Epidurals: All You Need To Know

If you are expecting, chances are that you know about epidural injections and its side effects. Today, talking about labour no longer gives rise to fear in the hearts of expecting mothers thanks to epidural anaesthesia. However, many expecting mothers worry about the effect of epidurals on the baby. Also, pain is often associated with an epidural injection. Even today, when women hear this term, images of a huge needle being inserted into the spine crop up. But, is an epidural painful? Know all about epidural injections, the different types, pros and cons, and its side effects on pregnancy.

What are epidurals?

Contrary to popular belief, epidurals need not be painful! Epidurals are regional anaesthesia that is used primarily to relieve expecting mothers from pain during labour and childbirth. An epidural injection obstructs pain in a body part. According to the website kidshealth.org, it is a regional anaesthesia used to "provide continuous pain relief to the entire body below the belly button (including the vaginal walls) during labour and delivery." An epidural involves injecting pain-blocking medication into a space between the vertebrae and the spinal fluid. The process normally takes about 15 minutes to work and can last as long as needed.

It is up to the patient to opt for an epidural or not. Also, when an expecting mother is heading into the labour room, she should be made aware of all the available options of pain relief.

Types of Epidurals Injections:

1. Traditional epidurals: Blocks the woman's entire lower portion of her body. These epidurals take about 20 minutes to take effect. However, it may affect one's ability to push the baby out.
2. Walking epidurals: Relieve labour pain in an effective manner and ensures comfortable childbirth. On using this epidural, the woman's abdominal nerves are numbed, which enables her to move around and feel the sensation of pushing a baby. Walking epidurals takes only two minutes to show their effect after two shots are injected.
3. Spinal epidurals: If an expecting mother opts for spinal epidurals during childbirth, a dose of one injection is given. The numbing effects of these epidurals fade off quickly as compared to other forms of epidurals.

The procedure:

An epidural is performed only by an anaesthetist. Before an epidural, the expecting mother will have a drip of fluids put into her arm. Her lower back will be washed with cold antiseptic and a small amount of local anaesthetic will be injected into the skin of the lower back after which a needle is inserted between the bones of the spine into the space around the spinal nerves. After a few minutes, a small soft plastic tube will be inserted, and the needle will be removed. This tube delivers the anaesthetic that will numb the pain. It will take between 5 and 30 minutes for the pain to be relieved by the epidural.

ParentCircle talks to Dr Rekha Rajendrakumar, Medical Director, Miracle IVF Centre and Chandana Hospital, to know more about this procedure. She shares these key points to remember with regards to epidurals:

Key points about Epidurals

• Epidural injections or anaesthesia must be exclusively administered by an anaesthetist.
• An anaesthetist should be around to give top-up doses of epidurals at regular intervals, in cases when the latent phases of labour last longer or get prolonged for a patient.
• It is important to monitor the blood pressure of the patients while administering the epidural injections.
• The presence of an anaesthetist is particularly necessary when a patient is fully dilated and is experiencing the second stage of labour - to help wean off the dose. Else, a woman will not feel the bearing down sensation. Also, the fetal head may not move correctly because of inefficient actions of the pelvic muscles. This results in an increased chance of operative vaginal delivery or caesarean sections.
• Suturing of the episiotomy or tear would be easier when the patient is anaesthetised even if weaned off.
• Epidurals are sometimes used in cases where the woman is unable to bear the labour pains. This way, the incidence of caesarean sections are reduced considerably.

Advantages of an epidural:

• Very effective and generally safe
• One can still move around and push when needed
• Enables one to stay awake during a caesarean
• Medications can be increased or decreased without giving extra injections

Disadvantages of an epidural:

• Not everyone can have an epidural
• One might need a tube in the bladder to help pass urine
• Legs might become numb for a few hours
• Second stage of labour might be slowed down
• During labour, the baby will be closely monitored

Note: Whether one has an epidural or not, it makes no difference to the chance of having a caesarean section.

Risks and side effects of epidurals:

• Some women may feel cold and itchy
• A small number may not get pain relief
• Weakness in the legs, headache
• Drop in blood pressure
• An increased risk of needing forceps or vacuum to help with the birth
• Few women may get permanent nerve damage

Who should not get an epidural?

There are many conditions that make it risky to get an epidural. Some conditions include women who have blood clotting problems, an infection, uncontrolled diabetes, anaesthesia drug allergies.

During labour and delivery, the medications used are safe and do not affect the baby in any way. However, the mother's blood pressure may decrease in the first few minutes. There is no need to worry because once an epidural shot is registered, the doctor and anesthesiologist will closely monitor the mother and the baby throughout the labour and delivery.

Every woman desires to undergo natural childbirth. However, sometimes the pain may become unbearable and it is here that epidurals can relieve pain during delivery. In the end, it is a subjective choice of all woman whether to opt for epidurals or not.

Also read: The first 24 hours after the baby

About the author:

Written by Ashwin Dewan on 19 February 2018.

About the expert:

This article is reviewed and validated by Dr (Mrs) Rekha Rajendrakumar.

Dr Rekha is the Medical Director, Miracle IVF Centre and Chandana Hospital, Bangalore.

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