Epidural anaesthesia is one of the most popular means for pain relief during labour. In fact, more women ask for an epidural by name than any other method of pain relief. As you prepare yourself for "labour day," learn as much as possible about pain relief options so you will be equipped and ready to make decisions throughout your birth experience.
What is epidural anaesthesia?
Epidural anaesthesia is regional anaesthesia that blocks pain in a particular region of the body. The goal of an epidural is to provide analgesia, or pain relief, rather than complete anaesthesia, which is total lack of feeling. Epidurals block the nerve impulses from the lower spinal segments resulting in decreased sensation in the lower half of the body. Epidural medications fall into a class of drugs called local anaesthetics, and are often delivered in combination with opioids or narcotics to decrease the required dose of local anaesthetic. This way pain relief is achieved with minimal effects.
How is an epidural given?
Intravenous (IV) fluids will be started before active labour begins and prior to the procedure of placing the epidural. An anaesthesiologist, a physician who specialises in anaesthesia, an obstetrician, or nurse-anaesthetist will administer your epidural. You will be asked to arch your back and remain still while lying on your left side or sitting up. This position is vital for preventing problems and increasing the epidural effectiveness. An antiseptic solution will be used to wipe the waistline area of your mid back to minimise the chance of infection. A small area on your back will be injected with a local anaesthetic to numb it. Then a needle will be inserted into the numbed area that surrounds the spinal cord in the lower back. A small tube or catheter is threaded through the needle into the epidural space. The needle is carefully removed leaving the catheter in place so medication can be given through periodic injections or by continuous infusion. The catheter will be taped to your back to prevent it from slipping out.
What are the benefits of epidural anaesthesia?
• Allows you to rest if your labour is prolonged
• Relieving the discomfort of childbirth can help some woman have a more positive birth experience
• Most of the time an epidural will allow you to remain alert and be an active participant in your birth
• If you deliver by caesarean, an epidural anaesthesia will allow you to stay awake and also provide effective pain relief during recovery
• When other types of coping mechanisms are not helping any longer, an epidural may be what you need to move through exhaustion, irritability, and fatigue. An epidural may allow you to rest, relax, get focused and give you the strength to move forward as an active participant in your birth experience.
• The use of epidural anaesthesia during childbirth is continually being perfected and much of its success depends on the care in which it is administered.
What are the disadvantages of epidural aanesthesia?
• Epidurals may cause your blood pressure to suddenly drop. For this reason your blood pressure will be routinely checked to make sure there is adequate blood flow to your baby. If this happens you may need to be treated with IV fluids, medications, and oxygen
• You may experience a severe headache caused by leakage of spinal fluid. Less than one per cent of women experience this side effect from epidural use. If symptoms persist, a special procedure called a "blood patch", an injection of your blood into the epidural space, can be done to relieve the headache
• After your epidural is placed, you will need to alternate from lying on one side to the other in bed and have continuous monitoring for changes in fetal heart rate. Lying in one position can sometimes cause labor to slow down or stop
• You may experience the following side effects: shivering, ringing of the ears, backache, soreness where the needle is inserted, nausea, or difficulty urinating
• You may find that your epidural makes pushing more difficult and additional interventions such as Pitocin, forceps, vacuum extraction or caesarean may become necessary
• For a few hours after birth the lower half of your body may feel numb which will require you to walk with assistance
• In rare instances, permanent nerve damage may result in the area where the catheter was inserted.
• Though research is somewhat ambiguous, most studies suggest some babies will have trouble "latching on" which can lead to breastfeeding difficulties.
Other studies suggest that the baby may experience respiratory depression, foetal malpositioning; and an increase in foetal heart rate variability, which may increase the need for forceps, vacuum, cesarean deliveries and episiotomies.