Your top 10 questions about epidurals

An epidural is one of the more commonly known pain relief methods used by women across the globe. So whether you plan to have an epidural or not, it’s important to know the where, what and how of this pain relief method, before you head towards the labour ward

1 WHAT IS AN EPIDURAL?

An epidural is a form of local anaesthetic. An anaesthetist will administer an epidural by injecting a specific area of your spine, called the epidural space. It effectively blocks pain signals from reaching your brain, so you feel little or no pain during labour.

2 CAN I ASK FOR AN EPIDURAL IF IT’S NOT IN MY BIRTH PLAN?

If you think you may need an epidural during labour, it’s best to discuss and confirm this with your gynaecologist or doctor during your check-up appointments, while pregnant. Whether you’re in a public or private health facility, discussing the use of an epidural is important, because they take a long time to set up. Dr Mike Blackburn, a specialist anaesthetist in a private practice in Johannesburg, says, “It takes approximately 45 minutes to an hour to site and set up an epidural correctly, and ensure that it’s operating properly.”

3 HOW LATE CAN I REQUEST ONE?

Dr Blackburn says, “If a labouring woman is within an hour of delivery – eight or more centimetres dilated – there isn’t much point in siting the epidural. I’d be reluctant to place an epidural beyond 7 to 8cm dilatation. It’s possible to provide rapid pain relief by performing a combined spinal and epidural during a late stage of labour. We inject a small amount of local anaesthetic into the fluid surrounding the spinal cord, and then place the epidural catheter and get it running. There’s almost always potential to do something for labour-related analgesia, but it’s always best to place it as early as possible, once true labour is confirmed.”

4 WILL I STILL BE ABLE TO PUSH IF I HAVE AN EPIDURAL?

Pushing your baby out while the epidural is in full effect can be difficult, and that’s why the epidural is often stopped once you reach the final stages of labour. Dr Blackburn advises that “once the mother is nine to 10cm dilated, we usually stop the epidural and, as it recedes, this allows for some sensation which helps with the final pushes needed for vaginal delivery.”

5 HOW WILL AN EPIDURAL AFFECT MY EXPERIENCE OF LABOUR?

Aside from the pain relief you’ll experience, many women report feeling a floating sensation, with tingling or loss of sensation in their lower body. Ultimately, an epidural will affect your experience of labour by removing the pain, but also allowing you to focus entirely on the birth process, and not on the pain.

6 HOW WILL I KNOW IF THE EPIDURAL IS WORKING?

Aside from the pain relief and physical sensations, you’ll also feel numb in your lower body. If you’re concerned that the epidural isn’t working, consult with your anaesthetist so that they can check it’s working properly, or resolve the issue.

7 WHAT ARE THE RISKS ATTACHED TO HAVING AN EPIDURAL?

The most common side effects include: low blood pressure, nausea and weakness in the legs. More permanent neurological risks, as outlined by Dr Blackburn, include paralysis, abscess formation and blood clots, but these are exceptionally rare.

8 HOW WILL AN EPIDURAL AFFECT MY BABY?

As always, anything that enters the mother’s body will be passed on in some way to their baby. An epidural may cause your labour to take longer than usual, but the effects on your baby are negligible. At worst, your baby may be a little drowsy after entering the world.

9 WHAT ARE THE SIDE EFFECTS OF HAVING AN EPIDURAL, AFTER LABOUR?

After you’ve given birth and the epidural has begun to wear off, you may still battle to move around, due to weakness in your legs. You may experience some backache and bruising, especially at your epidural site. Lastly, you may struggle to urinate, but most mothers who have an epidural are also fitted with a catheter, and this side effect usually wears off quite quickly.

10 “MY EPIDURAL ONLY WORKED ON ONE SIDE OF MY BODY”

Johannesburg-based mom to Rebecca, Kira Francis, tells us that her epidural didn’t work properly. Kira says, “When the epidural was administered, I felt a lot of pain relief. About three hours later though, pain slowly started seeping in on my right side. The nurses told me it sometimes happens, turned me onto my right side and said that would help. It didn’t help, as more and more pain came, predominantly on my right side, until the epidural wore off and I was in complete pain again. I wasn’t happy being in pain – that’s why I requested the epidural in the first place. If I knew that would’ve happened I would’ve rather opted for a c-section.”