Whether your birth plan includes an epidural, you don’t have a birth plan or the thought of an epidural is your worst nightmare, being armed with the facts before going into labour can make everything seem a little less overwhelming.
What is an epidural?
The ‘epi’ part of the word means ‘upon’ and the ‘dural’ part of the word refers to the ‘dura’, a thick membrane that acts as a sack for the spinal cord. When you have an epidural, an extremely thin plastic tube delivers local anaesthetic (the same as what dentists use to make your teeth numb) as a ‘bath’ around the dura, which them seeps through the membrane and makes the nerves of the spinal cord numb. This is important to remember as many people worry that needles are actually going into their spinal cord itself, this isn’t true!
Where can I have an epidural?
Epidurals can only be put in by an anaesthetist. Unfortunately this means that epidurals cannot be used to provide pain relief in a home birth or in a midwife led unit such as a birth centre. Birth centres can be alongside a hospital ward or completely separate. If the birth centre is not connected to a hospital and you change your mind about wanting an epidural during labour, this will mean a transfer to a labour ward which can take some time.
When do people have epidurals?
Epidurals are used in both pregnant women and for non-pregnant people. In non-pregnant patients they are used to provide pain relief in many different cases for example in big operations on tummy’s and chests. In pregnant women, epidurals can be used in labour, to provide pain relief when inducing labour and also for C-sections (as part of a combined spinal epidural (CSE) – more on this later!)
In some cases an anaesthetist may recommend to you that you have an epidural early in your labour, for example if a prolonged or complicated birth experience is anticipated due to your known medical conditions.
Another reason an anaesthetist may advise an early epidural would be if you are significantly overweight, making it a little bit more tricky for an epidural to be put in and therefore potentially taking longer to give you good pain relief.
Can everyone have an epidural?
Most people can have an epidural if they want one but there are some circumstances when the risk of having an epidural is too great. Some of the more common reasons that an epidural may not be an option to relieve pain in labour include but are not limited to: if you take blood thinners (excluding aspirin), if you have a low platelet count, if you have an infection of your back in the region where an epidural would go, if you have a blood infection or if you have had significant back surgery. Everyone’s medical situation is different so please discuss your individual circumstances with an anaesthetist.
What does it actually involve? – A step by step guide to having an epidural
- Prior to performing the procedure your anaesthetist will have a good chat with you so together you can decide whether its the best and safest option for you and your baby.
- Once we have all decided an epidural is the right choice for you, If you do not already have a drip (cannula) your lovely midwife will put one in and connect some intravenous (IV) fluids – usually salty water!
- The anaesthetist will then prepare their equipment and get “scrubbed up” This means they will put on a gown, hat, gloves and a mask as this procedure is done under sterile conditions to help prevent any nasty infections.
- Before doing anything your anaesthetist should tell you what they are about to do and what you can anticipate. If at any point you want them to stop or have any questions, please just ask.
- It usually takes approximately 40 minutes from starting the procedure to the onset of good pain relief.
- With the help of your midwife you will be asked to get in to a position that helps find the perfect spot for the epidural. Think of making the shape of an angry cat, a prawn or a banana. You should drop your shoulders down like a grumpy teenager and push your back out to make a c-shape with your body.
- Next the anaesthetist will clean your back with a cold sterile solution and then cover the area with a sticky plastic cover, this helps keep everything super clean and must not be touched by anyone.
- Using a very fine needle the anaesthetist will then numb your skin using local anaesthetic. This can sting a little bit for a few seconds, like a bee sting, before going numb.
- Once the area is numb, the epidural catheter (a very thin plastic tube) is put into your back. This shouldn’t be too uncomfortable, but you may feel some pushing and it can sometimes feel a bit like a dull tooth ache in your back. During this step it is really important that you stay really still. Many women think that they won’t be able to whilst they are in labour but your midwife is there to help you every step of the way.
- After the epidural catheter is fixed in place with tape you are free to move. It’s important to remember that there is nothing sharp (e.g. needles) left in your back after the epidural has been placed.
- The key to an epidural going in easily is good communication between you and your anaesthetist. You must let them know if you’re having a contraction and they might pause, or if they are in just the right spot they might ask you to hold still.
- Once your epidural is in place a special combination of pain killers is put into the plastic tubing. From this point it can take around 20-30 minutes to feel the full benefits. Usually each contraction becomes less and less painful. After the first dose is given by the anaesthetist, depending on which hospital you are in, further doses are either given by your midwife or via a pump which you control. Don’t worry, you can’t overdose yourself!
- While the epidural is starting to work your midwife will take your blood pressure frequently (about every 15 minutes.) Your anaesthetist will also come back and check that they are happy with how the epidural is working by testing whether you can feel a cold spray on your tummy or legs. The nerves that carry the signal that you have pain to your brain also carry temperature too. So if you can’t feel cold, you won’t feel pain either. How clever is that!!
Does having an epidural hurt?
Charlie had an epidural when she gave birth to her baby: “I remember having my epidural put in very clearly. I had an elective caesarean section due to the position my baby was in. The local anaesthetic does sting but the area very quickly became numb. I did then feel some discomfort like an electric shock as the epidural was being placed but I spoke to my anaesthetist the whole time and the procedure was over very quickly. My husband was able to hold my hand throughout, this stopped him watching too!”
On this note, we really recommend that husbands do not become curious at this point as to what an epidural is. The anaesthetist has to concentrate hard and by all means ask questions before or after but it’s best to just support your partner during! We all can also count on many hands how many of the wonderful birth partners have fainted by trying to watch epidurals be put in. Our top tip would be to sit facing your partner, holding her hand and uttering useful words of support.
What is a combined spinal epidural (CSE)?
