When an epidural is used it provides the most effective form of pain relief possible. It works by blocking pain-transmitting nerves that supply the uterus without seriously affecting motor function. It is a very safe procedure with less than a 1 in 10 thousand risk of serious problems.
An epidural is normally only given when you are in established labour- which will be confirmed by one or two examinations by a midwife or doctor. Established labour is usually confirmed when your cervix is more than 3cm dilated. The epidural has to be administered by an obstetric anaesthetist and involves inserting a small plastic tube or catheter into the epidural space in the back, which is outside the spinal cord. A local anaesthetic injection will be given first to numb the area before the epidural tube is inserted. Once inserted, it may take 10-20 minutes to become fully effective and the catheter/tube is left attached so that top-ups can be given regularly as required, by the patient herself or by the midwife. It may give complete pain relief and in 90-95% percent of cases is very effective. The epidural will be put in place in between contractions, so you will not have to worry about trying to stay still whilst you are contracting.
In theory, an epidural can be inserted any time in labour but if labour is going very rapidly and you are almost fully dilated it may be better to consider another form of pain relief or see if you can continue without pain relief, as having an epidural very late in labour can reduce sensation and the urge to push and can slow down labour. Having an epidural doubles the chances of needing an assisted delivery as you do not feel the urge to push and therefore may not push as effectively. An epidural may sometimes not be in the best interests of you and the baby. If you are nearly fully dilated, it is possible that an epidural could cause a drop in your blood pressure. This in turn could affect the baby’s heart rate and cause an unexpected drama and even occasionally an emergency Caesarean if doctors are worried about the baby’s condition. But this is not a common occurrence.
You will also have no awareness of your bladder filling up, meaning that your bladder can stretch and might become damaged- so you will need a catheter to drain your bladder whilst the epidural is in place.
You will also need an intravenous drip to keep you hydrated and to correct your blood pressure if it drops or rises.
The position you are lying in can be important – your midwife will instruct you how best to lie – this will normally be sitting up or lying on your side rather than lying down flat on your back. This is for the same reason that it may be uncomfortable to lie on your back during the late stages of pregnancy, the weight of the uterous can push down on the major vein that should be returning blood from the veins to the heart and can affect the flow of blood to the baby. Some patients can remain mobile during their epidural, but most are more comfortable on the bed as your legs may be weak due to the lack of feeling in the bottom half of your body.
If it is managed well, an epidural can be used as part of a very satisfying and painless delivery. To optimise chances of a spontaneous delivery (without forceps or Ventouse) you need to listen to your midwife or doctor about the volume and timing of top-ups especially in second stage of labour, before pushing. Some women are able to push effectively with a total block but many cannot feel to push and will then need assistance in the form of forceps or Ventouse. Generally, the more you can feel the better you can push, and the more epidural you have had, the less likely you will be able to push the baby out. There is a window of opportunity that a good midwife or doctor will be able to try and steer you towards– the idea is to try and let the epidural wear off enough so you have enough sensation to push, but not are not in uncontrollable pain. The skill of the midwife or doctor and the understanding and agreement of the woman are essential for this to work.
A common observation of husbands, birthing partners, doctors and midwives is the complete change in atmosphere after an epidural is given. The woman can turn from irrational, foul-mouthed, screaming banshee to a calm and collected, normal human being, capable of having normal conversations and making rational decisions. Women report feeling totally normal as soon as the epidural starts working. If before you have been writhing in pain, unable to speak or concentrate on any questions you are being asked, you may well find you can now relax, sleep, watch a film, chat to you partner or doctor and you may feel that you regain control of the situation.
If you are being induced you may be more likely to need or want and epidural. (see our section on Induction)
A Spinal Block is an injection of anaesthetic into the spinal cord. It is a very dense and even block of pain and works very rapidly within 5 minutes and lasts for up to 2 hours., making it ideal for an emergency caesarean.