What is an Epidural?
Epidural is widely used as a form of pain relief in labour. An epidural numbs the nerves that carry the pain impulses from the birth canal to the brain.
An epidural can provide very good pain relief, but it’s not always 100% effective in labour. The Obstetric Anaesthetists Association estimates that one in eight women who have an epidural during labour need to use other methods of pain relief.
The epidural can be topped up if a caesarean section is required.
Circumstances When an Epidural Is Advised
Many Obstetricians will advise an epidural for women in labour with high blood pressure, twins and breech or for premature delivery.
Ways to avoid an epidural.
Epidural is best avoided until labour is established.There is a variety of alternative pain relief methods described in the information leaflet “Pain relief in labour”.
• Have a supportive partner in labour to coach and help with contractions.
• Use alternative positions (sitting, squatting and using a birthing ball) to help the baby through the birth canal and ease back pain.
• Use breathing and/or meditation techniques to cope with contractions.
• Just get through the next half hour. Don’t get overwhelmed by how long the labour might be.
• Ask to be assessed before making a decision. You might be more advanced than you think.
• Trust your midwife, she will guide you.
What is involved in having an epidural?
A drip will run fluid through a needle into a vein in your arm. While you lie on your side or sit up in a curled position, an anaesthetist will clean your back with antiseptic, numb a small area with some local anaesthetic and then introduce a needle into your back.
A very thin tube will be passed through the needle into your back near the nerves that carry pain impulses from the uterus (womb). Drugs, usually a mixture of local anaesthetic and opioid (pain relieving medications), are administered through this tube.
It usually takes approximately 20 minutes to insert an epidural, and another 20 minutes for it to work. It doesn’t always work perfectly at first and may need adjusting. After it has been inserted, a continuous infusion will be used to maintain pain relief or the epidural may be topped up by your Midwife or the Anaesthetist. Your contractions and the baby’s heart rate will need to be continuously monitored. You will be in bed for the duration of your labour when the epidural is inserted.
Effects & Side effects of an epidural?
There are some side effects to be aware of:
• An epidural may make your legs feel heavy, depending on the local anaesthetic used. However, you will still be able to change positions in labour.
• Some women experience shivering, nausea, vomiting or itching due to some of the drugs administered.
• 20% of women may experience some level of hypotension (low blood pressure); the fluid given through the drip in your arm helps to maintain good blood pressure.
• Epidurals can prolong the second stage of labour (pushing part). If you can no longer feel your contractions, the midwife will have to tell you when to push. This means that assistance may be required i.e a forceps or a ventouse may be needed to help deliver the baby’s head (instrumental delivery).
• An epidural is not associated with a longer first stage of labour or an increased chance of caesarean birth
• A catheter (small tube) may be inserted into your bladder after the epidural as you may not feel the urge to pass urine (this catheter may be removed just before delivery).
• About one in 100 women gets a headache after an epidural. If this happens, it can be treated.
• Your back might be a bit sore for a day or two, but epidurals don’t cause long-term backache.
• About one in 2,000 women feel tingles or pins and needles down one leg after having a baby. This is more likely to be the result of childbirth itself rather than the epidural. You’ll be advised by the doctor or midwife when you can get out of bed.
• Epidural solutions contain opioids (pain relieving medication) and, whatever the route of administration, all opioids cross the placenta and in larger doses may make the baby drowsy and may cause short-term respiratory depression (breathing difficulties) in the baby.
The epidural catheter may be removed before leaving the labour ward.
Full sensation usually returns within a few hours. A catheter may be inserted into your bladder again after delivery until sensation returns. Women are asked to remain in bed until sensation in both legs returns and must be accompanied on their first time out of bed.
Reasons Why an Epidural May Not Be Suitable for Some Women
• Deformity of the spine, previous back surgery and being overweight does make the procedure technically more difficult or inadvisable.
• Infection at the site
• Certain medical problems and complications during pregnancy e.g. High Blood Pressure or if taking some medications e.g. anti coagulants as these may effect the way your blood clots.
• You may be referred to an anaesthetic consultant if there are any concerns about your suitability for an epidural.