Maternity - Epidural Pain Relief in Labour

Epidurals are a commonly used method of pain relief and are put in by an anaesthetist. An anaesthetist is a doctor who is specially trained to provide pain relief and to provide care for patients having operations. The anaesthetist is the doctor who would look after you if you were to need to have a caesarean section for the birth of your baby.

• Epidurals are the most effective form of pain relief.
• For an epidural, the anaesthetist inserts a fine plastic tube (called an epidural catheter) into the lower part of your back near the nerves in your spine. The epidural catheter is left in place so you can be given pain medication during your labour. This medication may be a local anaesthetic to numb your nerves, small doses of opioids, or a mixture of both.
• An epidural should not make you feel drowsy or sick.
• Having an epidural increases the chance that your obstetrician will need to use a ventouse (a suction cap on your baby’s head) or forceps to assist you to birth your baby. This can increase the risk of perineal damage to you and injury to your baby.
• An epidural can usually be topped up to provide pain relief if you need a ventouse, forceps or a caesarean section.
• If you need to have a caesarean section, and you don’t have an epidural inserted already, the anaesthetist normally inserts a spinal anaesthetic which feels similar to an epidural.

Most people can have an epidural, but certain medical problems (such as spina bifida, a previous operation on your back or problems with blood clotting) may mean that it is not suitable for you. The best time to find out about this is before you are in labour. If you have a complicated labour, your midwife or obstetrician may suggest that you have an epidural as it may help you or your baby.

If you are overweight, an epidural may be more difficult and take longer to put in place.

Epidurals do not have adverse effects on your baby.

Epidurals do not increase your chance of having an emergency caesarean section.

Epidurals give better pain relief for labour and birth than tablets, Nitrous Oxide gas or injections.

First, a cannula (a plastic tube) will be put in a vein in your hand or arm, and you will usually have a ‘drip’ (intravenous fluid) running as well.

You may also need a drip in labour for other reasons, such as to give you medication to support your labour or if you are being sick.

Your midwife will ask you to curl up on your side or sit bending forwards, and your anaesthetist will clean your back with an antiseptic.

Your anaesthetist will inject local anaesthetic into your skin, helping to numb the skin and assist the epidural to be placed comfortably.

The epidural catheter is put into your back near your nerves in the spine. Your anaesthetist must be careful to avoid puncturing the bag of fluid that surrounds your spinal cord, as this may give you a headache afterwards.

It is important to keep still while the anaesthetist is putting in the epidural, but after the epidural catheter is fixed in place with tape you will be free to move.

Once the epidural catheter is in place, you will be given medication through it. This is done using a pump that delivers the medications from a bag of fluid.

In addition, you may be given a handset than enables you to request further epidural doses from the pump. This allows you to control your own pain relief and has a safety lockout, so that you cannot accidentally use too much medication.

It usually takes about 20 minutes to set up the epidural and 20 minutes for it to give pain relief.

While the epidural is starting to work, your midwife will take your blood pressure regularly. Your anaesthetist will usually check that the epidural medication is working on the right nerves by putting ice on your tummy and legs and asking you how cold it feels.

Sometimes the epidural doesn’t work well, and your anaesthetist will need to adjust it, or even take the epidural catheter out and put it in again. This happens in about 10-15% of cases.

Your blood pressure may drop, causing you to feel light-headed or nauseated. We will check your blood pressure often while you have an epidural in place.

You are likely to need to stay in bed because your legs may feel heavy and numb.

The epidural may take away the feeling or urge to urinate. A urinary catheter will therefore be inserted into your bladder.

You may feel shivery, feverish, or itchy.

The epidural may not always provide total pain relief. If you are uncomfortable, the anaesthetist may use more local anaesthetic. Occasionally the epidural may need to be replaced.

Less than one in one hundred women will develop a severe headache in the days following an epidural. This can be treated.

MYTHS

• Hyperemesis gravidarumin is the same as morning sickness.
• You’re making a big deal out of nothing.
• My mum vomited when she was pregnant and she’s fine.
• It can’t be that bad.
• You’re weak. You just need to toughen up.

FACTS

Hyperemesis gravidarum is a significant debilitating illness affecting both the physical and mental aspects of women’s lives. If you get anything out of this website it should be to feel validated you don’t have to try and just carry on, what you are going through is incredibly hard, you are entitled to supportive care and treatment.

If you need a caesarean section, the epidural is often used instead of a general anaesthetic.

A strong local anaesthetic is injected into your epidural catheter to make the lower half of your body very numb for the operation. This is safer than a general anaesthetic for you and your baby.

Occasionally the epidural may not work well enough to be used for a caesarean section. This can happen in 1 in 20 people.

If this happens to you, you may also need another anaesthetic such as a spinal or general anaesthetic.

NSW Health mandates that we ask you to provide written consent before we insert an epidural. We want you to understand all your choices for pain relief and want you to be able to weigh up the benefits and risks of having an epidural. We therefore request that you read this information and ask any questions early. We are here to help.

There are occasions when an obstetrician recommends an epidural, but each woman can make their own decision. If you decide to have an epidural, you will be asked to sign a consent form before having an epidural. As you may be deeply focussed on your labour, distracted by pain, or may have had pain relieving drugs already at that time, we ask that you sign and date below. This just lets us know that you have received and read this information sheet.

The anaesthetist will provide this information to you again verbally if you decide that you would like an epidural during your labour.

Please remember that the anaesthetist will be happy to answer any remaining queries at the time of consent, but that you might have the distraction of pain or might have received potentially sedating analgesic drugs at that time.

References

• NSW Health; Having a baby, second edition, Sept 2020
• Schug SA et al (editors); Pain Management: Scientific Evidence, 4th edition, ANZCA & FPM, Melbourne
• Pain relief during childbirth, The Royal Australian and New Zealand College of Obstetricians and Gynaecologists, Australian Society of Anaesthetists, Edition 1, Dec 2006
• NSW Health; Consent for Medical and Healthcare Treatment Manual. Feb 2020
• Australian and New Zealand College of Anaesthetists (ANZCA) PS26 2020
• LabourPains, Obstetric Anaesthetists’ Association, 2020

This information was developed by

• Dr Olivia Williams, Senior Staff Specialist Anaesthetist
• Dr Mark Pulletz, VMO Anaesthetist and District Medical Lead for Anaesthesia

Reviewers

• Dr Elizabeth Mullins, Executive Director Medical Services
• Rebekah Bowman, District Midwifery Manager
• Dr Arnab Banerjee, Director of Anaesthesia, Goulburn Base Hospital
• Consumers, Bega Valley Shire

Professional interpreters are available if you need help to communicate with staff. Please ask our team who can make this booking for you. The service is free and confidential.