Epidural as pain relief

There are many forms of pain relief that a midwife may offer you during labour. However, it can be a difficult decision as to which choice of pain relief is best. One of the most highly effective forms of pain relief is an epidural. Many women choose this form of pain relief at the third phase of labour when the contractions intensify and the pain grows unbearable.

What is an epidural?

An epidural is a method of pain relief that uses painkillers which are passed through the small of your back via a fine tube. The painkiller drugs are injected under regional anaesthetic. The anaesthetic numbs your tummy to provide you with highly effective pain relief. The nerves which are receptive to pain during labour are treated with pain killers to stem the feel of any pain.

What does the epidural procedure involve?

When you are in labour you will be given the option to have an epidural. If you confirm that you do want one then you will need to request its usage before you start feeling the urge to push, otherwise it may be too late and the epidural may not work. It is an anaesthetist who will apply the epidural through an injection of local anaesthesia in your lower back. The anaesthetist will place a hollow needle between the small bones of your spine, which will then go into the epidural space (the space between your spinal tissue and spinal column). A fine tube is then placed through the needle and the tube taped to your back while the anaesthetist removes the needle.

Although the procedure sounds complicated it can be done fairly quickly. However, you are required to remain still while the anaesthetist places the epidural in your lower back.

Epidurals can be given in different ways, as described below:

• Mobile epidural – This is where you will still be able to feel your legs and perineal area which will help you to recognise when to push. Mobile epidurals are given like traditional epidurals with a combination of anaesthetic and pain relief drugs. Low dose mobile epidurals are a way to give you a brief rest from the pain with some women even able to have a short sleep.
• Continuous infusion – This is when your anaesthetist will use a catheter attached to a pump. The catheter will feed the epidural pain relief into your back continuously. You can top up doses of anaesthetic if you need to though this form of epidural is only available in a few hospitals.
• Injections – You could have your epidural with a mixture of painkillers which are sent through a tube to numb the lower part of your stomach. As the epidural progresses and comes into effect you may no longer feel any contractions; however, you can have the anaesthetic topped up if necessary.
• Combined spinal epidural – In this method of epidural you will be given a lower dose of painkillers which works more quickly and effectively than a single epidural procedure. The anaesthetist will insert a catheter without passing drugs through the tube. The epidural can be put in to offer a continuous form of pain relief.

When should I have an epidural?

Epidurals can be given at the time when you feel contractions are becoming stronger and more difficult to bear. Many women choose to have an epidural when their cervix has dilated from 5-6cm.

Some women are given an epidural due to emergency circumstances, such as when the baby is getting more tired. Women who have fainted during labour or no longer have the energy to push may be given an epidural to speed things up.

The moment when you should have an epidural is down to the time when you feel you can no longer control your contractions. One factor which can affect the time of having an epidural, or whether you can have one in the first place, is if the labour is your first or subsequent labour.

In some cases a women may have dilated too far to be considered for an epidural.

What are the advantages of having an epidural?

The advantages of having an epidural during pregnancy are as follows:

• It is a highly effective form of pain relief to leave your tummy numb to contractions
• It only takes 20 minutes to set up and works very quickly to provide you with pain relief
• You are able to enjoy the labour and birthing experience and have a clear and open mind
• Epidurals can lower blood pressure during labour which is especially beneficial if you suffer from high blood pressure
• Epidurals can be topped up if needed to provide you with maximum pain relief

What are the disadvantages of having an epidural?

It is inevitable that, as with any pain relief drugs, epidurals would have a fair share of disadvantages. They are described below:

• You are unlikely to be able to feel any contractions and will therefore be unaware of when to push. This can slow down the pregnancy.
• Some women can feel dizzy.
• You may feel itchy or have a fever.
• You may need to stay in bed rather than be mobile.
• You may need a catheter in order to empty your bladder.
• Some women need more monitoring if they have an epidural.
• There is more chance of your baby being born by assisted delivery, such as ventouse.
• You may get a severe headache.
• In very rare cases you may develop a problem with your nerve endings which can leave your feet and legs with a numb sensation.

How does an epidural affect my baby?

Women who have epidurals may have their blood pressure drop, which could affect the flow of oxygen to the baby. You may need to have a catheter – a small tube attached to your arm - to monitor the flow of oxygen more carefully during labour. An epidural may make your baby more tired during labour.

Where can I get an epidural?

Epidurals are not performed in home births. They can only be performed in hospital obstetrician led settings as it requires special attention and extra care during labour. An anaesthetetist will need to be there to perform the epidural and close monitoring facilities are needed to ensure that your baby is doing well.

When is an epidural recommended?

Your doctor may recommend you have an epidural in the following scenarios:

• When there is the risk of having an operation in childbirth.
• For the delivery of twins or multiple babies.
• If you have a medical disorder which could affect you during labour.
• For caesarean delivery.
• During painful, prolonged labour.
• For a delivery where it is necessary to use forceps or ventouse to deliver the baby.

Can any pregnant women have an epidural?

In some cases an epidural may not be suitable for pregnant women due to previous medical disorders or blood clots. Your doctor or midwife will be able to further advise you on pain relief methods which are suitable to your individual circumstances. If you are having a normal pregnancy and have no other medical conditions then your doctor should offer the epidural as a method of pain relief. It is always best to discuss with your doctor and midwife about the pros and cons of having an epidural beforehand as per your individual circumstances.

Recovery after an epidural

Following epidural anaesthesia your doctor will make sure that the numbed area of your body is protected from any pain or pressure until sensation returns. It usually takes a few hours for the sensation or feeling of numbness to the area to return and women are advised to rest during this time. As the feeling returns you may feel a slight tingling sensation on your skin but this will soon wear off.

If you do start to feel any pain you should immediately inform your doctor or nurse who will be able to further assist you with relevant pain relief medication. As the epidural wears off you may need help getting in and out of bed as you may still feel shaky and weak. Within an hour of the epidural you can start to drink and eat light foods. Your doctor or nurse can offer additional advice on how to recover after an epidural assisted child birth.