Should I have an epidural?

Regrettably the confusion about epidurals is aggravated by misinformation distributed by inexperienced and ill-informed individuals, often with ulterior motives and mischievous intent.

Hopefully this article will help you clear up some of the confusion and help to make your decision easier.

Firstly, it is important to appreciate that the need for pain relief varies massively from individual to individual; and even from pregnancy to pregnancy in the same individual. For this reason the value of the advice that you get from someone who had an epidural or who did not have an epidural is limited.

What worked or did not work for them only applies to them and not necessarily to you.

I believe that it is vital that you are informed about all available forms of pain relief. That you go into labour armed with this information and with an open mind and that you make decisions on pain relief as pain relief is needed. This applies particularly to the decision to have an epidural.

People stress and agonise over whether they should or should not have an epidural. This is an incredible difficult decision prenatally, but when you are in labour the decision is generally very easy. You either need it or you don't. Don't even consider making a final decision until you are in labour.

How it's done
Once the decision has been taken and you request an epidural, a drip will be placed in your arm and fluid infused.

An epidural causes blood vessels to dilate (open up) and you need this extra fluid in your body to prevent your blood pressure from dropping. You will then be positioned either on your side or more commonly in a seated position with your legs hanging over the side of the bed. You will be asked to lean forward so as to open up the spaces between the vertebrae of your spine.

This is not always easy with a pregnant tummy in front of you. A very thin needle is then used to inject local anaesthetic into one of these spaces. This is not painful and involves a very small prick as the needle is inserted followed by a slight burning (like a small bee sting) as the local anaesthetic is injected.

Once the local anaesthetic has been administered you should not feel any further discomfort. The doctor then carefully advances a special needle through the space between the vertebra until he reaches the area just before the membranes that contain the spinal fluid. This space is known as the epidural space. A thin plastic catheter (pipe) in then threaded through the needle and into the epidural space.

The needle is then withdrawn and completely removed from the plastic pipe. The plastic pipe is then securely attached to your back. A small dose of long-acting local anaesthetic is then injected through the catheter as a test to make sure that the catheter is in the correct place and you don't have an adverse reaction to the local anaesthetic.

If all is well after the test dose you will either be given the full dose at once (a bolus dose) or the dose will be slowly administered through a special pump (continuous infusion epidural). If a bolus is given this usually lasts two to four hours and is followed by intermittent top-up as needed. The continuous infusion is continued until it is no longer needed.

Both techniques have advantages and disadvantages. The best one for you is the one that your particular doctor has the most experience with and is the most comfortable in using. Let her decide.

What you'll feel
Once the epidural has been administered you will notice a warm sensation and sometimes a pins-and-needles feeling in your legs and buttocks.

The pains will not disappear immediately, but each contraction will become less painful than the one before it until the pain is gone completely. This can take up to half an hour. You will usually still feel tightenings, but no pain.

Your legs will feel heavy at first and then you will progressively lose motor function (the ability to move your legs). The extent of the motor loss depends on the dose of local anaesthetic given and on individual variation. Some people cannot move their legs at all while others retain fairly good motor function.

Another technique, commonly called the mobile epidural, uses morphine-like drugs in the epidural space, rather than local anaesthetic. This allows better motor function, but does not give as good pain relief. The epidural blocks sensation (pain) first and then motor function and deep pressure.

It recovers in the reversed sequence; deep pressure and motor function recover before pain. For this reason epidural is usually allowed to wear off as delivery is anticipated in order to allow motor function to recover (ie the ability to push and feel pressure) but still have some benefit in terms of pain relief.

Risks
The risks of epidural are minimal if adequate precautions are taken and adequate resuscitation equipment is available.

If you were having your wisdom teeth out you would be very worried about your wisdom teeth and not too concerned about the anaesthetic. An epidural for pain relief and labour is much less risky than a general anaesthetic for wisdom teeth or tonsils.

The analogy should put the risks of epidural into perspective for you. I suggest you make sure you are properly informed regarding all forms of pain relief in labour (including the non-drug options).

I believe that you should go into labour with an open mind, be flexible and choose appropriate pain relief as needed. You have the right to choose and you have the right to change your mind.

No one should force you into a decision before you go into labour and no one should bully you into having an epidural, by the same token no one should bully you out of having an epidural.

Do what you feel is best at the time for you and your baby.