Pain relief options for labour – Pharmacological part 3
An epidural is widely accepted as a common form of pain relief for women in labour, with many obstetricians advocating the use of epidurals for their patients’ as they believe it has few side effects! I am going to explore the benefits and the side effects of having an epidural in labour and will leave you to make your own decisions.
What is an epidural?
An epidural is the introduction of a local anaesthetic into the epidural space in your spine. The anaesthetist will give you a local anaesthetic in your lower back before inserting a hollow needle between the bones of your spine. The local anaesthetic is added to the fine plastic tube inserted into your back through the needle, which is then removed. The tube is taped up your back and over your shoulder. The anaesthetic numbs the nerves that carry the pain signals up your spine to your brain. The most common ways to receive it are either by an intermittent ‘top up’ via the tube, as the anaesthesia wears off, or by a continuous infusion which pumps a regular amount of anaesthetic into your spine to maintain comfort.
Side effects on labour
- Increases the length of 1st and 2nd stage of labour
- More likely to need your labour speeded up with Syntocinon (synthetic oxytocin)
- It increases the incidence of the baby turning into a posterior position which is not optimal for an easy delivery
- It increases the need for instrumental deliveries such as forceps or ventouse, because of a posterior position or a delay in the pushing stage
- There is an increase in the number of 3rd and 4th degree tears of the perineum
- May increase the cesarean section rate if sited early
What are the advantages of having an epidural?
- It usually provides excellent pain relief during labour
- It works fairly quickly in about 40 minutes
- Your mind remains clear, and you can rest during labour
- If you have a problem such as pre-eclampsia it can help to bring your blood pressure down during labour
- It is valuable for those women whose labour is very long, or has been induced, and/or accelerated with syntocinon
- Useful for some women with tocophobia (fear of childbirth) and/or post traumatic stress disorder from a previous labour and birth
- The use of epidurals has made cesarean sections safer by reducing the need for a general anaesthetic
What are the disadvantages of having an epidural?
- 30% of women get partial but not complete relief
- A loss of mobility during labour, and continuous fetal monitoring which means you have to stay in bed
- You may develop a fever or itching
- It can become more difficult to empty your bladder and you may need to be catheterized
- A drip is inserted into your veins for extra fluids to counter-act the effects of low blood pressure, should it occur
- You may develop a fever and /or itching from the drugs used
- Headaches are a side effect if the needle has nicked the bag of fluid which surrounds the spine, with approximately a 1:100 chance of it occuring
- Babies heart rate may become raised due to the effects of a maternal temperature rise
- There is a reduction in the number of women who breastfeed successfully due to the effects of the epidural on breast seeking and feeding behaviours in your baby
In summary, it has never been safer to have a baby, and yet women have become more frightened than ever of what should be an exciting natural event. We no longer trust in our mammalian instincts and rely on an array of drugs and technology to support us through childbirth. Therefore, I believe it is important to explore the options for pain relief available to you in labour and to weigh up their advantages and disadvantages for you and your baby.
Photography: Deovolenti @Flickr