The use of epidural pain relief during labour is becoming more and more prevalent, and it is estimated that epidurals are administered in approximately 25% of all labours in New Zealand.
An epidural is a nerve block that goes into the area surrounding your spinal cord, known as the epidural space.
The epidural is always administered by an anesthetist, and can then be topped up as required by your LMC. The anesthetist will insert a needle into your epidural space in your lower back between two vertebrae. Then a small tube is thread through the needle into the space and the needle is removed. A top up of medicine is added every 2 hours, or as required.
While the epidural is administered you will be asked to sit very still, usually sitting on the edge of the bed with your back curved. The anesthetist will begin by injecting a small quantity of local anaesthetic near where the epidural will be sited to numb it, before inserting the larger epidural needle. Once the epidural is in, the anesthetist will check that it is in the correct place by asking you some questions about the sensation in your legs/lower body. The epidural will take between 10-20 minutes to become effective, and the effects will take up to two hours after the last top up is given to wear off. Your LMC will probably recommend allowing the epidural to wear off when you are ready to commence pushing, as the epidural can impair your ability to push if you can't feel the contractions.
The epidural is a good method of pain relief because it enables you to remain fully cognitively aware whilst eliminating the pain of labour entirely, and it can provide an opportunity to rest during a long or difficult labour. It also lowers your blood pressure which is useful if you have been experiencing high blood pressure during the pregnancy.
However, there are disadvantages to using an epidural. You will be unable to get up and move around during labour, and you will probably be required to have continuous foetal monitoring, either via a belt around your belly, or by attaching an electrode to your baby's head after your waters break. You will also need to have a catheter inserted into your bladder to allow you to pass urine.
There are also risks associated with the use of an epidural. Your blood pressure may drop too low, although this can usually be counteracted with a saline drip to stabilise your blood pressure.
If the anesthetist inserts the needle too far and punctures the sheath around your spinal cord it may result in cerebrospinal fluid escaping and causing a severe headache, known as an 'epidural headache'. This is very rare.
There is also a higher risk of intervention associated with epidural use, such as forceps or ventouse extraction or caesarian section.
"The epidural was my friend. I could still feel the contractions, but it kind of dulled them."
"I hated everything about the epidural, it took several goes to get it in, ouchy! I had some major twitches, hated being numb and took a long time to get into pushing."
"The epidural was good after a painful 15 hour labour, but I hated that I had no feeling for 12 hours afterwards."
"I hated the epidural, I couldn't feel to push and I hated being held down while they put a needle in my spine."
"I found the epidural great for my c-section where I didn't have to do anything, but it was no good when I had a quick second stage with my vaginal birth, I couldn't feel any pushing sensation at all."