Dr Chiara Hunt and Marina Fogle, founders of The Bump Class, explain everything you need to know about epidurals and how the pain relief works during labour.
You’ve probably heard the word epidural thrown around when discussing your birth plan or during your antenatal classes. Considered the ‘gold standard’ of labour pain relief, the subject spurs much debate and mixed feelings among expectant mums. But what actually is an epidural? And how does it work?
On The Bump Class, we recommend that all women know what an epidural involves, understand how it’s carried out and what the risks and side effects are so that, if they need one, they can make an informed decision about whether it’s appropriate for them.
What is an epidural?
An epidural is an injection of a combination of local anaesthetic and painkiller. It’s injected into the lower back and makes all the pain of labour go away.
People have mixed feelings around epidurals – some are scared that an injection near the spinal cord is dangerous and could cause paralysis, while others feel that only those with a low pain threshold “succumb” to an epidural and that as a result, labour is less of a rite of passage.
The trouble is, until you are in labour, you’re not going to know what it feels like and are therefore unable to tell whether you need an epidural.
How is an epidural carried out? And how does it work?
An epidural is always performed by an anaesthetist whose job it is to administer this type of pain relief every day; because of this, they are very good at their jobs.
The mother is asked to sit or lie down, bending forward to make space between the bones in her spine. The anaesthetist will first inject a little local anaesthetic into the skin in the back.
This is a sharp prick, no more painful than a normal injection. After this, no pain should be felt. Once the local anaesthetic is in, the anaesthetist inserts a needle into a specific space, and once this is in, they’ll insert a tiny plastic tube through the needle.
Once the tube is in place, they remove the epidural needle, so you are just left with a soft, flexible tube, taped to your back, that can be topped up with the medication as required. You should then be pain-free within a few minutes.
Can you still move when you have an epidural?
Epidurals have improved a lot in the last generation and nowadays it’s usually possible to continuously measure and adjust the balance of the dose so that the mother is pain-free but able to move.
This is known as a mobile epidural. This slightly depends on how she, as an individual, reacts to the drugs – some women, especially those who go to sleep or remain immobile, are less able to walk, but for most women, pretty good mobility is standard.
What are the risks of having an epidural? Are their any side effects?
An epidural is a very safe procedure, but as with all medical intervention, it does carry some risks.
In spite of what you may have read before, the risk of paralysis is incredible low, as the epidural is inserted well away from the spinal cord. The spinal cord ends about halfway down a mother’s back and from there the nerves hang loose, floating in spinal fluid. The epidural is inserted right at the base of her back, well away from the spinal cord.
A more common side effect is a postural headache. This is a pesky headache, lasting only when you stand and disappearing when you lie down. It’s caused when the needle punctures the dura, which drops the pressure in the fluid around the brain and spinal cord. This happens in about one per cent of epidurals, and will usually heal by itself but can take a few weeks.
A postural headache can also be fixed if the anaesthetist takes a bit of mum’s blood and makes a little patch over the puncture. It’s not pleasant but it is an uncomplicated, outpatient procedure and usually resolves the headache swiftly.
Another risk is that the epidural will only working on one side. The medicine can trickle down one side of the spine and mean only one side of your body is anaesthetised. If this happens, the doctor will simply repeat the procedure.
The side effects of the actual medication are pretty minimal. Some women say they experience itchy legs, and some get a bit shaky. Both of which are much easier to tolerate than contractions!
What’s the downside of an epidural?
Probably the biggest downside is that having an epidural medicalises your labour. If your labour has been “midwife-led”, you will now be reviewed regularly by doctors.
You would also need to transfer to the labour ward, where you and your baby will be monitored more closely, as you can’t have an epidural at a birth centre.
The medical team will use continuous monitoring, where they attach two disks to your tummy to monitor your contractions and the baby’s heart rate. You’ll probably have a cannula in your arm through which they can give you fluids if your blood pressure drops, plus a blood pressure monitor.
Because the nerves in the lower part of the body are numbed, they will usually put a catheter in your bladder, too. A lot of women hate the idea of this, but it’s only put in once the epidural is working, so you can’t feel it – in fact, it’s often a relief not to be peeing constantly!
Why doesn’t everyone have an epidural?
The majority of women in the UK give birth without an epidural, not because they don’t have access to one, but because they don’t need it. And no one should have pain relief unless they need it. But whether or not you have an epidural has no bearing on how healthy your child will be or how good a mother you will be.
Are epidurals safe for your baby?
It’s safe for the baby and for the mother, so our advice at The Bump Class is to embrace labour with an open mind, confident in the knowledge that effective pain relief, if you need it, is available.
Is it ever too late to have one?
Unless by the time the epidural is in and working, your baby is born, it is never too late to have an epidural.
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