Since its invention in the 1930s the epidural has become known as the most effective form of pain relief for labour, with some mums even recalling the anaesthetist who ‘took away’ their pain with huge affection! But it’s important to remember that there can be side effects that come with epidurals and so you really should get all the facts to make an informed choice about what’s best for you.
1. What is an epidural
An epidural is an anaesthetic (painkiller) that can take away the pain of your contractions. It’s injected through a hollow needle into the space just outside of your spinal cord’s outer membrane.
After this has been done, a thin plastic tube is fed through the needle, before the needle is removed and the painkiller continues to be given through the remaining tube, numbing the lower part of your abdomen.
2. How’s it given?
First, the anaesthetist will ask you to lie on your left side, with your knees curled up, or sit on the edge of the bed, with your feet on a chair and your chin tucked in.
Although you’ll be having frequent contractions at the time, it’s important for you to stay as still as possible when the epidural’s administered.
An epidural feels like liquid ice numbing your tummy, bottom and legs, and deadening the nerves that carry pain signals from your uterus. Your midwife can top it up – you tell her when the contractions start to hurt again.
Some maternity units will use PCA (patient controlled analgesia) this allows you to top up the epidural yourself by pressing a button when you feel you need pain relief. It comes with a cut-off which stops you from accidentally administering too much.
3. How is a mobile epidural different?
A mobile epidural lets you move around a little. It’s set up in the same way as a regular epidural, but the ‘cocktail’ of drugs is slightly different. Some mums will have some sensation in their legs, while others will be able to stand, or move a little, with support.
4. Are there any likely complications?
Epidurals can sometimes cause problems, but, considering around 25% of mums-to-be use them, problems should be kept in perspective.
In around one in every 1,000 cases, women experienced numbness in their legs which lasted for up to three months, while one in every 100 had a severe headache after leakage of fluid from around the spinal cord.
Permanent paralysis is almost unheard of nowadays and there’s no evidence that epidurals can cause long-term back problems. If you have a back ache after an epidural, it’s likely that your ache was caused by lying in one position for so long.
5. Will I have to give birth on my back?
The position you eventually give birth in will depend on how powerful the epidural is. Women who have no feeling from the top of their bump down after an epidural will most likely end up lying or sitting in bed, which can slow down labour. But women who have a mobile epidural may find they can stand or kneel to give birth.
6. Can anyone have an epidural?
Although most mums-to-be can have an epidural, some, such as those with a blood-clotting disorder or a pre-existing back problem will be advised against it.
It’s much better for your back to be moving around and to find the position in labour that’s most comfortable for you.
Women who’ve previously had a caesarean and are planning a vaginal birth should also avoid an epidural to make sure labour is as normal as possible, and so they’re aware of any pain that comes from the scar on their uterus.
7. Does it always work?
Around 96% of the time an epidural provides excellent pain relief. In the other 4% of cases, women may find they get a ‘partial block’ on one side, which means the anaesthetist may try and re-site the epidural to help distribute the drug more evenly.
8. When will I have it?
Usually, you’ll be in established labour when you’re given an epidural. If you’ve kept mobile for some time, you’ll have helped the baby descend lower into the pelvis.
There isn’t really a cut-off point for an epidural. For some women it’s still appropriate even if your cervix is 8cm dilated, as progress may have been slow with your baby in an awkward position.
If you’re in the second stage of labour and it looks like you’re heading for a forceps delivery, a spinal anaesthetic may be recommended. This is similar to an epidural but is given as a single dose in a heavy block, and takes about six hours to fully wear off, while an epidural wears off after an hour or two.
9. Advantages of epidurals as pain relief
- It numbs the area from the waist down and is an excellent form of pain relief – particularly with long labours.
- It can lower very high blood pressure.
- You’ll feel alert but also able to sleep if you’re very tired.
10. Disadvantages of epidurals as pain relief
- The anaesthetist may not be available. Which means you may miss the opportunity to have one.
- Increases the risk of needing an instrumental birth and of having an episiotomy.
- Your unborn baby needs to be continually monitored.
- You’ll have a drip set up in case your blood pressure falls.
- Your contractions can slow down – you might need another drip to speed things up.
- If you can move at all, your movement will be restricted.
- You may need to have a catheter.
Check out other pain relief options available for your labour...
