Labor & Delivery

Labour Analgesia: The Role of Epidural

Labour Analgesia: The Role of Epidural

Introduction 

Childbirth is a significant event in a woman’s life, often accompanied by considerable pain. Effective pain management is crucial for a positive birth experience. One of the most commonly used methods for pain relief during labour is the epidural. This article explores the use, benefits, effectiveness, and considerations of epidural analgesia in labour.



What is an Epidural?

An epidural is a procedure used to relieve pain during labour and birth. It involves injecting a local anaesthetic into the space around the spinal nerves in your lower back, performed by an anaesthetist. It works by temporarily numbing the nerves carrying pain signals during labour and delivery.



When to Take an Epidural

You can have an epidural at any stage of labour, usually during the first stage. It cannot be offered before labour begins and may be difficult to insert if you wait until late in labour.



Pre-Procedure Preparation

Before the epidural, you will have a cannula in a vein in your hand or arm, and a drip for fluids will be put into your arm.



Procedure

  1. Positioning: You will need to sit up and bend forward over a pillow or lie on your side curled up into a ball and let your back relax. Staying still during the procedure is crucial to avoid complications.
  2. Antiseptic and Local Anaesthetic: Your lower back will be washed with antiseptic, and a small amount of local anaesthetic will be injected into the skin of your lower back.
  3. Epidural Needle Insertion: The anaesthetist will insert the epidural needle between the bones of your spine into the space around your spinal nerves, usually between contractions. You must keep still and inform the anaesthetist when you have a contraction.
  4. Catheter Placement: A fine plastic tube (catheter) is threaded through the needle, which is then removed, leaving the catheter in place.
  5. Medication Administration: A mixture of local anaesthetic and painkiller is administered through the catheter using an epidural pump, providing continuous pain relief throughout labour.



Effectiveness and Timing

It usually takes 20 minutes to insert the epidural and test it, and an additional 20 minutes to relieve the pain effectively.



Post-Procedure

  1. Leg Weakness: You will develop some temporary weakness in your legs and will need to stay in bed to avoid falls.
  2. Monitoring: The midwife will continuously monitor your baby. Your blood pressure will also be monitored to manage any potential drops.
  3. Bladder Catheterization: You might need a catheter in your bladder to help you pass urine, as the epidural can numb the bladder.
  4. Replacement: Sometimes the epidural may not work well and may need to be replaced.



Advantages of an Epidural

  1. Excellent Pain Relief: Provides significant pain relief during labour.
  2. Recommended with Oxytocin: Useful when labour is augmented with a hormone drip (oxytocin), which can make contractions more painful.
  3. Anaesthesia for Caesarean Section: Can provide anaesthesia if a caesarean section is needed.
  4. Quick Recovery: Most women will regain feeling and movement in their legs within 4 hours after delivery.
  5. Safety: Generally a very safe procedure.



Effects on Labour

  1. Labour Progress: An epidural does not increase the chance of requiring a caesarean section but may prolong the second stage of labour and increase the likelihood of needing an assisted delivery (forceps or ventouse).
  2. VBAC: Epidurals can reduce the chance of requiring a caesarean section for those attempting a vaginal birth after a previous caesarean section (VBAC).



Effects on the Baby

The drugs and doses used in an epidural do not affect the baby.



Mobility After Epidural

While you may experience some tingling and heaviness in your legs, you will still be able to move around in bed. You are encouraged to choose any position you wish to deliver in.



Epidural and Backache

The epidural site may be tender for a few days. Backache is common after pregnancy but is not caused by the epidural.



Possible Problems

Though rare, potential complications include:

  1. Significant Blood Pressure Drop: Occurs in about 1 in 50 cases.
  2. Incomplete Pain Relief: May require additional methods for pain management.
  3. Inadequate for Surgery: May necessitate general anaesthesia if it doesn’t provide sufficient pain relief for a caesarean section.
  4. Severe Headache
  5. Nerve Damage: Rare instances of numbness or weakness in a leg or foot.
  6. Infections: Epidural abscess, meningitis.
  7. Haematoma: Epidural haematoma (blood clot).
  8. Severe Injury: Including paralysis, though very rare.



Cost

There may be extra costs or fees involved with an epidural.



Conclusion

Epidurals remain a widely used and highly effective option for pain relief during labour. They offer significant benefits, including substantial pain relief and the ability to stay alert during childbirth. However, their use should be carefully considered, weighing the benefits against potential risks and side effects. Open communication with your healthcare team is essential to make informed decisions about pain management during labour. By understanding the options available, including epidurals, expectant mothers can approach childbirth with confidence and a sense of control over their pain relief choices.



Message to Patients from Dr. Bushra Gul



Dear Patients,



I am dedicated to providing you with the best care and support during your labour and delivery. The use of epidural analgesia can offer significant benefits in terms of comfort and pain relief. If you are considering this option, please discuss it with your healthcare team to determine what is best for you and your baby.