Labour Epidural

What is an epidural?

An epidural is where painkiller drugs are passed into the small of your back via a fine tube. It is called a regional anaesthetic, which means the drug is injected around the nerves that carry signals from the part of your body that feels pain when you're in labour. The result will be that your belly feels numb, giving you very effective pain relief.

How is an epidural put in place?

Your anaesthetist will give you an injection of local anaesthetic in your lower back. She then guides a hollow needle between the small bones in your spine.

The needle goes into the space between the layers of tissue in your spinal column, called the epidural space. A fine tube, or catheter, is then passed through the needle.

Once the tube is in place, the needle is removed. The tube is taped up your back and over your shoulder.

Epidural painkillers are given in several ways:

Your anaesthetist will inject a mixture of painkillers into the tube to numb the lower part of your tummy. If the epidural is working well, you should no longer be able to feel your contractions. As the epidural begins to wear off, you can have top-ups which last between one and two hours.

Injection with top-ups

Your anaesthetist will set up an epidural catheter. The other end of the tube is attached to a pump, which feeds the pain-relieving epidural solution into your back continuously. You can have stronger top-up doses of local anaesthetic as well, if you need them.

Continuous infusion

You'll be given an injection which contains a low dose of pain-relieving drugs , which works more quickly than an epidural alone. At the same time, the anaesthetist will insert a catheter without passing any drugs down the tube. When the effect of the mini-spinal injection starts to wear off, your anaesthetist will pass the epidural solution through the tube to give you ongoing pain relief.

Combined spinal epidural (CSE) mini spinal

How does an epidural work?

It works in just the same way as a local anaesthetic. The anaesthetic deadens the nerves which are carrying pain signals from your uterus (womb) and cervix to your brain.

When should I have an epidural? You can have an epidural at , but most women choose to have an epidural when their contractions are getting pretty strong, which is often when their cervix has dilated by about 5cm or 6cm.

You'll also be offered an epidural if your with a Syntocinon drip. This is a synthetic version of the hormone oxytocin, which makes your cervix dilate and contractions intensify. You may need extra pain relief, because this can make your contractions difficult to cope with.

Once your epidural is in place, it should stay in until after your baby is born and your placenta delivered.

What are the advantages of having an epidural?

There are several ways an epidural can help you while you're in labour.

It usually provides excellent pain relief during labour.

It works fairly quickly, taking about 20 minutes to insert and set up and another 20 minutes once the anaesthetic has been injected before starting to work.

Top-ups can be given by an experienced midwife, so you don't usually need to wait for an anaesthetist once the epidural is in place.

Your mind remains clear. You may still be aware of your contractions, but feel no pain.

If you have , it has a useful side-effect of lowering blood pressure. high blood pressure

It can be topped up with stronger local anaesthetic if you need a caesarean section.

What are the disadvantages of having an epidural?

However, there are some cons to using an epidural as pain relief in labour.

It may not work properly at first. You may find that you are numb in only parts of your tummy. If you're not pain-free within half an hour of the epidural starting, ask for the anaesthetist to come back to adjust it or try again.

It may make you feel shivery.

You may develop itching or a fever.

After Epidural placed

You may need a catheter to empty your bladder. You will need more monitoring. Your baby's heartbeat will be monitored continuously for at least 30 minutes when you're first given an epidural, and after each top-up. Your blood pressure has to be taken every five minutes when the epidural is started, for about 30 minutes, and after each top-up.

You're more likely to need your labour speeded up with a Syntocinon drip. However, hospital staff should give you the chance to have a longer, slower labour, before using drugs to speed it up.

the pushing stage, may last longer if you have an epidural. second stage of labour

There's more chance of your baby needing to be born with the aid of and this may be because epidurals can make it difficult for your baby to move into the best position to be born. Your baby is more likely to end up in a , with the back of his head towards your spine, by the time you're ready to give birth, even if he wasn't in that position when labour started.

forceps or ventouse

posterior position

There is a small risk of you having a severe headache. This can happen if the epidural needle punctures the bag of fluid which surrounds the spinal cord, causing a leak of fluid. There is about a one in 100 chance of this happening. It's usually treated by taking a small amount of blood from your arm, and injecting it into your back to seal the hole made by the needle. This is done after your baby is born, and may need to be done more than once to achieve a seal.

There's a very small risk of nerve damage, leaving you with a numb patch on your leg or foot, or a weak leg. This rarely happens. The risk is about one in 1,000 for temporary nerve damage and one in 13,000 for permanent damage.

 How might an epidural affect my baby?

An epidural can affect your baby directly and indirectly.

It may make your blood pressure drop, which can affect the flow of oxygen to your baby. You'll need to have a small tube, called an intravenous cannula, inserted into your hand or arm in case your blood pressure drops suddenly. Low blood pressure can be treated by fluids fed through the cannula to increase your blood volume.

Epidural solutions contain the opioid, fentanyl, or a similar drug, which can cross the placenta. In larger doses (more than 100 micrograms), these drugs may affect your baby's breathing, or make him drowsy.

Any useful tips? Some additional points about epidurals:

Keep very still while your anaesthetist sets up the epidural. You will either be on your side or sitting on the edge of the bed. You'll be asked to curl forward to open up the spaces between the bones of your spine. Concentrate on your breathing to help you to keep still. Breathe in deeply through your nose and sigh out slowly through your mouth. Hold hands with your birth partner and keep eye contact with him.

Not everyone can have an epidural. Talk to your doctor if you think you have a medical condition that might affect whether you can have one.

If it's important to you to feel your baby being born, ask about letting the epidural wear off before you give birth. Being able to feel the contractions may help you push. However, some women find it hard to cope with the pain and stopping your epidural late in labour won't necessarily reduce your risk of needing to deliver your baby.

K.K.L.I.U 0610/2018

     

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