An epidural is a type of pain relief technique that can be placed by an anesthesiologist during labour. It involves a small tube placed in the lower back that delivers a small amount of anesthetic and pain medication to numb nerves in the lower back and pelvis.
TECHNIQUE
You will need to sit upright, with your lower back curved outward, as in a cat stretch. You need to sit very still during certain parts of the procedure. The skin is then numbed with local anaesthetic. A needle is inserted between vertebrae into the epidural space and a small plastic catheter is then threaded into this space while the needle is removed. The tube is secured in place with an adhesive dressing. The tube stays in place for the duration of labour and delivery to deliver anaesthetic and pain medication.
It often takes effect within fifteen minutes, reaching full effect usually by thirty minutes. Often our anesthesiologists place PCEA(patient controlled epidural analgesia), which allows you to give yourself more medication if you begin to experience more pain with your labour. It is pre-set so that you cannot accidentally give yourself too much medication,
EFFECTIVENESS
Epidurals are most often extremely effective in reducing the pain of contractions. Many women experience only mild pressure with contractions. The dose of medication is adjusted according to the patient’s needs. It does not completely relieve the pressure sensation in the vagina and rectum during the later stages of labour. Occasionally, pain relief is patchy or one sided. This can usually be improved by adjustments that the anesthesiologist makes in catheter placement, but does uncommonly require the epidural catheter to be replaced.
COMMON SIDE EFFECTS
It is common for blood pressure to fall, but this can be treated quickly and effectively. Numbness, tingling or heaviness in the legs is a frequent occurrence, and disappears within a few hours of delivery. Itching is also possible due to the narcotic medications infused though the epidural catheter. As well, bladder sensation is occasionally temporarily affected, and may require a catheter to empty the bladder. This sensation returns within a few hours of delivery.
A less common side effect (2-3%) is a post-epidural headache, which can be caused by inadvertently placing the epidural catheter though the dura, the outer covering of the spinal cord. This headache can occasionally be severe, but is temporary and can be treated by laying flat and by placing a patch over the dural space.
RARE SIDE EFFECTS
A small number of patients experience minor neurologic symptoms post delivery, such as patches of numbness. This usually resolves with time, and is not necessarily related to epidural analgesia, as delivery of the baby’s head through the pelvis also can cause compression of pelvic nerves.
COMMONLY ASKED QUESTIONS
Does an epidural increase the chances of a C-section?
There is no evidence to suggest that epidurals increase the risk of a Caesarean section. This is the position of the American College of Obstetrics and Gynecology.
Does an epidural affect the progress of labour?
An epidural can occasionally slow down contractions during the first stage of labour(0-10 cm dilated). This can be treated by giving the hormone oxytocin. It often has no effect on progress through the first stage, and occasionally speeds progress through the first stage of labour, as it allows relaxation even during contractions. The second stage of labour (from 10 cm dilated to delivery) can be slightly longer with an epidural, but there is no evidence that this is harmful to either mother or baby.
