If that falls out, can you then re insert it? Or is that no more epidural?

GARETH SYMONS

You can. Sometimes if that first insertion that we do doesn’t work as well as we would like it to we might repeat it and just do the procedure again, there’s no problem with doing it for a second time. And if the epidural catheter does fall out during labour, yes, it can be repeated. I mean, it depends a little bit on the setting how quickly that might occur. And depending on the progress of the labour, if the baby is sort of on the way out and may not actually be a good time to try and do it.

KATH BAQUIE

Totally understandable. Okay, so let’s move on to the rarer potential risks.

GARETH SYMONS

Yeah, so the things that people worry about, and understandably worry about are injuries to nerves in their back. And certainly something that we have top of mind when we’re putting epidurals in, the chance of a nerve injury with putting an epidural in it’s very small. And that’s one in 1000s the chance of a nerve injury that doesn’t get better and causes weakness, which doesn’t resolve quickly after the epidural has come out would be one in hundreds of 1000s. So because it’s so rare, the numbers are a little bit hard to pin down, but somewhere between one in 100,00 and 1 in 250,000, of having a really severe complication from an epidural in terms of weakness, or even paralysis, which is obviously a horrific side effect to occur but incredibly uncommon.

KATH BAQUIE

Yep. And I’m putting you on the spot here. But is that step for Australia or more worldwide?

GARETH SYMONS

Ah, it would be in Australia and hospital systems like Australia’s. Yeah.

KATH BAQUIE

Yeah, okay. Would you say that’s the main risk to mum that the biggest rare risk?

GARETH SYMONS

I guess the other thing is, which could happen very rarely sort of meningitis is another one. So you get an infection in the central nervous system. From you know, any time we put a needle into the body, there’s a small chance of introducing some bacteria. That’s why we do it in such a clean fashion. Yeah, epidural abscess, so an infection at the side of where the epidural went in. And the other one is an epidural hematoma where there’s a blood, some bleeding and bruising around where the epidural is gone in, which again, can cause nerve injuries. We worry about those things. But all of those things, the abscess, and the hematoma with the main thing we worry about is injuries to nerves and that setting. I think that would be about it. Yeah.

KATH BAQUIE

Okay. Now, how about the, is there an increased risk of instrumental delivery with an epidural?

GARETH SYMONS

Yeah, that’s a really good question. Traditionally, we’ve always thought that there was. Right now there’s probably some conflicting evidence, recent evidence saying that perhaps because of the reduction in the concentration of local anesthetic used in epidurals that there may not be an increase in the risk of instrumental deliveries, it’s hard to be absolutely sure but there possibly is an increased risk of instrumental delivery. So if that’s really, really important to somebody, then that might form part of their decision. It’s hard to tease out there’s lots of things going on during labour. We know there’s no increased risk of cesarean section. Instrumental delivery is a little bit more nebulous, and probably on the improve as people continue to use lower concentrations of local anesthetic and epidurals.

KATH BAQUIE

Yeah, it’s interesting. Obviously, being a pelvic floor physio, I do see a lot of women who have pelvic floor issues. So it’s, as you said, there’s so many factors, so it’d be really hard to research to see what the causative factors are or for example, pelvic floor dysfunction as a result of forceps, which is as a result of an epidural, it’s really hard to. Yeah, it would be really hard to research that.

GARETH SYMONS

I should say as well. But whilst everyone’s worried about the risk of having a nerve problem from having an epidural, what we actually see in practice more commonly is women with either sensation changes or weakness in their legs, which is actually due to a nerve injury during delivery of the baby. The baby actually causing a nerve injury on the way out of the vaginal canal. But usually those things are sort of pretty self-limiting and get better on their own.

KATH BAQUIE

Yeah, that’s a good point. Are there any, just to finish off the risks, are there any risks to babies, the baby with epidural?

GARETH SYMONS

No. So look I would say the epidural is very safe for the baby. So the medicine, which is put in through the epidural catheter is really limited to the epidural space. So the baby doesn’t see any medication from the epidural, which would be different. For example, if the if the woman was given systemic opiates, obviously they can get to the baby. Very occasionally, you might see a change in what’s called the CTG, which is the monitoring of the baby’s heart rate soon after an epidural is put in, whether that’s related or unrelated, sometimes hard to know, there’s theoretical reasons why the sometimes things might change. After the epidural has gone in and just even just the fact of relieving pain can change the way things are going a little bit during the labour. But no, look, I would say very safe for the baby is the way I would describe the epidural. Yeah.

KATH BAQUIE

And we were discussing off air, there’s been some recent research, talking about epidural, do you care to share what that, you know, in general term for that research was referring to?