A CSE is very similar to having an epidural. It does the same thing as an epidural i.e. makes the discomfort go away from your waist down, however, the technique is slightly different. Whether you have a CSE or a standard epidural is not a decision that you would have to make, it would usually be up to the anaesthetist to decide what variety suits you better.
A CSE includes one more step than an epidural and this is placing anaesthetic into the sac that holds your spinal cord (this is why it’s a combined “spinal” & epidural). The benefit of doing this is that the onset of pain relief is quicker as the local anaesthetic (numbing medicine) doesn’t have to seep across the sac wall like it does with an epidural, it gets delivered right into where it needs to be. In some hospitals a CSE is given to almost all women requesting an epidural but in others it is used for only a few women. It just depends where you are!
What is a mobile epidural?
We often get asked by our lovely women whether they can have a ‘mobile’ epidural. What’s great is that all epidurals that anaesthetists now give for labour are ‘mobile’ epidurals. This is because a study done in 2001 called COMET demonstrated that ‘mobile’ epidurals are superior to what we used to give. In particular they are associated with a 25% reduction in needing help to deliver baby using instruments such as forceps compared to the old method. Hence, we now call ‘mobile epidurals’ just ‘epidurals’ as we no longer use the traditional type.
If you do decide to move around during labour, you must be accompanied at all times and won’t be going very far from the edge of your bed. This is because you need to be monitored and having an epidural can alter how your legs feel meaning the chances of you falling over are high. You definitely don’t want that to happen!
What are the positives of having an epidural?
Epidurals have consistently been shown to provide better pain relief when compared with other forms of pain relief used in labour. By decreasing the discomfort of labour, some women have a more positive birth experience.
If you have a prolonged labour and are exhausted, taking away the discomfort can allow women to have a rest and be better prepared for the pushing stage.
Compared to some other painkillers given in labour such as pethidine and “gas & air”, you remain alert after having an epidural allowing you to play an active part in the birth of your baby
If an epidural has been put in during labour and is working well, if you or your baby’s circumstances change, for example needing help with forceps or an emergency c-section, in most cases the epidural can be used to quickly make you totally and completely numb from just below your breasts and no further injections in your back are required.
- Studies have now shown that having an epidural does not increase the likelihood of you having a caesarean section.
- Studies have also shown that epidurals do not increase the likelihood of back pain after childbirth. Back pain is common after having a baby with almost 50% of women reporting it 6 months after delivery whether they have had an epidural or not.
- Studies have shown that epidurals are not associated with an increased risk of severe tears.
- Having an epidural should not affect the condition of your baby when it is born.
- Having an epidural does not make it harder to breastfeed.
What are the negatives of having an epidural?
In terms of your labour:
- Having an epidural can make your labour last slightly longer. You will however, hopefully be much more comfortable. In the study that looked at this, the first stage (contractions and the opening of your cervix) increased by 42 minutes and the pushing stage was increased by 14 minutes (compared to with no epidural.) To put this in context, every woman and labour is completely different but for a first time mum the average first stage is around about 13 hours and the second stage is anything from 20 minutes to two hours.
- Having an epidural increases the likelihood of you having an ‘instrumental delivery’ (this mean helping your baby out with either a suction cup or forceps).
- Having an epidural makes it more likely that you will need some medication (oxytocin) to make your contractions stronger.
Other side effects or complications associated with epidurals:
- The most common complication is that the epidural doesn’t work as well as we would like and as a result you need some additional pain relief. This happens in around 1 in 8 women. The epidural may need to be adjusted or even taken out and put in again.
- As we mentioned before, an epidural can be used to make you numb enough should you need to have an emergency C-Section. However, in about 1 in 20 women the pain relief it provides just doesn’t cut the mustard and you may need to have another injection in your back (a spinal) or be drifted off to sleep (a general anaesthetic.)
- You may find it difficult to go for a wee after having and epidural. This is because the nerves that tell your brain your bladder is full are also numbed by the epidural. Most women have a tube passed into their bladder (urinary catheter) after having an epidural put in. Don’t worry, because you are nice and numb from the epidural, it doesn’t hurt!
- Some women will experience a drop in their blood pressure which might make you feel a bit sick or light headed. There is a significant drop in blood pressure in around 1 in 50 women. This normally improves with some fluids into your vein, which is why we always make sure you have a drip in before we start!
- Having an epidural can be associated with a fever. This is a known side effect of epidurals but may lead to you having investigations done to rule out infections and is associated with a greater use of perhaps unnecessary antibiotics.
- The medicine given in epidurals can make you feel itchy but this will go away once the epidural is stopped. If you do feel itchy, please do let your midwife or anaesthetist know as there is medication that can help reduce the itch!
- 1 in 100 women that have an epidural will experience a severe headache that may need further treatment. We will go into more detail about this type headache in a future post.
- Some women may experience a temporary numb patch on their leg or foot or have weakness in a leg that gets better in under 6 months. This happens in approximately 1 in every 1000 women that have an epidural. Very rarely this can last permanently in the case of 1 in 13,000 women. This is about the same risk of you dying from being electrocuted in your lifetime!
- Very rarely women experience serious complications from having an epidural. These include the epidural causing: an abscess (1 in 50,000), meningitis (1 in 100,000), accidental unconsciousness (1 in 100,000), a blood clot around the spinal cord (1 in 170,000) and paralysis (1 in 250,000).
Overall, like with any procedure associated with labour and childbirth, the risk and benefits to both mother and baby must be carefully considered. Epidurals can provide the most wonderful pain relief for women really in need but they do come with their own risks. Make sure you’re armed with as much knowledge before you go into labour and if you have any questions, do reach out to your midwifery and medical team. If they don’t know the answer, they will contact an anaesthetist who will!