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Epidural – Your Choice

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What is an epidural?
An epidural is a method of pain relief used to relieve pain during labour. An injection of local anaesthetic is passed into your lower back close to the nerves which carry the pain you feel during
labour. The epidural works by blocking these nerve messages, this causes numbness, which varies according to the amount of local anaesthetic given. The amount of local anaesthetic given is
carefully controlled according to the needs of each individual person. When the epidural is stopped, full feeling will return after approximately 6 hours.

Who will perform the epidural?
An anaesthetist will perform the epidural. An anaesthetist is a medically qualified doctor specialising in administering anaesthetics.

Can anyone have an epidural?
Almost every woman can have an epidural. However, an epidural may not always be possible if the risk of complication is too high. Your anaesthetist will ask you questions about your medical history to make sure it is safe for you to have an epidural. You can decide during pregnancy that you may want an epidural, when you are in labour, or you can request an epidural once labour has commenced. This will only be possible providing there is an anaesthetist available to perform the procedure and a midwife available to give one to one care.

How is an epidural given?
Your anaesthetist will ask you some questions about your general medical history and this is your opportunity to ask any questions about anything you wish explained in more detail. Sometimes your blood pressure can drop during the epidural. This is why a thin plastic tube (a cannula) will always be connected into a vein in your hand or arm before starting the procedure. Should your blood pressure fall, fluid from the drip can correct the problem.

• You will be asked to sit up or lie on your side, bending forwards to curve your back.
• The skin where the epidural is being placed will be washed with antiseptic.
• It is important that you try to keep as still as possible whilst this process is going on. However, your anaesthetist does understand that keeping still whilst having a contraction is not always easy.
• Local anaesthesia is injected into the small area of the skin on your back that has been cleaned. This will numb the area.
• The local anaesthetic stings for a short time, but usually allows an almost painless procedure whilst the special epidural needle is pushed through this numb area and a thin plastic tube (catheter) is passed through the needle into your epidural space. The needle is then removed, leaving only the catheter in your back.
• You should tell your anaesthetist if you feel any pain or pins and needles in your legs or bottom as this may indicate irritation or damage to a nerve and the needle will need to be repositioned.
• The plastic tube (catheter) stays in place and is secured with plaster tape.
• Some epidurals do not work fully and need to be adjusted or replaced.

What does the epidural do?
A small dose of local anaesthetic is injected via a thin tube which has been inserted into the back. The local anaesthetic acts on the pain conducting nerves. The injection is painless, although you may feel a cold sensation. It usually takes about 20 minutes to be fully effective. Once the tube is positioned, it is easy to deliver additional anaesthetic as often as is necessary to maintain your pain relief during labour.

The dose of anaesthesia can be adjusted so that you can still feel your contractions. This means that you will be able to push when the time comes.

Advantages of an epidural
• Usually provides excellent pain relief.
• Sometimes a spinal is given first for a quicker effect.
• The dose or type of local anaesthetic can sometimes be altered to allow you to move around the bed. This is a low-dose (or mobile) epidural.
• In general epidurals do not affect your baby
• Can be topped up for caesarean section if required.

Possible problems with your epidural
• Repeated top-ups may cause temporary leg weakness and increase the risk of forceps or ventouse delivery.
• The epidural may slow down the second stage of labour slightly.
• You may develop low blood pressure, itching or a fever during the epidural.
• 1 in 8 epidurals do not work well enough to reduce labour pain. Other methods of pain relief may be required or an anaesthetist can put another epidural in (but there are no guarantees that this will be effective either).
• 1 in every 100 women having an epidural will develop a severe headache
• 1 in every 1000 women will develop a numb patch on a leg or foot which disappears usually within a few weeks. Rarely (1 in 13000) nerve damage can occur which can be permanent.
• The epidural site may be tender but usually only for a few days. Backache is NOT caused by epidurals but is common after any pregnancy.

Further information is available from www.oaaformothers.info

Ref: Obstetric Anaesthetists’ Association, January 2008