An epidural or spinal block allows a woman in labour to be fully awake and aware during delivery without unbearable pain, and to enjoy her baby afterwards without the mind-numbing effects of painkillers and general anaesthetics.
An epiduralmeans injecting an anaesthetic agent into the epidural space that surrounds the spinal cord. This space is filled with nerves and blood vessels and the anaesthetic temporarily paralyses these nerves. This blocks messages of pain from being relayed to the brain.
This type of pain relief takes a little while to work and it wears off quite quickly. For this reason, a fine plastic catheter (or tube) – about the diameter of a hair-brush bristle – is inserted into the space and attached to a continuous supply of the anaesthetic agent. This looks much like a drip and the mother can comfortably lie on her back on this tube, which provides complete pain relief that is sustained for many hours.
Because an epidural can be well controlled, it is possible to isolate and anaesthetise specific nerves that originate from the abdomen and pelvic area. In this way, mothers who have a “walking epidural” can have the best of both worlds – natural birth and movement without the pain.
A spinal block, on the other hand is a once-off injection into the subarachnoid space, a fluid filled space (or cavity) immediately surrounding the spinal cord. The anaesthetic is injected into this space and mixes with the existing fluid. This means that it is effective almost immediately and lasts for 2-and-a-half to 3 hours – just the right amount of time to perform a caesarean section.
A spinal-epidural combines the 2 methods, with the spinal block offering immediate relief and the epidural being effective for many hours.
The exceptionally small diameters of the epidural tubes and spinal needles used today have eliminated many of the problems that epidurals posed in the past, including the risk of infection and severe headaches.
Ask for an epidural beforehand
Make sure you ask for an epidural beforehand as an anaesthetist may not be readily available, or labour may be too advanced by the time you feel you need one.
An epidural birth can become invasive
One drawback is that an epidural birth can become invasive. A drip is inserted into the vein to counteract hypotension (low blood pressure) and a catheter put into the bladder because the birthing woman will lose her urge to urinate.
Her blood pressure must be monitored regularly along with her baby’s heartbeat, and the length and strength of contractions will be recorded on a foetal heart monitor.
The mother loses control over her body and, with the lower half of her body paralysed, she will not know when and how to push effectively during the birth.
Alternative techniques for pain relief
During warm-up and early-labour while contractions are mild, it may be useful to use other techniques for pain relief. Bathing, showering, walking and squatting will help the baby’s head to engage into the pelvis. You can then have an epidural once labour is established and the cervix has dilated to between 4cm and 6cm.
How it is done:
You will be asked to sit at the edge of the bed bending as far forward as possible, or to lie on your side with legs curled into a C position to curve the spine when the needle is inserted. The sudden loss of blood pressure may cause a woozy sensation. You may also feel nauseous, short of breath or dizzy. It’s important to tell the anaesthetist how you are feeling during the procedure so that he can give you something to counteract these reactions.
Once the anaesthetic takes, the lower half of the body will feel numb and you should feel no pain or sensation from the waist down. To push effectively when you give birth, ask to have the epidural switched off at 8cm to 9cm dilation.