Regional epidural anaesthesia, known commonly as an epidural, is a method of relieving pain during labor and childbirth. The procedure is performed by anaesthetic staff who are extensively trained in this technical procedure. In countries like Australia we are fortunate to have ready access to this therapy when requested by the laboring woman or the obstetrician.
The Choice to have an epidural:
Laboring women may request an epidural early in labor, as a planned choice they have decided on during their pregnancy. At other times patients may choose this towards the end of a longer labor, when other forms of pain relief have already been tried. On occasion the attending obstetrician will recommend an epidural be inserted: for example when the patient has high blood pressure in labor, when the patient is tiring and labor still has a while to go, or to assist the safe performance of a vacuum or forceps delivery.
What actually happens when an epidural is performed:
The patient will have an intravenous line (known commonly as a “drip” or “I.V.”) to enable rehydration and help maintain good blood pressure and circulation. Antiseptic fluid is used to wash the back and the anaesthetist inserts local anaesthesia to numb a patch of skin on the back. The doctor then inserts an epidural needle into the space outside the coverings of the spinal cord ( known as the dura. Through this needle a fine plastic tube is placed through which anaesthetic fluid is inserted. The plastic tube is taped in place and connected to a special pump which delivers continuously local anaesthetic fluid. Within approximately 15-20 minutes there is a marked reduction in pain through numbing of nerves to the abdomen, pelvis and legs.
What happens next?
The woman can now rest and regain some energy while the labor continues. On occasion she may even fall asleep for a little while particularly if she has been in labor for some time. The condition of her unborn baby will be continuously monitored using a CTG (foetal monitor) strapped to her abdomen. A catheter will be inserted to keep the bladder empty. The attending midwife and obstetrician will keep an eye on the progress of the labor by vaginal examination until it is time for the mother to begin pushing.
You will learn about epidurals through reading and antenatal classes, but also please discuss this with me at your antenatal visits.
For further information you may find the following link useful: Epidurals
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Author: Dr Peter England, Obstetrician and Gynaecologist.
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