Article: Tina Otte from Your Pregnancy magazine
Image: Your Pregnancy Magazine

1. What is an epidural?
An epidural is the injection of a local anaesthetic – given at the level of the lumbar area of the back into the space surrounding the spinal cord.

2. Why is it referred to as a "regional anaesthetic"?
An epidural numbs only a certain area or region of the body, unlike a general anaesthetic that renders you unconscious.

3. How does it work?
It works by numbing the nerves of the lower half of the body that transmit pain signals to the brain.

4. What is the difference between an epidural and a spinal?
The needle that is used when giving an epidural will only penetrate the skin and move between two vertebrae, but does not enter the spinal canal where the cerebrospinal fluid is found. The local anaesthetic is injected into a fatty area rich in blood vessels and nerves. A spinal involves a smaller, thinner needle that moves through the vertebrae and does inter the spinal canal allowing the local anaesthetic to mix into the cerebrospinal fluid.

5. Can I have an epidural for a caesarean or do I need to have a spinal anaesthetic?
Usually this decision is made by your anaesthetist, but he will discuss this with you. In the case of caesarean, spinals are very popular as they act faster and are fairly quick to administer. They do not last as long as an epidural and you tend to get your feeling back a lot sooner. Should you need a caesarean during labour and you already have an epidural in place, this would be modified for surgery.

6. When should I have one?
An epidural can be given at any time during labour, but it is preferable to be in active established labour first. This means that your contractions are strong and regular. It is too late to ask for one when you are close to pushing stage, although many women who make it that far without, have been known to ask for it then. Usually you will be coached and supported through this time.

7. How long does it take to work?
The initial effects of pins and needles will be felt quite quickly, but FULL effect takes about 30 minutes. A spinal takes effect almost immediately.

8. How does it affect labour?
If given before labour is properly established, it may knock the contractions off entirely. If labour is going strong and well established it has no apparent effect on the length of the first stage. Second stage (pushing) may be lengthened if the mother has no urge to push and cannot work with her body.

9. Will I be able to push?
Pushing may be affected and the need for assistance in the form of forceps may be increased due to the fact that the mother cannot feel the bearing down sensations as the baby moves through the birth canal.

10. What are the after effects?
Initially the only side effect is the continued loss of mobility until the epidural wears off. Sometimes women have experienced headaches, itching, a severe drop in blood pressure and bruising or tenderness at the injection site.

11. How long does it last?
This depends on the dose of local anaesthetic that has been given to you if a single dose only has been given via the tube. You may however be attached to a continuous infusion that will ensure you have adequate "cover" for the entire labour and will only have feeling return once the infusion has been turned down or turned off completely. This is the more popular way of having an epidural today.

12. What if it does not work?
Epidurals work in most cases, but there are a small percentage of women who experience hot "patches" of pain if the epidural has taken in some areas and not in others. It is usual for the mother to be turned from side to side in order to bathe all the nerve endings properly.

13. When should you not have an epidural?