These days when you tell your friends that you are having a baby, those that have had babies before will congratulate you and then quickly tell you, "Get the epidural immediately!" They laugh but then proceed to tell you a horror story about their own birth. It's unhelpful for them to do that and you definitely have more options than just an epidural to manage the discomfort of labour.
In the simplest of terms, epidurals are a continuous flow of medication into the epidural space in your spine that dulls the nerves and blocking pain sensations from travelling to the brain. The medication is a combination of an anesthetic and an analgesic. The medication is delivered through a very thin, flexible tube that is inserted below the level of the spinal cord.
Benefits: Full and complete blockage of labour pains. The ability to remain alert and awake during the birth and pushing. Can speed up a labour that may have stalled.
Risks: You will be stuck in bed for the remainder of the labour and birth. You will need a catheter as you will not be able to get up to pee and a possible headache. And more serious but rarer risks including, nerve damage or paralysis. These rare risks are estimated to happen 1 in 200,000. May slow labour down if given before the contractions are progressively opening your cervix.
The best time to get an epidural is when your contractions are strong enough to open the cervix in a regular pattern or when you reach the Active Labour Phase. This usually happens around 6 cms dilated. Ultimately, however, the best time to get an epidural is when you want an epidural.
Injectable analgesics such as Morphine or Demerol can be used during early labour if you are struggling with the discomfort of the early contractions. It is generally administered via intramuscular injection into the thigh.
The pain relief lasts approximately four hours and must be out of your system before the baby is born, which is why it is not an option once active labour starts. If the baby is born within the four hours after it is given, the baby may have breathing difficulties and need another medication to push the analgesic out of their system.
Benefits: Effective pain relief that does not numb your muscles so you are able to walk around. It can be helpful if you are struggling with a painful early labour or a prodromal labour (contractions that last for days on and off but do not make much progress in dilation)
Risks: It can make you feel dizzy or disoriented and does not always work. Since it goes into your bloodstream, it does go into the baby and can affect baby's breathing, causing them to be sleepy after birth, which can affect bonding and breast/chest feeding.
Analgesics are only available during the early stages of labour. Generally, during this time you would still be at home and have other, non-medical pain management options available to you such as deep breathing, position changes, massage, or the use of a hot shower or bath.
Towards the end of labour, when getting an epidural may not make sense, labour can be intense. The use of gas or nitrous oxide can be very helpful in getting you over the last phase of labour called Transition. The gas is self-administered with an oxygen mask. When the contraction begins, you apply the mask to your face and breathe in very deeply and let the breath out slowly until the contraction is finished. Between contractions rest and breathe normally.
Benefits: If you have gotten to transition without an epidural, nitrous oxide can help take the edge off and get you to push with more ease. It has little to no side effects for the birthing parent or the baby as it is in and out of your system very quickly.
Risks: It is only available for use for six hours, and once you have hit the six-hour mark, if the baby is not born then you must stop using it. It can also cause dizziness, nausea or vomiting.
Nitrous oxide is a great option if you were hoping to birth without an epidural. The best time to use it is when you hit transition or 7-8 cms dilated. At this time, the contractions are quite intense and the gas can take the edge off of the contractions and get you to the pushing stage where the contractions space out and become easier to manage.
Ultimately the use of any medication in labour is your own personal choice. Even if your friends have used it, or if they had a terrible experience, you need to remember that is their experience and your birth story has not been written yet. Attend a good prenatal class that will inform you of all your options and not make you feel pressured to making decisions you aren't comfortable with and consider hiring a doula to help you with advocating for the birth you want.