Epidural During Labour
The most popular form of pain relief used in labour today is the epidural.
Over 50% of women giving birth at hospital will have an epidural at some stage during their labour.
Epidurals were first used for pain relief during labour in the early 1900s. But it wasn’t for another 70 years before epidurals became incredibly popular amongst childbearing women.
Early use of the epidural showed around 40% of women would experience a reduction in contractions, making labour a much longer and difficult process. During the 1970s synthetic oxytocin was discovered, which meant doctors were able to speed up contractions if this side effect occurred.
There are many reasons why an epidural seems like an attractive idea, so it’s a good idea to know the risks and benefits of this procedure well before your labour begins.
What Is An Epidural Injection?
Epidural aneasthesia blocks pain in a particular part of the body by blocking the nerve impulses from the lower spine. During labour, epidurals aim to provide pain relief rather than complete lack of feeling in the lower part of the body.
During natural labour, your body produces oxytocin which is a hormone that stimulates contractions. As contractions get longer and stronger, more oxytocin is released. When you have an epidural in place, oxytocin production is reduced or does not rise. The huge surge of oxytocin that happens in the last moments of birth is also reduced when an epidural is in place.
How Are Epidurals Given?
Epidurals are administered by an anaesthetist. In preparation for the epidural you will need to either lie on your left side or sit up, curling your back so as to open the spaces between your vertebrae. A local anaesthetic will be injected into a small area of your lower back to numb it.
The anaesthetist will ask you to sit very still while a hollow needle is inserted between the small bones of your spine. The needle will go into the epidural space between the layers of tissue in your spine. A very fine tube called a catheter is inserted into the needle and when it is in place, the needle is removed. The catheter is taped to your back and over your shoulder. This allows medication to be provided in a number of ways:
- Injection with top-ups: pain medication can be injected into the catheter which should last between 1-2 hours. As the medication wears off, you are able to have top ups.
- Continuous infusion: the end of the catheter is attached to a pump, feeding pain medication into your spinal area continuously.
- Spinal epidural: you can be given a low dose of pain medication via injection into the sac of fluid below the spinal cord, which works very quickly. This potentially allows you more freedom to move while in bed and ability to change positions without assistance. A catheter can also be inserted and when the spinal injection wears off you are able to have continuous medication if you wish.
Hospitals and anaesthetist will differ on the dosages and combinations of medication, but epidurals will contain a local anaesthetic and a narcotic or oipoid.
Should I Have An Epidural?
During pregnancy it is not uncommon for women to be told to demand an epidural as soon as they get to hospital. The reasons are many: incase the anaesthetist is busy/off site; avoid being in any pain; keeping your dignity; because pain relief is available.
In many cases women believe labour is going to be so painful they will not be able to cope and are afraid of the pain of contractions when they first begin. Women may want to try natural labour but are constrained in their movements or become exhausted trying to get things going, according to hospital policies around labour positions and time. Other women may be induced and find the contractions much more intense than expected.
There are lots of ways to avoid making labour pain worse.
The decision to have an epidural is a very personal and individual one. It should always be your choice and one you make with as much information available.
Benefits of An Epidural
The benefits of an epidural are:
- If labour is prolonged and you are exhausted, an epidural can give you time to rest and recover your strength so you can continue to actively labour
- When epidurals work they are the most effective pain relief available
- Epidurals allow you to be alert and awake for your baby’s birth
- If you require a c-section an epidural allows you to be conscious and aware during your baby’s birth and provides effective pain relief after surgery
- Providing relief from suffering (intense physical and emotional response to pain) can allow you to have a more positive birth experience
Epidural Side Effects And Risks
Epidural side effects and risks include:
- You may only have partial pain relief
- Your blood pressure can suddenly drop which can mean IV fluids, medications and oxygen
- Continuous fetal monitoring is necessary to track baby’s heart rate
- Lying in one position can slow labour or cause it to stop, requiring synthetic oxytocin
- Around 1% of women experience severe headaches from spinal fluid leakage. This requires a ‘blood patch’ which is an injection of your blood into the epidural space
- Side effects from epidurals include shaking, nausea, backache, maternal fever
- Baby may be unable to find an optimal birth position, increasing the risks of an assisted birth with forceps, vacuum or c-section
- The risk of severe tearing is increased substantially and potential pelvic floor problems after birth are more likely after an epidural
- You will be unable to move for a few hours after the birth and will need assistance
- Permanent nerve damage is rare but can happen in the area where the catheter was inserted
- Epidural haematoma (where the epidural causes a clot, which compresses the spinal cord) is rare but does happen. It can cause long term paralysis – here is one mother's story.
The medications in epidurals cross the placenta and babies can be affected by these drugs during labour and for quite some time after birth. During labour babies may experience reduced blood and oxygen supply, causing fetal distress and leading to instrumental birth (forceps or vacuum).
Babies whose mothers developed fever during labour are more likely to be born with low APGAR scores and require assistance such as resuscitation and time in a special care unit. Babies may have difficulties latching or may be less alert, leading to early breastfeeding difficulties that can have long-term consequences.
If you wish to avoid an epidural it is a good idea to find out your care providers philosophy on natural birth. Some research shows women birthing in private hospitals are twice as likely to have an epidural as women in public hospitals.
While the compassionate use of epidurals has its place, the best way to avoid one is to ensure you are supported to have an undisturbed labour, trust in your body’s ability to cope, and avoid being induced.