Epidural and Spinal Anaestthesia

Methods of pain relief childbirth

Pain varies enormously from person to person, and labour to labour. The technique of pain relief that best keeps you comfortable and able to cope is the one best suited for you.

Who needs an epidural?

Epidural anaestthesia is the most significant advance in the relief of pain during labour. Many women choose to have an epidural if other more simple methods such as pethidine and nitrous oxide gas fail to give adequate control of their pain.

What is an epidural anaesthetic?

An epidural is an injection of local anaesthetic into the epidural space deep inside the back. 

Epidurals are administered by doctors skilled in this technique.

How is this done?

An intravenous (IV) drip is put into a vein prior to the epidural being given to help prevent any drop in blood pressure occurring. A local anaesthetic is given into the skin over the epidural site, low in the back. The woman will be placed on her left side in a curled up manner or in a sitting position and must remain very still so that the needle can be inserted into the epidural space.

How does an epidural work?

The sensation of the pain of uterine contractions and the other sensations of the skin and lower abdomen and genital areas are carried by nerves which enter the spinal cord in the lower back. The epidural blocks these sensations. Pain relief usually starts within minutes, but may take up to 20 minutes, and may last from one to four hours from single dose.

What does it feel like?

Early sensations will be like “pins and needles” followed by a feeling of warmth in the legs and finally, numbness from the waist down. There may also be some loss of muscle power in the legs.

What are the advantages of an epidural?

An epidural gives pain relief and avoids the use of other pain relieving drugs, e.g. pethidine, which may cause drowsiness for mother and baby.

What problems are associated with an epidural?

Shivering is not uncommon after an epidural.

A drop in blood pressure may occur in some patients, causing nausea and sweating. This can be corrected with medication.

Bladder sensation is temporarily lost and therefore a catheter may need to be inserted into the bladder to allow emptying.

Rarely, the epidural needle pierces the covering (dura) around the spinal cord, causing a small leak of spinal fluid which may result in a headache lasting for several days. This can be treated if the headache remains.

Will it harm my baby?

The amount of local anaesthetic drug that crosses to the baby is very small. There are no effects know to significantly affect the baby either at the time of delivery, or afterwards.

What about spinal anaesthesia?

Spinal anaesthesia involves a single needle injection at a similar site to an epidural. The anaesthesia is injected into the actual spinal fluid covering the spinal nerves and cord, rather than the space outside this layer. The needle is much finer, no catheter is used, and the dose of local anaesthetic is even less than for epidural. The loss of all sensation is usually more rapid and complete with extreme muscle relaxation and leg weakness. Spinals are usually used around the time of delivery and especially for caesarean section.

When is an epidural or spinal anaesthetic used for a caesarean section?

When a caesarean birth is planned (an elective caesarean section), an epidural or spinal anaesthetic is most suitable for most mothers who choose to be awake. Being awake offers increased safety in many situations, with distinct advantages over general anaesthesia. It enables the mother to participate in the birth of her baby- she is able to see her baby first, and hold it immediately. The mother does not have the unpleasant after effects of a general anesthetic, including having to wait to cuddle her baby.

Are there any reasons not to have an epidural?

If an emergency birth is necessary and time does not allow, e.g. with severe fetal distress in labour, general anaesthesia may be necessary.