Pain relief in labour: Epidural

An epidural is an injection of a mixture of drugs into the space just before the spinal nerves. In labour the epidural is placed so that the nerves which carry messages from your womb, your lower back, pelvis and perineum are bathed in a combination of local anaesthetic and pain relieving drugs.

Epidural and spinal anaesthetics, which are similar, are the only available methods of pain relief used in labour that can potentially relieve all your pain.

In order to have an epidural you need the services of an anaesthetist. Most large hospital units have an anaesthetist on call 24 hours a day, but this will vary in smaller units.

The anaesthetist will first explain the procedure to you and make sure you understand it. He will then site a canula, this is a small, hollow, flexible tube placed in the back of your hand or lower arm to allow a drip to be started if it is needed. You will then be asked to either lie on your side or sit up and curve your back out. The anaesthetist will place some local anaesthetic in the skin and muscle of your back. He will then put a needle in your back to find the epidural space. A fine, flexible tube is pushed through this needle, which is then removed. The drugs are given through the tube, which is known as a catheter.

The epidural is usually working within 10 to 20 minutes. It remains in place until after you have delivered your baby.

A measured amount of drugs may be given each hour or your epidural may be topped up using a syringe. In some places you are able to control the amount of pain relief you receive yourself by pressing a button.

Occasionally epidurals do not give good pain relief, if this happens to you your epidural may need to be repositioned, a different combination of drugs used or possibly replaced.

Advantages of epidurals

• Epidurals nearly always give good pain relief
• Because the drugs used are injected into your back, very little goes through to your baby.
• An epidural can help to control your blood pressure if it is a little high while you are in labour. (if you have very high blood pressure and your blood clotting is affected then it may not be safe for you o have an epidural, but this is rare).

Disadvantages of epidurals

• Your blood pressure may drop, which can make you feel sick and dizzy. If this happens you will be asked to turn onto your side, you may be given fluid through a drip and might possibly need an injection to bring your blood pressure up again.
• Your labour may slow down. You are three times more likely to read a drip to speed things up.
• Your mobility is likely to be limited this will vary so it is a good idea to ask your anaesthetist what to expect.
• You may not be able to pass urine. If this happens a small tube (catheter) will be used to empty your bladder.
• You may feel itchy, sometimes the combination of drugs used can be altered to help relieve this.
• You may feel itchy, sometimes the combinations of drugs used can be altered to help relieve this.
• A small number of women develop a severe headache following an epidural, usually this can be treated effectively fairly quickly, but it can sometimes last for a number of weeks.
• You may develop a high temperature which could lead to an abnormally fast heart rate in your baby. This may lead to you and/or your baby being treated with antibiotics and screened for infection.
• There is an increased risk of your baby being delivered by forceps or ventuse.

Some of the disadvantages of having an epidural are less likely to be a problem if the epidural is not commenced in early labour. It is a good idea to try out some coping strategies first and see how you get on.