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SugarTown Babies
Information Pages
Epidurals in Labour
An epidural is an injection of local anaesthetic or
pain-relieving drugs (or both) into the lower back to
block the nerves that come from the uterus and the
surrounding muscles.
These arethe source of the pain felt during
contractions in labour.An epidural takes about 10 to 20 minutes to work after you have had the injection.
To have an epidural you will be asked to sit up or lie on yourside.It is usual for you to have an intravenous fluid ‘drip’started if you do not already have one.This will be placed in the back of your hand or your lower arm. A drip is a platic tube that will be introduced by a needle into a vein so that an attatched bag of fluid can administer a fluid solution and if necessary medications.).
Before an epidural is sited you should have or have had the potential negative effects and risks explained to you, include health related risks to yourself and/or baby, and the effects on the birthing process and implications for care.
The basic procedure requires a small hollow needle to be inserted through the skin in your lowerback. The skin is made numb first via a local painkiller which most people report as being a stinging sensation. A very fine soft plastic tube (catheter) is threaded through the hollow needle, this catheter stays in place for as long as you have the epidural but once this is in place, the needle is taken out. It is a misconception that the needle remains in the back.
The catheter is long enough to reach from your lower back to your shoulder and this is secured by being taped onto your skin.
The local anaesthetic and pain-relieving drugs (if used) are then injected through the catheter.
There are three ways that these drugs might be given
- by top-ups,which you ask for when the last dose begins to wear off
- all the time (this is called a ‘continuous epidural infusion’),in which case you will not need top-ups
- through a special drip which you control yourself (‘patient-controlled analgesia’) by pressing a button on a handset that is attached to this ‘drip’.
Your midwife will be able to tell you what options are available in your local maternity unit.
Advantages
Currently, about one in four women in labour will choose to have an epidural.
Most women have said that it gives great pain relief, many say they would have one next time and only a small number of women find epidurals give little or no pain relief
Epidurals appear to have no long-term direct effects on the baby.
We do know that having an epidural
- lengthens the time of labour or the birth journey
- it is more likely that you will need a drip to keep the labour going
- it is more likely that you will need help to give birth using forceps or a ventouse (‘assisted’ birth).About half of first-timemothers who have an epidural in labour need this kind of help, because the effects of the epidural can make labours longerand it can be difficult to
‘feel’ where to push.Your midwife may suggest stopping the
epidural when it is time to push;this means that although you
will then feel the urge to push,you will also feel the pain of
your contractions
- your mobility may be restricted – if your legs feel too numb,
you may need to stay on the bed during labour as it would be
unsafe to walk about
- the drugs used in the epidural can make your blood pressure
drop and your midwife will check your blood pressure
regularly. If your blood pressure drops,you may feel sick or
dizzy andyou should tell your midwife if this is the case.
A few women will need to be given a specific drug that is
injected throughthe ‘drip’ needle to bring their blood pressure
up again
- because the epidural makes you feel numb,it may be
difficult to pass urine and you are more likely to need a small
tube (catheter) put into your bladder to help with this
- the epidural drugs can make your skin itch and you should tell your midwife if this is the case.If the itchiness is uncomfortable, the anaesthetist can change the drugs used in your epidural
- sometimes the epidural only works properly on one side,so you may continue to feel the pain/discomfort from contractions on the other side. If this happens, the anaesthetist should be told,so that they can check the position of the epidural and the drug dosage prescribed
- a small number of women get a bad headache (1:100-200) as a result of the epidural and over half of these women have a very severe headache.You should tell the midwife if this is the case as it can be treated.
- some women still have small patches of numbness on their legs after they have given birth.This is quite rare, only one in 550 women suffer this and the problem does tend to get better on its own though it can last for up to 3 months.
- Permanent damage,such as paralysis (complete loss of sensation and movement) is a possability but is extremely rare
- a woman can have a life-threatening problem because of an epidural this is also very rare. You should find out the individual hospitals and if possible practitioners rates of negative outcomes like this. Most anaesthetist will be able to answer these questions for you and would or should consider these questions an opportunity to better assist your care.
- Although many people believe that epidurals cause more backache,most research has not shown any link.
Some maternity units offer women low-dose (mobile) epidurals, which mean women are able, with help, to walk around during their labour. The injection for a mobile epidural may be given in two parts and a mixture of drugs can be used; otherwise they are similar to ordinary epidurals. Some types of low-dose epidurals may slightly increase your chance of having low blood pressure in labour or a headache afterwards.
Some Considerations
Your midwife may suggest that you don’t start pushing until your contractions have moved the baby’s head low down in the birth passage.If you start pushing once this has happened,there is lesschance that you will need help with forceps or a ventouse to give birth to your baby
Epidurals are the most effective way of ensuring a pain-free labour, although there are other ways of managing the pain.
Epidurals,whilst being effective, are complicated to set up and there can be some involved and far reaching draw backs to having one. It is important to make the right choice for you. Some women decide that they want to have an epidural before they go into labour, while other women prefer to wait to see how they cope with their labour contractions. For some women, the idea of needles might be very off-putting or they feel adamantly against thewhole idea of having an epidural. However,you may change your mind in labour and that is why it is a good idea to know as much as you can about what is available. You can talk to your midwife who will understand that you may want to change your mind at any time. There are, however a few situations when the doctor might recommend that you have an epidural, most would largely be for using a side effect the lowering of the blood pressure for someone who has dangerously high blood pressure.
Read Dr Sarah Buckleys article HERE
