An epidural is a form of regional analgesia (it works in a specific area) where local anaesthetic is injected into the epidural space of the spinal column. It numbs the nerves transmitting pain signals from the uterus and birth passage during labour. It eliminates pain from the belly button down.
While it sounds quite daunting, be assured that the skin of the back is numbed with local anaesthetic before the epidural needle is inserted, and it is unusual to feel anything more than mild discomfort during the process.
There are three ways of introducing local anaesthetic into the epidural space of the spinal column:
1. A single initial injection of a specific amount of local anaesthetic.
2. The top-up system where local anaesthetic is injected at regular intervals, via an epidural catheter into the epidural space.
3. Continuous infusion of a local anaesthetic via an epidural catheter regulated by an infusion pump – the rate of which is determined by the doctor.
The extent of analgesia or anaesthesia depends largely on the amount of the medication used. A mild solution will block small nerve fibres and a stronger solution blocks the more resistant fibres.
Why so common?
There are a number of benefits to receiving an epidural:
- It usually provides excellent, fairly quick pain relief during labour.
- It allows you to rest if your labour is prolonged. Relieving the discomfort of childbirth can help some woman have a more positive birth experience.
- When other types of coping mechanisms (like massage) are not helping any longer, an epidural may be what you need to move through exhaustion, irritability and fatigue. An epidural may allow you to rest, relax, get focused and give you the strength to move forward as an active participant in your birth experience.
- Unlike some other pain relief medications, your mind remains clear. You may still be aware of your contractions, but feel no pain.
- An epidural can be used throughout labour, as early or as late as you choose. But if labour has progressed too far and you are not able to remain still for the anaesthetist to perform the procedure, then you may be refused the epidural.
“It’s a catch 22 situation. Because while you want to get the best analgesia for a mother during labour, in 20 percent of cases, an epidural can reduce the strength of contractions in labour and make them less frequent, stopping labour progressing properly, and thus prolonging labour,” says obstetrician and gynaecologist Dr Edwin Assan.
It can also reduce the urge to bear down and push (which comes from the nerve roots in the spinal cord) once the mother gets to the second stage of labour and her cervix is fully dilated. This can prolong delivery.
“This can also lead to a lot of anxiety because while on the one hand she’s being told her baby’s there, an hour later nothing might be happening because an epidural slows everything down. This is stressful for her.
Ultimately, this increases the odds of an instrumental delivery (a vacuum or forceps delivery) and such birth interventions could potentially pose a risk to the baby,” says Dr Assan.
Birth Options midwife Susan Lees says that while an epidural leaves behind a degree of sensation, it takes away the pain and mothers can sleep through their labours. This may detach them from the birth process.
An epidural can also result in foetal distress due to reduced maternal blood pressure.
“As midwives, we know that the majority of labours can be managed without an epidural and that there are benefits to the mother in terms of her embracing the process of labour and finding a way to deal with the pain via proper antenatal information and labour support. It brings about a huge sense of achievement, self esteem and confidence in a mother’s ability to ride out the pain of labour and work with it,” she says.
But there are some cases in which a mother benefits enormously from an epidural, and that some vaginal births are “saved” because of the epidural, says Susan. If a pain free labour is what you are looking for then an epidural is definitely an option to discuss with your doctor.