Ambulatory Walking Epidural

What is a walking epidural?

Ambulatory walking epidurals are a pain relief used during labour which enables you to keep the sensation in your legs in order to effectively mobilise and walk around. The walking epidural is still able to act as an effective form of pain relief and uses regional anaesthetic.

The pain relief drugs are injected around the nerves that carry signals from the area around which pain is felt during labour. In walking epidurals you will need monitoring and support from the hospital to ensure you are safe when moving around during labour.

The main aim of the walking epidural is to keep you calm and provide an effective form of pain relief; however, many women benefit from immobilising themselves as they are able to identify when to push. Walking epidurals use a low dose of drugs, normally a combination of local anaesthetics and painkillers.

Walking epidurals are not offered in home births and are only available in selected hospitals. This is due to the additional trained staff that are needed when a mother has a walking epidural. Those that do offer walking epidurals have established procedures to ensure the safety of the mother and baby at all times.

Walking epidurals only numb the mother’s abdominal nerves. This enhances comfort and allows for the mother to walk around the delivery room. Not all mothers who have the walking epidural do physically walk around, but they do feel more comfortable in being mobile.

What does the walking epidural procedure involve?

Walking epidurals use the same method of low dose drugs and anaesthetic as the normal epidural, though they are used to only numb the abdominal nerves. When the spinal needle is positioned through the epidural the pain relief will then be passed through it.

When the walking epidural is applied the mother should start to feel the difference within one or two minutes. The spinal needle is then taken out while the epidural needle is left in the same location. A catheter will be applied through the remaining epidural needle and held to the patients back using tape.

The walking epidural should start to come into affect fairly quickly but you will still be mobile to walk and move around and feel the sensation in your legs. Your blood pressure will be observed by a trained member of staff assisting with your labour. Your muscle strength will likely need to be tested before you are allowed to walk around, as everybody responds in a different way to medication. In some circumstances the mother may be unable to mobilise themselves, even after the walking epidural is applied.

What are the advantages of a walking epidural?

Many women find the walking epidural effective in providing them with the sensation they need to move about during labour, but which also gives them effective pain relief. Below are some advantages of the walking epidural:

• Many mothers feel in control of their body when they have the walking epidural.
• The walking epidural allows mothers to identify when to push effectively.
• Many mothers feel mobile and therefore more comfortable during labour.
• Women are able to regulate their own dosage, giving themselves more pain-relief medication if necessary.
• The walking epidural has minimal risks to both mother and baby in comparison to other forms of pain relief.
• Mobility promotes contractions to effectively speed up the labour.
• There are specialist staff to assist you when having a walking epidural to closely monitor its effects.
• It takes around 20 minutes to set up and works quickly and effectively.
• It helps to lower blood pressure.

What are the disadvantages of a walking epidural?

There are certain disadvantages concerning the walking epidural that need to be considered:

• You may suffer from headaches depending on how your body reacts to the walking epidural.
• In some cases the walking epidural is does not allow the woman to walk unaided and assistance may be required.
• Some women may find the extra monitoring required intrusive.
• Some facilities do not allow you to walk with this type of medication.
• Some women may still be able to feel strain on their legs and decide that it is not for them.
• Movement can be limited for some.
• It may make you feel shivery.
• You may feel itchy or develop a fever.
• You may be more susceptible to having an assisted delivery, via ventouse or forceps

When can I have a walking epidural?

You can request to have a walking epidural at any stage of labour; however, you are advised not to request it too late as it may not be able to take effect in time. Most women are recommended to have a walking epidural in the first stage of labour.

If you find your contractions are too painful to bear than you can request to have a walking epidural, especially if you want to retain some sensation in your legs.

What is the difference between a standard epidural and a walking epidural?

The main difference between a standard and walking epidural is the numbing sensation and the dosage of pain relief used. A walking epidural allows for you to be mobile, whereas a standard epidural can often leave you confined to the delivery bed.

A walking epidural is often a combination of spinal and epidural analgesia, the level of anaesthetic used is significantly lower. This reduces risk for both mother and baby during labour. The walking epidural may require more monitoring from trained healthcare staff in comparison to the standard epidural.

Is it necessary that I walk if I choose to have the walking epidural?

You will not be made to walk during the walking epidural; however, you will be able to move about more freely even if you are stationed near the bed. Not all women walk around but if you do choose to have the procedure then you have the option available in preparation for the birth. Some women may have to walk with the assistance of their partner or midwife while controlling contractions.

Can anyone have a walking epidural?

A walking epidural may not be recommended for women who are having a high risk pregnancy. The suitability of pain relief methods such as a walking epidural can be discussed with your doctor, who may recommend alternative pain relief. Most women are advised, especially by midwives, to have a natural birth; however, if you feel that you cannot bear contractions any longer then a walking epidural can significantly help to make the labour easier. In some emergency cases a walking epidural may be needed in order to deliver the baby more easily, especially if the labour is being prolonged and both the mother and baby are becoming increasingly tired.

Do all hospitals in the UK offer services for walking epidurals?

Not all hospitals in the UK offer services for walking epidurals due to the specialised care and monitoring it entails. However, there are selected hospitals that will offer it to patients. It is best to find out from the maternity unit at your chosen hospital about the various methods of pain relief available. You can always ask your doctor or midwife who can offer advice on which hospitals in the local area offer walking epidurals.