About epidural in childbirth
An epidural stops you feeling pain without putting you to sleep. It can be used to provide pain relief during childbirth and can also be adapted to provide pain relief during a caesarean.
An epidural involves local anaesthetic and sometimes other pain-relieving medicines as well, being injected into your lower back, just above your waist. After an epidural, you shouldn't be able to feel any pain in your abdomen (tummy) or the tops of your legs.
Epidurals are usually very effective, but take about 30 minutes to work. If you have an epidural, your second stage of labour may take longer because you won't feel the urge to push. It may also make moving around more difficult because you will have less feeling in your back and legs and you may find it difficult to move your muscles.
An epidural isn't suitable for you if you have a blood-clotting problem. You must tell your midwife or anaesthetist if you're taking blood-thinning medicines such as aspirin, warfarin or clopidogrel. An epidural may not be suitable for you if you have had an operation on your back. Ask your midwife or anaesthetist for more information.
How does an epidural work?
Your spinal cord runs through a channel formed by your vertebrae (irregular-shaped bones in your spine) and is surrounded by three protective layers of tissue called the meninges. A protective layer of fluid lies between two of these tissue layers (this is known as the cerebrospinal fluid or CSF). The area just outside all these layers is called the epidural space.
Your spinal cord carries signals, in the form of electrical impulses, between your brain and the network of nerves that branch outwards from your spine to all parts of your body. At each level of your spine, nerves leave your spinal cord to go to specific parts of your body. For example, nerves from the lower part of your body join your spinal cord in your lower back.
The epidural space in your lower back is where your anaesthetist will inject the local anaesthetic. This blocks the nerves in your spine that lead to the lower part of your body, stopping you feeling pain. Your anaesthetist can control how much feeling is lost, depending on the amount and type of medicines used. A caesarean may be done with an epidural, without the need for you to have a general anaesthetic.
What are the alternatives?
There are several other methods of pain relief you may be able to try if you don't wish to have an epidural. Talk to your midwife or doctor about the risks and benefits of these.
- Gas and air. This is a mixture of nitrous oxide and oxygen and is a mild painkiller. As you feel a contraction starting, you breathe the mixture in through a mouthpiece or a mask placed over your nose. It will probably make your contractions less painful, although not all women find it effective.
- Opiate medicines. These medicines include diamorphine, morphine and pethidine. They are very effective at relieving pain, but can make you feel sick or dizzy. Opiate medicines can also make your baby feel sleepy and can sometimes temporarily reduce your baby's ability to breathe at birth.
- Transcutaneous electrical nerve stimulation (TENS). Two electrodes are placed on your back and electrical impulses are sent to your nerves to block the perception of pain going from your uterus (womb) to your brain. TENS is often used early in labour and may become less effective as labour progresses.