Epidurals

Most of us have heard of epidurals for pain relief in labour. After all, epidurals are the most common type of anesthetic used by laboring women to help manage their pain. An epidural is an injection given into the mother’s back which anesthetizes (numbs) the never endings which register pain. The epidural is inserted into the epidural space, in the lumbar region around the spinal cord. This creates an area of numbness from the mother’s belly button to the top of her legs.

Sometimes an epidural is put in a little higher in the mother’s spinal cord, depending on her individual anatomy. 

Epidurals are very safe and complications from epidurals are rare.

How is an epidural put in?

An anaesthetist inserts a very fine needle into the lower part of the mother’s back, this helps to guide a tiny tube, called a catheter into a space between her vertebrae. The needle is gently removed, though the catheter stays in place. Through the catheter drugs are inserted which block the pain messages running from the uterus to the mother’s brain. 

When is an epidural put in?

An epidural can be inserted at any time during labour, before or during delivery.

Benefits of epidurals

Some women have very clear ideas on whether an epidural is the right thing for them or not. Speak with your maternity care provider about your individual circumstances.

• Can be very effective as a means of pain relief.
• The mother doesn’t feel any pain though can still feel pressure and push her baby out. 
• Epidurals are safe for a mother and her baby. 
• Can be given at any stage of labour. 
• The mother stays awake during her baby’s birth.

Epidural procedure

• You will need to discuss the procedure with your midwife and/or doctor. An anaesthetist will talk with you about what’s involved and get your consent. 
• The anesthetist will ask you if you have any drug or other allergies.
• A drip will be inserted into your arm and a bag of saline will be started. This is to make sure you are well hydrated and can be given intravenous drugs if needed. 
• You will be assisted to sit up or roll onto your side. This is so the anesthetist can ensure the needle goes into the right place in the lumbar region of your back. 
• Your back will be swabbed (wiped over) with an antiseptic solution. This may feel cold, especially if you’ve been covered with blankets. 
• You will have a local anesthetic injected into your back. This is to numb the area before the epidural goes in. The local anesthetic can sting for a minute or two, especially as it’s being injected. 
• The anesthetist will wait for a few minutes to make sure the local anesthetic has taken effect.
• You’ll be asked to stay very still and they will wait until between your contractions to proceed.
• The anesthetist will then insert the needle into your back. They’ll pull this out and leave the fine tube in the space so that anaesthetizing medication can be inserted. It can take around 15 minutes for an epidural to work. 
• There are two ways the analgesia can be dispensed – you may be given a device called a patient controlled analgesia (PCA) which works by pushing a button so the medication can flow or, the anesthetist or midwife will control the dose of analgesia you receive.
• Your contractions and the baby’s condition will be monitored. 
• Once your baby is born and you don’t need pain relief any more, the tube will be removed. 
• An adhesive bandage will be put on your back where the tubing was removed. 

Will the epidural affect my baby?

No, the medications used in an epidural are very safe. Very small amounts of the medication can filter through to the baby but are not harmful.

Risks of epidurals

For a mother 

• A drop in blood pressure. This is why there is always close monitoring of the mother’s condition after she has an epidural.
• May need a urinary catheter. This is because the nerves supplying and controlling her bladder will be numbed by the epidural.
• Some women get itchy skin.
• May feel cold and shiver.
• Unable to walk and move around in labour.
• Walking may be affected for a couple of hours after the epidural has stopped. 
• The second (pushing) stage of labour may be slowed.
• Increased risk of assisted birth e.g. forceps or vacuum extraction if having a first baby. 
• Tender back where the epidural was inserted. 

Epidural side effects

• A bad headache which can be fixed by a procedure known as a ‘patch’. This is where a small amount of the mother’s own blood is used to seal the hole in the epidural space where spinal fluid may be leaking out.
• There is a very small chance of a skin infection in the area where the epidural was inserted.
• Sometimes epidurals are not as effective as they could be. Other pain relief options need to be explored. 

Top tips for epidurals

• Discuss with your maternity care provider if you’d like to have an epidural. Learn as much as you can about the procedure.
• Avoid making definite decisions about labour pain relief and your baby’s birth until that time. Keep your options open. 
• Let the midwife or obstetrician know how you’re coping with labour pain. It can take up to 15 minutes for an epidural to work so if you think you’re going to need one, let them know early.
• Discuss pain relief options with your partner. Ultimately, you have the final say in what’s right for you. The time to have a debate about an epidural is not in labour ward.

Written for Huggies by Jane Barry Midwife and Child Health Nurse on 25/04/20.