Epidural and mental preparation: do they go together?

The epidural: what health authorities say

In France, the national health authority asks that women who wish it be offered regional analgesia such as an epidural, which it describes as the safest and most effective method, with no minimum cervical dilation required (HAS, 2017). The WHO also recommends it for healthy women who request pain relief, depending on their preferences (WHO, 2018).

It is the most common option: in 2021, 82.7% of women who attempted a vaginal birth in mainland France had one (ENP, 2021).

What it relieves, and what to know

An epidural relieves pain more than opioids do, and women report being more satisfied with it. It also has effects worth knowing: low blood pressure, fever, reduced mobility, urinary retention and longer stages of labour (Anim-Somuah et al., 2018). UK guidance asks that women be told it is not always fully effective, that it lengthens the second stage and increases assisted births, but that it is not linked to long-term backache (NICE, 2023).

It does not always relieve pain completely: in France’s 2021 National Perinatal Survey, 70.8% of women who had one rated it perfectly effective, but 19.6% found it “slightly or partially effective” and 3.6% “totally ineffective” (ENP, 2021). That is no reason to fear it; it is a reason to keep other resources within reach.

Why preparation remains useful, with or without an epidural

Mental preparation is not only about avoiding medication. It helps you approach labour with less apprehension, stay available for the decisions to be made, and live the waiting times calmly. These resources keep their value whatever path the birth takes.

Non-drug methods are also often combined with pain relief: in 2021, almost one woman in two used at least one non-drug method, such as moving, a bath or massage, alone or alongside analgesia (ENP, 2021).

Before, during and after it is placed: practical pointers

Here are a few pointers to practise during pregnancy. They do not replace the instructions of the care team, who alone judge what is possible for you on the day.

• before it is placed: slow breathing, changes of position, the partner’s presence through contractions and the move to the room;
• while it is placed: fix your gaze on a point, relax your jaw and shoulders, lengthen the out-breath, feel your partner’s hand;
• afterwards: keep breathing calmly, change position if the team allows it, and keep your images or anchor phrases;
• if the epidural relieves less than expected: return to your breathing and your partner’s support while the team adjusts it.

Talk about it before the day

Options vary from one maternity unit to another: when it can be placed, the dose, how much you can move afterwards. The simplest approach is to discuss it in advance with your midwife and at the anaesthetic consultation, and to note your wishes in your birth plan.

To decide on the day, a simple grid can help the couple: what are the benefits, the risks, the alternatives; what does my intuition say; and what happens if we wait a little? Preparing these questions together lets you ask them calmly, without opposing the team.