This description of epidural pain relief is for general information only.
Your Anaesthetist will assess your specific circumstances prior to your epidural insertion and discuss your epidural with you, including risks, benefits and alternatives. You can obtain more information beforehand from your Obstetrician, Midwife or antenatal classes. There are also links to recommended sources of information at the end of this section.
It is important to know about epidurals before your labour, as you may find other forms of pain relief to be insufficient and decide to have an epidural once you are in labour. You may also be too distressed to take in all the information once labour is established.
An epidural provides very effective, safe pain relief for women in labour, historically achieving patient satisfactions of about 95%. Some women elect to use an epidural from the onset of painful contractions, others decide to use them if other methods aren’t effective. Some women are advised to use them for obstetric reasons, such as breech presentations, twins and high blood pressure.
You may wish to see your Obstetrician’s regular Anaesthetist in the weeks beforehand, even though you may be treated by a different Anaesthetist when you are in Labour. This is recommended if your Obstetrician has concerns, or you have had previous anaesthetic problems, have medical problems or if you have specific issues you would like to discuss. You can arrange this by asking your Obstetrician for a referral, or by contacting Specialist Anaesthetic Services at 8273 5666.
Who Administers Epidural Pain Relief?
Epidurals are always administered by a Specialist Anaesthetist – see further notes from ‘Caesarean Section’ for a detailed description.
Details of Epidural Insertion
Most Anaesthetists follow the routine outlined below:
- The Anaesthetist will assess you prior to insertion of your epidural. They will then explain the procedure and answer your questions. At this stage you need to provide your consent (usually verbal is sufficient) for the procedure.
- An intravenous “drip” is inserted, and intravenous fluid is given.
- You are then positioned either lying on your side or sitting up.
- Your back is washed with an antiseptic solution and a sterile drape is applied to your back.
- The midwife will help you arch your lower back to open the spaces and help the insertion of the needle.
- Local anaesthetic is injected into the skin.
- The epidural needle is then inserted. It is important not to move during this process. 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.
- Most women are aware of pressure rather than pain. 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 unusual sensation in the back or buttocks.
- The epidural needle is removed, leaving behind only the thin soft 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 lower part of the body including the uterus, cervix and birth canal.
The epidural takes 20 minutes or so to take effect, sometimes further doses of local anaesthetic are required to obtain adequate pain relief. It is estimated that 88% will have satisfactory pain relief 45 minutes after insertion.
Epidural Top Ups
Epidural “top-ups” are generally required every few hours during your labour.
Most women will commence with a low strength local anaesthetic, or local anaesthetic and opioid mixture sometimes called a “cocktail”. Generally, this stops pain sensation but retains some touch sensation and most 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. A bladder catheter might be required. Your Anaesthetist and Midwife will help manage the appropriate local anaesthetic to use.
Stronger top-ups are used if a forceps delivery or if a caesarean section becomes necessary.
Epidurals have been extensively used in labour, and are known to be very safe for mother and baby. Epidurals probably have very little effect on the progress of the labour.
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.
Early communication between yourself, the Anaesthetist, Obstetrician and Midwives is very important if you have any concerns after your epidural.
Discomfort with Epidural Insertion
Most women only feel a dull pressure, especially if she is experiencing painful contractions. Women who have the epidural inserted early, before labour is established, will be a bit more alert to the insertion process.
Inadequate Pain Relief
Epidurals are inserted by feel. Although the Anaesthetist will have a good feel for the success of the insertion, they can only be sure that it is in the correct place when drugs are injected, and the patient gets the expected pain relief. Sometimes the block doesn’t work properly or might favour one side or the other. Some epidurals will need the catheter tube position to be adjusted or give stronger or extra top-ups. It is estimated that up to 15% of epidurals need to be removed and replaced at some point during the labour.
Epidurals are sometimes inserted too late in the labour, and the baby is born before it has time to work properly.
A mild backache, similar to a bruise, at the site of epidural insertion may last for several days.
Low Blood Pressure
Your blood pressure may decrease after an epidural. Your blood pressure is monitored closely after each top-up. Low blood pressure is treated with intravenous fluids and occasionally a drug may be used as well.
Post Dural Puncture Headache
Epidural insertion may result in a post dural puncture headache. This is usually due to spinal fluid leaking from an accidental puncture of the dura (spinal membranes) with an epidural needle. This is thought to occur in about 1 in 100 – 200 (0.5-1%) epidurals. Sometimes a procedure like an epidural, called an ‘epidural blood patch’, is required to try to settle the headache.
Thankfully, serious complications from spinal and epidural anaesthesia, including nerve injury, are extremely unlikely and rare. Please discuss your concerns with your Anaesthetist.
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.
One in 1000 - 3000 women having a baby (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, rarely, 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. This can also occur without ever having had a needle near the spine.
Links to recommended sources of additional information
For more information you may wish to visit the following patient information sites where you can find:
- General information about Anaesthesia
- Specific information about pain relief for Labour
- Specific information about Anaesthesia for Caesarean Section.
Australian and New Zealand College of Anaesthetists: http://www.anzca.edu.au/patients
Australian Society of Anaesthetists Patient information: https://asa.org.au/patients/ and https://asa.org.au/anaesthesia-for-specific-operations/
The Obstetric Anaesthetists Association (UK) patient information site: https://www.labourpains.com/home