GARETH SYMONS

There’s a lot of research being done on epidurals in childbirth all the time. And when there is so much research being done, I think there’s pretty variable quality of that research. And whilst there’s sometimes things which are reported reporting that research that could sound scary, I think it’s probably best to talk to your doctor or to the person looking at you during your, during your pregnancy for sort of clear information that sort of has some context that I probably wouldn’t go into detail about sort of the different publications which come out, because sometimes they’re hard. It’s hard to give context to those studies. Yeah.

KATH BAQUIE

Yeah. And we’d need hours to discuss them as well. And that’s great advice, Gareth. So anyone listening today, if you’re not, if you’ve read something, or heard something, go and have a chat to your healthcare provider. And yeah, it’s really good advice. Thank you, Gareth. So to finish off, and again, I’m just throwing this question at you. To all the women listening, if they’re thinking about their pain relief options for the upcoming birth, what advice would you give them? To a pregnant woman here or listening today.

GARETH SYMONS

Yeah, first of all, I think well done thinking about it now, before you come to deliver, because I think it’s absolutely the right thing to just consider these things before you’re in the moment and what can be really quite a painful experience. For some people. Beyond this combination. I think that there are some fact sheets put out by some of the healthcare networks and the hospitals, particularly potential hospitals, like the royal women’s in Melbourne, for example, which you can probably put in the show notes if you need to, which go through the risks and the pros and cons of different sort of forms of pain relief. I guess, from my perspective, I would encourage people to be open minded. You should absolutely make a plan that’s right for you. But from my perspective, I think having a degree of flexibility in that plan is a good idea. Because it’s hard to know what it’s going to be like until you’re in the moment. And so even if you feel like maybe if it was not for you, for example, and that’s totally fine. If it’s not, I’d still educate myself about it, and try and find out a bit about it before I come to Ferber. That’d be my advise.

KATH BAQUIE

Alright. Before we wrap up, I had one more question considering the current climate. So at the time of recording, the COVID saga is continuing, but it’s really impacting the hospitals. And I think it’s great to talk about has COVID affected the way you work at all and the pain relief options, you’re able to provide women in hospital?

GARETH SYMONS

Yeah, absolutely. Without a doubt, it’s affected the way we work. But I don’t think it’s affected the pain relief options that we’re able to offer. At the moment, I can say as of January 2022, where I work, we’re seeing a lot of pregnant women with COVID. And their pain relief options are exactly the same as they’ve always been, they’re still able to get an epidural, we ensure that we do that in a safe way for, you know, the patients and their family and also for us and the other staff. So we can use PPE or personal protective equipment to make sure that everyone’s safe, the pain relief options are the same as they’ve always been. It can be a little bit more complicated in terms of arranging like cesarean section deliveries, and there can be some medical complexity on that side of it, particularly if women are unwell with COVID. And I should take this opportunity to really advocate for vaccination in women who are pregnant or planning pregnancy, because we know that they are at increased risk of really severe COVID. So I would absolutely advocate being vaccinated, we know that there’s no harm to the baby and there’s huge amounts of evidence to support that. But in terms of pain relief, same options as normal, the cesarean section can be tricky. I would try not to worry about that and leave that up to us to work it out. The only other thing which I guess is particularly impactful on women in what is a super important part of their life, an important point event in their life, is about whether able to have with them. Obviously, having a child is an important event in people’s lives. And we would like them to have the loved ones with them that they would like. Sometimes, depending on the situation with COVID at the time when the delivering in may affect who can be there and for how long, but I know that hospitals are trying their very best to make sure that the partners are facilitated and being there for as long as they want to be there and all of those things, but obviously there’ll be examples when it’s not the same way as it would have been prior to COVID.

KATH BAQUIE

Yeah, okay, great. Well, thank you for clarifying that. And hopefully this episode is reassuring to women out there who are considering your choices and trying to navigate having a baby in this current COVID climate. So thank you very much Gareth for coming onto the podcast. I really do appreciate it.

And before I sign off, remember my team and I will be putting together the show notes for this episode with all the links at fitnestmama.com/podcast. And also if you did enjoy this episode, let me know on Instagram and come and send me a DM a message. And my instagram handle is @fitnestmama. So have a fabulous day everyone and I look forward to you joining me next week for another episode of the Fitnest Mama Podcast.

Thanks for listening to the FitNest Mama Podcast brought to you by the FitNest Mama Freebies found at www.fitnestmama.com/free. So please take a few seconds to leave a review, subscribe, so you don’t miss an episode. And be sure to take a screenshot of this podcast, upload it to your social media and tag me, @fitnestmama, so I can give you a shout out too. Until next time! Remember, an active pregnancy, confident childbirth, and strong postnatal recovery is something that you deserve. Remember, our disclaimer, materials, and contents in this podcast are intended as general information only and shouldn’t substitute any medical advice, diagnosis, or treatment. I’ll see you soon!

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