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Using epidurals for pain relief in labour

The key points


Posted: 26 March 2009
by Maria Muennich

What is an epidural and how does it work?
An epidural is an anaesthetic-analgesic mix delivered to the spine via a fine tube inserted with a curved, hollow needle under local anaesthetic. The anaesthetic in the epidural numbs the nerves in your spine, preventing them from carrying pain signals from the womb and cervix to your brain. It allows you to remain conscious while blocking labour pains and at it's most effective can remove the pain of contractions completely without preventing you from feeling touch and the birth of your baby.

You will need to lie on your side and stay very still for the anaesthetist to insert the epidural. Under local anaesthetic the needle is inserted into the epidural space in the spinal lumbar vertebra, the thin tube is then inserted before the needle is withdrawn and the tube taped in place so that the epidural can be topped up via a pump. The pump may be under your control, or under the control of the medical staff. It usually takes about 10 to 30 minutes for the epidural to take effect.

There are two different types of epidural, a mobile epidural and a full epidural. Under a full epidural you are likely to lose the feeling in your legs and feet and so be immobile. Full epidurals are usually favoured when intervention such as forceps, ventouse or caesarian section is necessary.

Mobile epidurals are a newer technique using a lower-dose anasethetic that should mean that you retain feeling in your legs and feet and control of your bladder and abdominal muscles, while blocking the pain of contractions. The mobile epidural is favoured in most hospitals for many situations as it usually allows you to minimise pain while retaining some of your control over labour and pushing, meaning intervention is less likely than with a full epidural. However, there is no guarantee that you won't experience numbed legs and feet and so limited movement with a mobile epidural.

When can I use an epidural?
Epidurals are most easily administered in early labour and are often used when women are in the last few centimetres of dilation and the contractions are coming thick and fast. When you are nearly fully dilated you may be told it's too late for you to have an epidural, as birth may not be far off. Technically it's never too late for you to have an epidural, but your midwife will help guide you through what is appropriate according to how your labour is progressing. You may also be offered a spinal block at this later stage as an alternative to an epidural as it is faster to administer.

Once in place the epidural can be topped up throughout labour or used solely as a means of providing temporary respite, allowing you to regain your strength but then wear off so you have complete feeling for the pushing stage.

You may be recommended an epidural if you suffer from high blood pressure as it acts to lower your blood pressure.

Advantages

  • A highly effective form of pain relief, most women experience complete relief from pain
  • The anaesthetic does not affect your state of mind
  • An epidural for a c-section allows you to be conscious for the delivery of your baby
  • Can be used to give you a break during labour and allow you to regain strength for delivery
  • At their most effective, mobile epidurals can allow you to feel and work with your contractions through birth and to feel the birth itself, while blocking the pain
  • A mobile epidural may allow you to retain some mobility
  • In the case of intervention being necessary, an epidural is far safer for both mother and baby than a general anaesthetic

Disadvantages

  • With a full epidural you are likely to lose the feeling in your legs and feet as well as control over your bladder - in which case a catheter is used. This is far less likely with a mobile epidural
  • An epidural may slow labour and require Syntocinon to be administered to stimulate contractions. This is less likely with a mobile epidural
  • You and your baby will be monitored closely for signs of fetal distress, dropping blood pressure and rising temperature
  • An epidural may increase the chance of further medical intervention in your labour if it slows labour or interferes with your ability to push in time with your contractions
  • An epidural may result in fetal distress and a lowered fetal heartbeat if some anaesthetic reaches the baby, making an urgent delivery necessary. This is far less likely to occur with a mobile epidural
  • You will need to be set up with a drip to provide you with fluids in the event of your blood pressure dropping
  • In a small number of cases the epidural does not effectively numb all relevant nerves and may need to be repositioned
  • In a small number of cases the epidural may lead to a very bad headache (in the event of some spinal fluid leaking when the epidural is set up)
  • You cannot continue to labour in a birthing pool if you opt for an epidural
  • In very rare cases an epidural may have serious side-effects. Nerve damage from the needle is a possibility but it is extremely rare. With higher doses of anaesthetic there may be an impact on the nerves controlling chest movement meaning assisted breathing with a ventilator is temporarily necessary, but this is rare with mobile epidurals

Availability
Epidurals can only be administered by a qualified anaesthetist - although once set up control will pass to your midwife or even to yourself - which means they are not available for home births. Epidurals are usually available in hospitals, but the hospital policy on administering epidurals may not fit with your requirements, so it's best to check in advance. Also, you should remember that there may not be an anaesthetist available when you decide you want an epidural. If you know in advance that you will want an epidural then check the policy regarding epidurals in your chosen hospital and make your wishes clear to your birthing team as soon as you can.


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Use of spinal blocks for pain relief in labour

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