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BY MONIQUE MAITLAND | REGISTERED MIDWIFE & CHILDBIRTH EDUCATOR I MIDDEE SOCIETY | MIDDEE PODCAST
Epidurals have become an increasingly popular pain relief option for many women during labour with its aim to provide relief from contractions. Let's delve into what epidurals are, how they work, their potential risks and benefits, and when it's best to consider them during labour.
1. How does an epidural work?
An epidural is an injection of analgesia into the epidural space, which runs along the spine. This anaesthesia works by blocking pain signals from the lower spinal nerves, which effectively numbs the lower half of the body and therefore blocks the ‘pain’ associated with contractions. During the insertion of the epidural your back is numbed with local anaesthetic and then a needle is inserted into your epidural space. From here a small plastic tube, called an epidural catheter, is threaded between the bones of your spine into the epidural space to allow a continuous flow of medication.
2. What are the risks or side effects associated with epidurals?
An epidural is a medical intervention and just like any medical intervention, epidurals do have potential risks & limitations. The risks can range from mild to more severe. Like any intervention it is always important that these risks are explained to you to allow you to make an informed decision.
- Common risk factors and side effects:
- Drop in your blood pressure - common 1 in 20: This can make you feel quite lightheaded
- Require additional anaesthetic: Common 1 in 8
- Post dural headache 1 in 500
- Less common risk factors and side effects
- Nerve damage - Very rare Less than 1 in 13,000
- Epidural infection / meningitis - Very rare 1 in 50,000
- Epidural blood clot - Very rare 1 in 170,000
- Unexpected anaesthetic spread - Very rare 1 in 100,000
- Severe injury, including paralysis - Extremely rare 1 in 250,000
3. What are the pros / cons of an epidural?
- Advantages of an epidural
- When working well removes all discomfort from contractions
- When the cervix is identified to be swelling can help relax your body and prevent further swelling
- Disadvantages of an epidural
- Requires you to be continuously monitored via CTG
- Requires an intravenous cannula
- Requires you to have a catheter into your bladder
- Doesn’t get rid of the feeling of pressure
- Can cause uncontrollable shakes
- Can cause itchiness
- May work only on one side
- Limited mobility
- May not have the urge to push
- Pushing can be more challenging with reduced feeling
- May require coached pushing form your Midwife
- Can slow down the progression of labour
- More likely to require oxytocin
- Increased risk of operative delivery/ c-section
4. When is the best time to request an epidural during labour?
As a midwife our philosophy is to promote an intervention free birth. In labour we would always encourage the use of non pharmalogical pain relief options such as movement, massage, tens & water immersion prior to using pharmacological options like an epidural.The decision of when to get an epidural can vary from person to person depending on that individual’s pain tolerance and labour progression.
Ideally when opting for an epidural it is best to wait until you are in active labour. Which is defined by cervical dilation ≥ 5cm and full effacement (thinness) of the cervix in the presence of strong uterine activity. This is because it has been shown that if you get an epidural in early labour where your oxytocin levels are suboptimal it can slow down your contractions and stall labour progression. This will then increase your need for intervention via either artificially breaking your waters or the oxytocin drip, kickstarting the cascade of intervention. Meaning when you have one intervention it puts you at higher risk of requiring another.
5. When & why does it become too late to request an epidural?
There’s a misconception that midwives will try to delay an epidural when a woman asks for one. This is simply not true. The only time it is too late to have an epidural is if you are about to give birth to your baby and you’re quite literally sitting on their head. This is because the set up time of an epidural is around 20 minutes requiring another 20 minutes for the medication to become effective. The woman also needs to be able to sit completely still during administration. Therefore it has to be appropriate timing to allow for both the set up and therapeutic effects to take place.
6. Can I still move around and actively participate in labor with an epidural?
While an epidural provides significant pain relief, it also causes loss of sensation and mobility in the lower body. For example if I placed an ice block on your foot you wouldn’t be able to feel the coldness. Within Australia we currently do not allow walking epidurals which you may have seen in other countries such as America. For women in Australia they will remain in the bed once an epidural is inserted for safety reasons. However, a good working epidural will still allow you to have mobility. Meaning you can still move your legs allowing you to rotate onto your side or knees when on the bed.
7. How long does the effect of an epidural last, and can it be adjusted?
Once the epidural is inserted we want the effects of it to last for the entirety of your labour and birth. When you have an epidural you are given a PCA, which stands for patient controlled analgesia. This allows you to be in control of the amount of medication you will receive. You can continue to press a button every 15 minutes, or when needed which delivers analgesia into the epidural space to prolong it’s effects. If required, the epidural can be adjusted or supplemented with additional medication to maintain adequate pain relief.
In conclusion, epidurals can be a valuable tool for managing pain during labour, but it is always essential to weigh up the risks and benefits to make the best decision for you and your baby.
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