Epidural Pain Relief for Childbirth

An epidural provides very effective pain relief for women in labour. Even though your birth plan may not include epidural pain relief it is important to know about epidurals before labour as you may not manage with other forms of pain relief and you may consider having an epidural once you are in labour.

While everything is done to provide a prompt service, at times there can be delays that may inconvenience you and very rarely be unsafe. If you have concerns about this please speak to the hospital and obstetrician.

This text provides some information about epidurals, however it would be wise to also obtain information from other sources such as antenatal classes and recent consumer publications. If you have specific medical problems or concerns regarding epidurals you can contact the Anaesthetist who provides an anaesthetic service for your Obstetrician and make an appointment to discuss these problems prior to delivery.

Epidurals are commonly used in labour for pain relief. Some women elect to use an epidural from the onset of painful contractions, others decide to use them if other methods aren’t effective and some women are advised to use them for Obstetric reasons. Epidurals are very helpful in the management of some Obstetric problems such as breech presentations, twins and high blood pressure.

Who puts the epidural in?

Epidurals are always administered by a Specialist Anaesthetist. A Specialist Anaesthetist is a medical practitioner who has undergone a minimum of 5 years specialist training in Anaesthesia, Pain Management and Intensive Care following their Medical Degree and two years as a hospital doctor.

Details of Epidural Insertion

Most Anaesthetists follow the routine outlined below:

  1. The Anaesthetist will assess you prior to insertion of your epidural. They will then discuss the epidural with you including the side effects and benefits of epidural pain relief. At this stage you will have the opportunity to ask the Anaesthetist any questions about the epidural. Some women may be distressed at this stage, so it is important to be informed about epidurals earlier in the pregnancy.
  2. An intravenous line or “drip” is inserted and intravenous fluid is given.
  3. You are then positioned either lying on your side or sitting up.
  4. Your back is washed with an antiseptic solution.
  5. At this stage you need to arch your lower back to open the spaces and help the insertion of the needle.
  6. Local anaesthetic is injected into the skin.
  7. The epidural needle is then inserted. Most women are aware of a dull pressure – surprisingly, for most women, this is not painful. When the anaesthetist locates the epidural space they insert the epidural catheter a few centimetres into the space. Some women may briefly feel a dull pressure or sensation extending into the buttocks – it is important not to move at this stage.
  8. The epidural needle is removed, leaving only the thin plastic catheter which is firmly secured to your back.

Local anaesthetic is then injected into the epidural catheter. The local anaesthetic slowly spreads to the nerves which supply pain sensation to the uterus, cervix and birth canal.

The epidural takes 10 – 20 minutes to take effect, sometimes further doses of local anaesthetic are required to obtain adequate pain relief.

If you have a contraction during insertion of the needle you should stay very still and the Anaesthetist will wait until the contraction is finished before proceeding.

Epidural Top Ups

There are several different strengths of local anaesthetic solution available for use in labour. Most women will commence with a low strength local anaesthetic. Generally this stops pain sensation but retains touch sensation and muscle strength.

Some women will need a stronger local anaesthetic to control their labour pains. The stronger solutions may cause numbness, pins and needles and weakness in the legs. Your anaesthetist and mid-wife will help you decide the appropriate local anaesthetic to use.

Epidural “top-ups” are generally required every 1 – 2 hours during your labour.

Side Effects

Epidurals have been used in labour for over 20 years and are known to be very safe. However, as with any other medical procedure or treatment, epidurals have side-effects and these need to be considered along with the benefits of epidural pain relief. If you have particular concerns about the side-effects of epidurals it is important to discuss these with your Anaesthetist prior to insertion of the epidural.

The method of insertion and monitoring of the epidural are all designed to minimise the risk of side-effects.

Epidural side-effects can be divided into those that are common, uncommon and rare.

Common Side-effects

Low blood pressure

Your blood pressure may decrease after an epidural. This is why you have an intravenous drip inserted and your blood pressure is monitored closely after each top-up. If your blood pressure falls significantly it is treated with intravenous fluids and occasionally a drug may be used as well.

Discomfort with epidural insertion

Most women only feel a dull pressure. It is important you tell the Anaesthetist if there is pain during insertion.

Mild backache at site of epidural insertion may last for 2 – 3 days.

Uncommon Side-effects

Inadequate Pain Relief

About 1 in 20 women will need additional doses or adjustment of the epidural catheter in order to obtain satisfactory pain relief.

Dural or Spinal Tap

If the epidural needle punctures the covering of the spinal nerves and spinal fluid leaks out this may cause a spinal headache a day or two later. The chance of this happening is approximately 1 in 200.

Rare Side-effects

High epidural block

This may occur if the local anaesthetic spreads to the nerves higher up in the back and neck. Your Anaesthetist and mid-wife will monitor the height of your epidural block.

Nerve damage

Approximately 1 in 1000 women having a child (with or without an epidural) will experience temporary numbness due to the bruising of a single nerve by either the baby’s head, forceps or the epidural. This will usually settle after several weeks.

Permanent nerve damage

This is extremely rare – probably less than 1 in 100,000. When this has occurred it has usually been associated with a bleeding disorder or an infection causing pressure on the nerves.