Using an Epidural for Pain Relief During Childbirth

Childbirth is a physically demanding end to your pregnancy, and unfortunately it can be quite painful. Fortunately modern medicine provides a number of different methods of effective pain relief designed to make childbirth as bearable as possible. The level of pain involved in labour varies from person to person, which is why having so many options when it comes to pain relief is so useful. The epidural is an extremely popular choice in many cases, and this article details why and how it is used.

What is an epidural?

Epidural anaesthesia is usually just shortened to epidural, and is an injectable local anaesthetic designed to numb pain in the area to which it is applied. Epidurals are applied to a particular place on your back to number the lower half of your body during childbirth.

The anaesthetic works by targeting the endings of nerves which signal pain to your brain. By blocking these nerves, the signal that tells your brain that you are in pain is stopped, so what you experience instead is a far more pleasant sense of numbness. This sensation will vary depending on the quantity and type of anaesthetic used, but regardless of those factors, the anaesthetic will be temporary and normal feeling will return.

Epidurals can also be used to numb your stomach area (abdomen), legs, chest, and pelvic region (which is what is targeted during childbirth). While most epidurals are applied as an injection, there is a type called the mobile epidural, aka the walking epidural. These epidurals apply a low-dose of the anaesthetic which, alongside painkilling medication, works to block pain, but helps to alleviate the feeling of complete numbness which can be uncomfortable for some women receiving the full epidural.

The walking epidural also means that you can still feel contractions during labour, meaning that you will be able to feel when you need to push. You are likely to still have some feeling in your lower half, and if needed will be able to move around, although you are advised not to do so.

When are epidurals used?

Epidurals can be used during a number of surgeries as well as childbirth (natural and caesarean). Your midwife or doctor will give you any information you need about the epidural, and tell you if your birth plans accommodate its use. If you choose to have your baby at home or in a midwifery centre that is not part of a hospital, then you probably won’t have access to an epidural.

Epidurals are often recommended during particular painful instances of childbirth. For example, where there is an uncomfortably long and painful labour, or where there are complications. The delivery of multiple babies (twins and triplets) can benefit from the use of an epidural, as can assisted deliveries where forceps or vacuum suction are used to deliver a child.

Epidurals are avoided if you have a known allergy to local anaesthesia, as this can be risky and complicate labour. If you have any kind of blood clotting issue, or are taking medication which affects blood clotting (like the blood thinning agent Warfarin) epidurals are not suitable for you. Similarly if you have any spinal problems like previous surgery, deformities, neurological conditions, or even arthritis, epidurals are too risky to be used, and alternative methods of pain relief will be needed. 

How effective are epidurals?

If you are approaching the end of your pregnancy, then you will undoubtedly be concerned about the effectiveness of pain relief options available to you. Fortunately the epidural is known as one of the most effective methods of pain relief currently available, however that being said it is thought that about one woman in every 8 might need to supplement the epidural with another form of pain relief.

Are epidurals safe?

Safety is always a concern when it comes to administering any kind of drug or anaesthetic, particularly during pregnancies where both a mother and child’s health are concerns. Epidurals are only really offered where your midwife (or doctor) consider it a safe option, however there are some risks of side effects which include:

• Low blood pressure – this is the probably the most common side effect of this type of pain relief, and it occurs because of how epidurals work. The anaesthetic relieves pain by affecting your nerves, unfortunately these nerves are also connected to your nerves, and the result is a drop in blood pressure. Fortunately your pressure will be monitored if you have an epidural, and certain medications will be administered if your BP drops too much.
• Mild pain – is common as the anaesthetic needs to be injected, sometimes this can be more severe if the epidural isn’t enough to completely relieve your pain. This can happen as a consequence of, for example, a faulty fitting to the epidural catheter. If you do find that the epidural isn’t relieving all of your pain, then you should tell your doctor straight away so that they can provide you with a supporting form of pain relief.
• Bladder control – is often lost after an epidural as you lose signals from your bladder, meaning that you won’t be able to tell when you need the toilet. A catheter is usually inserted into the bladder at this point, which is designed to draw urine away from the bladder when it fills up. This is no cause for concern as your bladder control will return as soon as the anaesthesia wears off.
• Itchy skin – is a mild side effect which can sometimes be treated with antihistamines.
• Nausea – you may experience some vomiting or just nausea after an epidural, but fortunately anti-emetics (anti-sickness) medications are usually available.

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