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Worried about the global epidural shortage? Here's the alternatives


Are you aware that there is currently a global shortage of epidural kits? Manufacturers have been unable to supply their usual number of epidural kits for several months because of a worldwide lack of the blue dye used to distinguish epidural syringes from other types. Stocks of epidurals are being safeguarded for patients with allergies to other anaesthesia. This may mean if you plan to ask for an epidural it may not be available for you to use during labour. A recent article in the Guardian says:

Anaesthetists have told the Guardian that the simultaneous shortage of both forms of pain management has led to “difficult discussions” with women who had been told during their antenatal care that they would have that choice but were upset to learn that it was not available.
The disruption to supplies of epidural kits is so acute that NHS Supply Chain (NHSSC), the health service body that ensures hospitals in England and Wales receive regular supplies of drugs and equipment, to ration deliveries to just one week’s worth of stock.

If you’d planned to ask for an epidural, you may be worried about how to cope during labour and what your alternatives are. Don't worry! I got you! Here's some of your other options for keeping you comfortable:


Hypnobirthing

You know I'm going to call on hypnobirthing at the top of my list! Hypnobirthing can't promise you a "pain free" birth, but it can genuinely help with your perception of pain and comfort. A recent study (Veringa-Skiba et al 2021) looking at the effects of fear of childbirth, the use of “mindfulness based” childbirth education and obstetric interventions found that parents who had a fear of childbirth and took a class were:

  • 36% less likely to have an epidural

  • 51% less likely to ask for a caesarean birth

  • twice as likely to have an unmedicated birth than those who didn’t do the course

  • had babies with higher apgar scores 1 minute after birth

The hypnosis-based interventions improved women's emotional experiences and outlook towards birth, with less anxiety, increased satisfaction, fewer birth interventions, more postnatal well-being and better childbirth experience overall.

Entonox

Gas and air is a very common comfort measure. 50% oxygen and 50% nitrous oxide, it’s essentially laughing gas. It’s very safe for you and baby. It can make you feel spaced out and nauseous but the effects wear off quickly if you stop breathing it.


TENS machine

This battery powered unit sends electrical pulses to sticky pads placed on strategic points on your lower back. It stimulates endorphins which are your body’s pain relief hormones. It also distracts you focussing your brain on the pulses, not your contractions. TENS machines should be used early on in labour, building a bank of endorphins in your blood stream so you have high levels to help you cope once your contractions are more intense. One of the benefits of using a TENS machine is it's a drug free option. You can get a 10% discount on BabyCare TENS here.


A comb

It may sound bonkers but gripping a flat toothed comb in the palm of your hand tightly can distract your brain from your contractions the same way a TENS machine does. There are also acupressure points in your palm for pain relief. This is a great one to try as most people have a comb at home and if it doesn't work you've lost nothing!


Warm water

Birthing in a birthing pool is a fantastic option for labour. It can provide comfort, relaxing you and providing buoyancy to facilitate getting in to different birth positions. The pool creates a physical barrier around you meaning people are far more hands off, and it's a more gentle transition for baby. There's also evidence to show birthing in a pool reduces the chances of 3rd or 4th degree tears. The only way to guarantee access to a birthing pool however is choosing a home birth, as there's always a chance that pool rooms may not be available when you go in to labour and arrive at hospital. Alternatively you can get in the bath or stand under the shower.

The 2009 systematic review (Cluett and Burns, 2009) concluded that labouring in water reduces the need for pharmacological pain relief [11]. This study also found a reduction in the use of pain relief in the form of inhalation/Entonox, epidural, and opioid in the group of women who used water immersion for labour and birth.

Opiates

Pethidine and diamorphine are opiate drugs. They are administered via injection and take 20 mins to work, lasting 2-4 hours. These can be a very effective form of pain relief, however they are not risk free. They cannot be used near the end of labour as they pass through the placenta to baby and can affect baby’s breathing, meaning baby may need help with breathing after they're born. They can also affect breastfeeding and bonding. Diamorphine is a medical grade form of heroin, and although has fewer side effects to pethidine, affects oxytocin production more and can prolong labour.

Newborns exposed to pethidine have significantly impaired normal infant behaviours such as hand and mouth movements, nipple touching before suckling, and licking movements. Half of the infants exposed to pethidine fail to breastfeed and cry more in the neonatal period.15 In addition to the maternal sedating effects of pethidine, there is also the theoretical risk of maternal delayed gastric emptying, aspiration and respiratory depression. Norpethidine can also induce seizures.

If you're concerned about not being able to access epidural anaesthesia, speak to your midwife and find out if the shortages are affecting your hospital, and what alternatives are on offer.


If you'd like to consider hypnobirthing to help you with labour, get in touch or join one of my classes. Check out my events page for dates of my group courses.

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