A guide to epidurals
FROM THE HILARIOUS (“it was like eating 100 hot peppers and pooping out a watermelon”) to the downright horrifying (“it felt like my spine was going to break away from my body”), all it takes is a “birthing stories” trawl through Google to get you thinking about an epidural.
WHAT IS AN EPIDURAL?
It’s a regional anaesthetic that blocks pain in a specific region of the body – in the case of labour, the abdominal region. Its purpose isn’t to block all feeling, but rather to numb or relieve the pain. “It’s an excellent form of pain relief during labour,” says Dr Gavin Jones, a specialist anaesthetist at hospitals throughout Cape Town. Timing is everything here. An epidural shouldn’t be given too soon into labour, but leave it too late and it’s a no-go. “It’s usually inserted during the first stage of labour from four to five centimetre dilation,” explains Dr Jones. “Once the patient is nine to 10 centimetres dilated, it’s usually too late.”
WHAT TO EXPECT
The procedure is straightforward and mostly painless. For Lynn Robinson, 40, a project manager for a Cape Town-based publishing firm, it was entirely painless. “The doctor said he was going to insert the needle into my spine; that it was going to feel like a small prick, and that I must just put my chin on my chest. But I was very calm and I didn’t feel anything.” Dr Jones runs through the process: “First an intravenous line is set up and
fluids administered via a drip. Monitors are connected, including a blood pressure cuff, which feels tight on the arm every time a reading is taken. “Mom is either asked to sit and lean slightly forward or asked to lie on her side. The lower back is cleaned with an ice- cold antiseptic solution, which is comforting for some and chilly for others. Then, a small needle – which may sting a bit – injects local anaesthetic into the skin and soft tissue of the back, to numb the area before insertion of the larger epidural needle. “The anaesthetist will then insert the epidural needle between contractions when the mother can keep still and calm, until it reaches the space between the layers of the lower spine. Once this needle is in place, the anaesthetist can insert a small plastic catheter (or tube) that will remain in place during the delivery (taped over your shoulder) and will be used to pump the pain medication into your body continuously. “Sometimes one can feel a sharp, tingling, or electric shock sensation down one leg. This may be due to the catheter making contact with a nerve. The anaesthetist may reposition the needle or nerve if the sensation doesn’t subside,” says Dr Jones.
WHEN WILL IT KICK IN, AND FOR HOW LONG?
“Once inserted it takes about 10 to 15 minutes to start working. If working adequately, the pain from contractions can be well controlled,” says Dr Jones. “Once the dosage is achieved, the pain block is maintained through hourly topups or an infusion.” Epidural dosing can be adjusted to provide more or less sensation – so you will still feel something. “At one stage the pain got worse and I thought they must not be giving me an epidural anymore, but they were,” recalls Lynn. “I can’t imagine what it would have been like if I hadn’t had an epidural.” It’s only if anaesthesia is being provided for a C-section that a patient feels immobile or totally numb from the waist down. With an epidural, you should still be able to move your legs somewhat, but it’s unlikely you’ll be able to walk much after the epidural is administered – despite the fact many hospitals call it a “walking epidural”. “Once the baby has been delivered, there’s usually no reason to keep the epidural in. The catheter is removed and full sensation usually returns within a couple of hours,” says Dr Jones.
IS AN EPIDURAL THE SAME AS A SPINAL BLOCK?
No. A spinal block is typically used during C-sections or for shorter periods of pain relief. It’s a once- off injection, not a continuously administered drip like an epidural. “With a spinal block, a much smaller needle is passed through the same lumbar space into the area of spine where cerebrospinal fluid is found,” explains Dr Pieter Roux, an anaesthetist who works at Christiaan Barnard Memorial Hospital and various Mediclinic hospitals in Cape Town. “Local anaesthetic is injected, which causes a more sudden, reliable and profound pain relief [than an epidural].” This relief, however, is only limited to five hours.
WHAT ARE THE RISKS?
As with any type of medication, there may be side- effects. The most common side- effects experienced are: • A drop in blood pressure (can cause light-headedness, nausea and vomiting, which might make it more difficult to breastfeed as a result). • Loss of bladder control (doctors can insert a catheter to drain the urine). • Itchy skin (caused by an opioid narcotic that is often added to the epidural mixture). • Heavy legs and a feeling of paralysis. • Headache (occurs in about 1.5 percent of women). More severe but extremely rare sideeffects are: • Temporary nerve damage (1 in 6 700)* • Permanent nerve damage (1 in 240 000)* • Infection at the site of needle insertion • Seizures • Paralysis • Death *Based on a review of 27 studies (which included 1.37-million pregnant women who received epidurals or spinal blocks).
HOW TO DECIDE…
“I think all mothers should plan their personal birth plan in conjunction with their chosen obstetrician,” says Dr Roux. “Your obstetrician will know what’s best for you based on many factors: your physical health during pregnancy, the size of your baby, your pelvic shape or type and, to a degree, your preferences – after all pros and cons have been explained to you.” He says moms are the best ones to know their own pain threshold and values, but to remain open-minded since plans in the delivery room can and often do change. “No one should be forced to have an epidural if they don’t want one,” stresses Dr Roux. “Epidurals aren’t essential for natural birth, and if birth is problematic or prolonged, the obstetrician will usually proceed to C-section.” And remember: epidurals and spinal blocks aren’t the only way to relieve your pain during birth. Changing positions often, having a massage, spending time in the bathtub and using nitrous oxide (aka “laughing gas”) can all help, too. Get the facts and choose what’s right for you.