Epidural As Pain Relief During Labour: What You Need To Know

An epidural is a special type of local anaesthetic. It numbs the nerves that carry the pain impulses from the birth canal to the brain.
For most women, an epidural gives complete pain relief. It can be helpful for women who are having a long or particularly painful labour, or who are becoming distressed.

An anaesthetist is the only person who can give an epidural, so it won’t be available if you give birth at home. If you think you might want one, check whether anaesthetists are always available at your hospital.

How much you can move your legs after en epidural depends on the local anaesthetic used. Some units offer “mobile” epidurals, which means you can walk around. However, this also requires the baby’s heart rate to be monitored remotely (by telemetry) and many units don’t have the equipment to do this. Ask your doctor if mobile epidural is available in your local unit.

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.

What’s involved in having an epidural?

To have 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. Drugs, usually a mixture of local anaesthetic and opioid, are administered through this tube. (An opioid is a drug that binds to special opioid receptors in the body, reducing pain.)
– It takes about 10 minutes to set up the epidural, and another 10 to 15 minutes for it to work. It doesn’t always work perfectly at first and may need adjusting.
After it has been set up, the epidural can be topped up by your midwife, or you may be able to top up the epidural yourself through a machine.
Your contractions and the baby’s heart rate will need to be continuously monitored. This means having a belt around your abdomen and possibly a clip attached to the baby’s head.

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Side effects of obstetric epidurals

There are some side effects to be aware of:
– An epidural may make your legs feel heavy, depending on the local anaesthetic used.
– An epidural shouldn’t make you sick or drowsy.
– Your blood pressure can drop (hypotension); however, this is rare, because the fluid given through the drip in your arm helps to maintain good blood pressure.
– Epidurals can prolong the second stage of labour. If you can no longer feel your contractions, the midwife will have to tell you when to push. This means that forceps or a ventouse may be needed to help deliver the baby’s head (instrumental delivery).
– When you have an epidural, your midwife or doctor will wait longer for the baby’s head to come down (before you start pushing). This reduces the chance that you will need an instrumental delivery. Sometimes, less anaesthetic is given towards the end, so that the effect wears off and you can push the baby out naturally.
– You may find it difficult to pass urine as a result of the epidural. If so, a small tube called a catheter may be put into your bladder to help you.
– 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 feels 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.

Source: nhs.co.uk