Epidurals - A look at Australia's statistics & options for active birth positions

It’s one of the first things that comes to mind for most people when they think or speak about child birth – the pain. So it goes without saying that many people go into their births expecting that they will need or that they are going to opt for pain relief, regardless of how their actual birth transpires.

What many women aren’t aware of though, is how their choice in pain relief can directly affect their birth outcome. For instance, epidurals render the birthing woman numb from the waist down therefore inhibiting her movement and ability to change positions during labour, this lack of freedom to move has a direct effect on the progress of her labour and also what other interventions may follow during her labour and birth.

The Australian Institute of Health and Welfare (AIHW) Australia’s Mothers and Babies report 2016 (the most recent report) states the following:

  • 78% of mothers who gave birth in 2016 had pain relief. That’s almost 4 out of 5 women!
  • 55% of women chose nitrous oxide (gas and air);
  • 36% of women chose regional analgesic (epidurals)
  • 17% of women chose systemic opioids (morphine/pethidine)
  • 63% of women who opt for an epidural (who don't birth via c-section) end up having instrumental vaginal deliveries (use of forceps, vacuum etc.)

Just by choosing to have an epidural you are increasing your chances of having other medical and instrumental interventions by well over 50%.

You not only increase your chances of an instrumental delivery by forceps or vacuum extraction, but you also increase your chances of severe trauma to your perineum and episiotomy.

A study published in 2001 concluded that women receiving an epidural were more likely to receive an episiotomy compared to women who didn’t receive an epidural – 27.8% for women with epidurals compared with 13.1% of women with no epidural.

This is commonly due to the lack of mobility in the birthing mother and inability to seek a better position to birth from (squatting, standing, kneeling etc.).

You are also more likely to opt for or end up with an epidural if you choose to birth in a private hospital. 84% of women birthing in private hospitals receive epidurals compared with 77% of women birthing in public hospitals.

 

What are your options?

A common trend I see amongst birthing women is that, once they consent to receiving an epidural they feel as though they have then lost all choice. They feel as though they need to request permission to eat/drink and to move around.

But this is not the case! Consenting to any sort of intervention or pain relief does not then automatically strip you of your choice! You still own your body and your baby and you still have to give INFORMED CONSENT before anything is done to you and or your baby.

You may be told that once you have an epidural you will be bound to the bed and have to birth your baby on your back, well actually, the chances are you won’t be informed of this, most hospitals assume this factor is implied and won’t specifically inform you that this is the case…which is why it is so important for birthing women to educate themselves on their choices, hospital staff aren't likely to have the time or the inclination to sit with you and explain every detail of your choices and rights...that's on you.

Alas, you will most likely be bed bound by choosing an epidural...

Why you don’t want to labour flat on your back, if you can avoid it:

  • When birthing on your back you are literally pushing uphill; the birth canal curves upwards when lying down so you are pushing against gravity;
  • Birthing on your back decreases the room in your pelvis by up to 30%;
  • Lying on your back constricts blood vessels, meaning your baby won’t be receiving optimum levels of blood, and as the baby receives their oxygen through blood in utero, your baby’s oxygen supply is thus also affected;

In a 2017 Cochrane review combined results from more than 9,000 birthing people in hospital settings, people who were assigned to upright positions for birth were:

  • 25% less likely to have a forceps or vacuum assisted birth
  • 25% less likely to have an episiotomy
  • 54% less likely to have abnormal fetal heart rate patterns

In the name of transparency, whilst there is a lower risk of episiotomies when birthing in upright positions, there is an increased risk of second degree tears. However, researchers have found that natural tears heal faster and easier than episiotomies.

Other studies have shown that mothers birthing in upright positions can experience a shorter second stage of labour (pushing stage) by up to 34 minutes and that they are likely to experience less pain and a higher degree of satisfaction from their birthing experience compared to mothers who chose to/are made to birth on their backs.

 

Even with an epidural, you do have options!

You can opt to use the epidural during labour so you can get a break from the pain of contractions and rest, but when it comes close to time to pushing your baby out you can ease off the epidural release so that you gain feeling back in your legs and thus have the freedom to move about again.

Just because you’ve opted for the epidural, does not mean that you have to keep pressing the button for the drug release. Let it wear off so you can move about again and open up your options for birthing positions AND decrease your chances of tearing and instrumental deliveries.

If that isn’t an option for you, consider the following positions which are ALL achievable in conjunction with an epidural (despite what your healthcare provider may tell you…).

SIDE LYING

sydney birth photographer - woman birthing in side lying position

This is probably the only position that you’ll easily get past the hospital staff if you’ve had an epidural – they can still see what’s going on at a height and position that is convenient to them – and if this is your only other option then it is still better than lying flat on your back!

To achieve this position you can roll onto your side (you may need assistance to do so if you’ve had an epidural) and have one of your birth supports hold your leg up.

This is a gravity neutral position and is said to be good for births where the baby is descending fast, to avoid perineal tear and trauma. This position also increases the room in your pelvis, thereby allowing baby more space to move through and down.

sydney birth photographer - woman birthing in supported squat position

SUPPORTED SQUAT POSITION

Some hospitals have squat bars attached to their beds. The lower half of the bed is dropped down/removed and the bar is brought upright – you are then able to sit with your bum on the edge of the bed and support yourself in this position by holding onto the bar – you will most likely still need assistance from your birth supports to get into and maintain this position.

In this position you regain the benefit of gravity, you expand the room in your pelvis and also have more power to bear down during contractions.

No squat bar? No problem! You can also put yourself into a supported squat position with a birth support hooking their arms underneath your underarms to hold your weight upright.

 

KNEELING POSITION

sydney birth photographer - woman labouring whilst kneeling

You can kneel at the side or end of the bed, using the bed to support your upper body weight – throw a cushion or some towels/yoga mat on the ground to protect your knees from bruising. You can also kneel over a bunch of pillows or over the top end of the bed propped up.

This position puts gravity back into play and opens up your pelvis to allow more room for baby to move down. Your care provider can still easily see what is going on with baby and their positioning.

sydney birth photographer - WHO childbirth infographic

 

At present The World Health Organisation recommendation is that women should have mobility in labour and birth position of choice! So remember that, write it in your birth plan, tell all of your support team and regurgitate that to the medical staff should they try to restrict you from choosing how you want to birth!