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Epidurals: Your questions answered

Without a doubt, epidurals are the most effective form of pain relief for labour and have a special place for many women giving birth. Some recall the anaesthetist who ‘took away’ their pain with huge affection! But it’s important to remember there can be side effects that come with epidurals, so it’s best to get all the facts and make an informed choice about what’s best for you.

What is it?

An epidural is an anaesthetic injected through a hollow needle into the space just outside your spinal cord’s outer membrane. It’s given by an anaesthetist. A fine plastic tube is fed through the needle, the needle is then removed and the anaesthetic continues to be administered through the remaining tube. This numbs the lower part of the abdomen, easing the pain of contractions.

How is it given?

The anaesthetist will ask you to lie on your left side, knees curled up, or sit on the edge of the bed, with your feet on a chair and chin tucked in.

It’s extremely important that the injection goes into the right space, so it’s essential you keep still as it’s administered – easier said than done with frequent contractions. The midwife will make sure the anaesthetist is aware of when you have a contraction.

The anaesthetic feels like liquid ice, numbing your tummy, bottom and legs, and deadening the nerves that carry pain signals from your uterus. It can be topped up by your midwife, or is given continually through an infusion pump.
Some units use PCA (patient controlled analgesia), allowing you to press a button to top up your epidural when you feel you need it. A cut-off stops when you administer too much.

How is a mobile epidural different?

A mobile epidural enables you to move around a little. Both kinds of epidural are set up in the same way, but the ‘cocktail’ of drugs is slightly different. For some, a mobile epidural means they have some sensation in their legs, others can stand, or move with support.

Are there any risks?

Epidurals can cause problems, though rarely, and considering how many Australian women use them, problems should be kept in perspective. Numbness in your legs, lasting up to three months, occurs in around one in 1,000 cases, or a severe headache in around one in 100, after leakage of fluid from around the spinal cord.

Permanent paralysis is almost unheard of nowadays. There’s no evidence that epidurals cause long-term back problems.

Will I have to give birth on my back?

The position you give birth in will depend on how powerful the epidural is. Women who have an epidural where they have no feeling from the top of their bump down will inevitably end up lying or sitting in bed, which can slow down labour. But women who have a mobile epidural may find they can stand or kneel to give birth.

Can anyone have an epidural?

Most women can have an epidural, however some would be advised against it, such as those with a blood-clotting disorder or pre-existing back problem. It’s much better for your back if you can move around to find the position most comfortable for you. Women who’ve previously had a caesarean and are planning a vaginal birth should avoid an epidural in order to keep labour as normal as possible, and also so they’re aware of any pain from the scar on their uterus.

Does it always work?

In 96 per cent of cases it provides excellent pain relief. For the other four per cent, the anaesthetist may try to re-site it. Some women find they get a ‘partial block’ on one side. Sometimes a change of position helps to distribute the drug more evenly.

When will I have it?

You should be in established labour, and if you’ve remained mobile for some time, you’ll have helped the baby descend lower into the pelvis. There isn’t really a ‘cut-off’ point. For some, it’s still appropriate even if their cervix is already 8cm dilated, as progress may have been slow with the baby in an awkward position.

If you’re in the second stage of labour and are heading for a forceps delivery, a spinal anaesthetic may be recommended. Similar to an epidural, it takes about six hours to wear off fully, while an epidural usually wears off within an hour or two.

THE DRAWBACKS
★ The anaesthetist may not be available.
★ There’s an increased risk of instrumental birth and caesarean.
★ Increased risk of episiotomy.
★ The baby needs to be continually monitored.
★ You’ll have a drip set up in case your blood pressure falls.
★ Contractions can slow down – you might then need another drip to speed things up.
★ Restricted movement, if at all.
★ May need to be catheterised.

“I had no idea when I was having a contraction”.
“It’s weird not being able to feel what’s going on with your body. I had no idea when I was having a contraction and just couldn’t push properly. Though it was good not to have any pain, I still felt out of control.”
Nula Greig, 24, mum to Oscar, three months.

THE POSITIVES
★ It numbs the entire area from your waist down and is an excellent form of pain relief – particularly with long labours.
★ It can lower your blood pressure if it’s very high.
★ You will feel alert but also able to sleep if very tired.

“I was sitting up in bed watching Neighbours!”
“Although I’d said all along that I didn’t want an epidural, I had no idea that my labour would go on for so long. I was at 7cm dilated for four hours and in the end was pleading for an epidural. I’ve never been so pleased to see anyone as when the anaesthetist walked into the room. Half an hour later I was sitting up in bed watching Neighbours and contracting in complete comfort and control – I’d definitely recommend it to anyone!”
Jemma Pemberton, 36, mum to Lilly, eight weeks.

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