Month 9: Wave the pain goodbye

Considering epidural anaesthesia during your labour? Here’s what you need to know before the big day.

Epidural anaesthesia comprises a local anaesthetic (one that only numbs one part of your body) being injected into the epidural space in the spine. This space is between the spinal cord and the dura mater, a thick membrane that surrounds the spinal cord.

Thanks to the injection, you don’t feel any pain from your navel down. This is because the pain messages sent by the nerves of the uterus and the birth canal during labour are dulled.

The injection itself is also not too sore, because the skin of your back where the epidural needle enters is also anaesthetised. It’s highly unlikely that you’ll feel anything more than mild discomfort.

There are three ways in which the anaesthetic can be injected into the epidural space:

1 A single initial shot of a specific amount of anaesthetic;

2 The supplementary system, where a catheter is placed in the epidural space, and the anaesthetic is injected at regular intervals; and

3 Continuous flow of the agent through an epidural catheter. This flow is regulated by a small pump, and the speed at which the anaesthetic comes in is determined by the doctor.

The reach of the agent largely depends on the amount used. A mild solution will block small nerve fibres, and a stronger solution blocks the more resistant fibres.

THE PLUSSES

Epidural anaesthesia has quite a couple of benefits.

■ It usually offers excellent and fairly quick pain relief during labour.

■ It allows you to rest if the delivery takes long.

■ Some women find that they have a more positive birth experience when the discomfort of birth is relieved.

■ When other coping techniques like massage is no longer effective, epidural anaesthesia might be just what you need to get over the exhaustion, irritability and fatigue. It can give you a chance to rest, relax and focus, and it gives you the strength to be an active participant in your birth experience.

■ Unlike many other pain relief options, your mind remains clear. You’re aware of the contractions but don’t feel any pain. ■ The anaesthesia can last throughout labour and start whenever you prefer. Just note that it might not be administered if the labour process has advanced beyond a certain point and you can no longer sit still for it to be administered.

THE CONCERNS

In 20 percent of cases, epidural anaesthesia can reduce the contractions themselves and also their intensity, says Dr Edwin Assan, an obstetrician and gynaecologist based in Kempton Park near Johannesburg.

During the second phase of labour, it can also decrease the urge to push, which could make labour longer.

“It can make the mom-to-be anxious, because even if she hears that her baby is here, an hour later, nothing might have happened, because the anaesthesia delays the process. It’s very stressful for the mom, and it increases the chance of an instrumental birth – and these interventions can in the end pose a small danger to the baby,” Dr Assan says.

Susan Lees, a midwife with Birth Options in Cape Town, says that while you retain some feeling with epidural anaesthesia, it could make the pain disappear so that you can fall asleep while you’re in labour. It could mean that you detach yourself from the labour process. Epidural anaesthesia can lower your blood pressure, which could cause foetal distress.

Susan reckons that in many instances, labour can be controlled without epidural anaesthesia and that it’s beneficial for you to “take charge” of your birth process and find a way to handle the pain with enough antenatal information and labour support.

“It results in an enormous sense of achievement, self-image and selfconfidence in your ability to tackle the pain of birth and work with it,” she says.

“On the other hand, epidural anaesthesia is also beneficial for many moms, and an epidural sometimes ‘saves’ a vaginal birth.

“If you’re striving for a pain-free birth, an epidural is definitely an option you need to discuss with your doctor.”