Pregnant women should discuss the methods of pain relief available with their obstetrician, anaesthetist and midwife well in advance of their labour. Relaxation exercises, breathing techniques, massage, acupuncture/acupressure and other active labour strategies can be effective. Some forms of pain relief may be prescribed by a doctor and do not require the services of an anaesthetist (ie nitrous oxide, fentanyl, pethidine). Epidurals are an effective form of pain relief for labour and are only administered by specialist anaesthetists.
Anaesthetists are also involved when pregnant women have their babies delivered by caesarean section, providing the most appropriate form of anaesthesia; either a spinal block, an epidural block, a combined spinal-epidural block, or general anaesthesia.
Epidural analgesia provides the most effective relief for labour pain. This is where local anaesthetic is administered into the epidural space numbing painful sensations at the level of the spinal cord.
An epidural is inserted using local anaesthetic to reduce discomfort from the procedure. A fine soft plastic tube (“epidural catheter”) remains in the epidural space and it is removed after delivery of the child. Medications are usually administered intermittently by a midwife or by a machine controlled by the patient.
As a general rule, you can request the epidural at any stage during labour provided there are no medical reasons not to, and following consultation with your midwife and obstetrician.
RISKS ASSOCIATED WITH EPIDURALS:
- Block failure can occur in approximately 10% of epidurals. The block may be a ‘patchy’ or absent and the epidural may need to be reinserted.
- Low blood pressure can occur after the administration of local anaesthetic via the epidural.
- Post-dural puncture headache is when the epidural needle makes a hole in the tissue surrounding the spinal fluid. It occurs in approximately 1% of epidural blocks. Not all patients develop headaches following a dural puncture. Most headaches will settle within a few days but some may last longer. Conservative treatment includes bed rest, adequate hydration and pain relieving medications. If this approach fails and the headache is severe then an epidural blood patch may be considered.
- Temporary leg weakness may occur due to the effect of local anaesthetics on nerves controlling the movement of legs. This effect is temporary.
- Epidural analgesia is associated with up to four times the incidence of fever. It is not known why but is usually of no significance.
- Permanent nerve injury is rare with less than 1 per 100,000 women who have an epidural.
- Epidurals are generally not associated with increased incidence of back pain after childbirth.