Epidural
Effects
- Can ease pain and help you relax
- The most effective method of pain relief in labour
Who
Almost anyone with the exception of women with allergies to local anaesthesia, abscess/infection at the injection site or coagulopathy.
How
An epidural is administered by a doctor – an anaesthetist. If you decide you want an epidural when you are in labour, then your midwife will call the doctor. An epidural cannot be booked in advance, but the doctor will get to you as soon as possible, usually within 1 hour.
Before the epidural is administered, the midwife will monitor your baby's heart rate continuously with the CTG monitor, measure your blood pressure and put a salt water drip in your hand. The drip in your hand is because one of the common side effects with the epidural is lowered blood pressure. It may be necessary to administer medicine through the drip if your blood pressure drops below a certain point.
It takes approximately 10-15 minutes to administer the epidural. You can either sit or lie on your side as it is given. You need to arch your back “push your back out". The doctor and midwife will help you and tell you what they are doing throughout the procedure.
The doctor will start by washing your back to keep it as sterile as possible during the procedure. He will inject a local anaesthetic under the skin at the location where the needle will be inserted. When the local anaesthetic is working, the doctor will insert the needle into your back. Through the needle, the doctor inserts a very thin plastic tube, also called a catheter, into the location of the nerves causing your pain. When the catherter is placed, the needle is removed. The only thing remaining in your back is the very thin plastic catheter which is secured to the outside of your back with tape to prevent it from moving or falling out. Through the catheter you will be administered pain relieving medicine continuously via a small pump. The medicine given is a mixture of a local anaesthetic and a morphine-like drug.
Your contractions and the baby's heart rate will be monitored continuously with the CTG monitor after you have had an epidural.
How quickly does it work?
After the catheter has been placed and the medicine has been given, you will usually feel an effect after 10-15 minutes. Maximum effect is usually reached after 25-30 minutes. When the epidural is effective, the doctor leaves. The midwife continues to care for you.
How effective is it?
At best, you do not feel the contractions at all, very little or have a tightening sensation. The epidural is most effective on the pains in the uterus and less on the pains caused by the baby's head stretching the pelvic floor and the vagina in the late stage of labour. You will usually start to feel the contractions again at this stage. An epidural does not increase your risk of caesarean section.
Side effects
- Lowered blood pressure: May cause nausea or dizziness and can affect the baby's heartbeat temporarily. Lowered blood pressure can be treated with medicine.
- Problems passing urine: The epidural numbs your bladder which can make it difficult to feel when you need to pass urine. The midwife will remind you to go to the toilet regularly and if you are unable to pass urine yourself, she will insert a catheter and empty the bladder for you. The catheter is removed when your bladder is empty.
- Itching: Due to the morphine-like medication given, you may feel itching. It goes away after the epidural is removed.
- Fever: An epidural can cause fewer. It happens to approximately 24% of women, who have an epidural. You may be given penicillin.
- Longer birth: An epidural may cause you to dilate slower and it may take longer for you to push out the baby which increases the risk of needing a ventouse to help you deliver your baby.
- Headache: An epidural may cause you to get a headache during the first couple of days after giving birth. It happens to 1-2% of women. The headache occurs because the doctor accidentally has pierced the membranes surrounding the spine during the procedure. You will feel the headache as you stand up and it will go away when you lie down. The headache needs to be treated by an anaesthetist otherwise it does not go away until after several weeks. The treatment consists of the doctor injecting a small amount of your blood into the area by the membrane surrounding your spine.