Some notes on Epidural, taken from:
http://www.babycentre.co.uk/pregnancy/labourandbirth/painrelief/epidural/
What is it?
It's an injection into the small of your back, using a curved, hollow needle. The needle goes between the vertebrae of your back, and into the space outside the coverings that surround your spinal cord. A fine tube is passed through the needle and then the needle is removed. The tube is taped up your back and over your shoulder. The anaesthetist injects a local anaesthetic (similar to what you would have at the dentist) into the tube to numb the lower part of your abdomen. Generally, your legs and feet go numb as well. You can't feel your contractions any longer. Sometimes, the tube is attached to a small pump, which allows you to control how much local anaesthetic you have, or the pump may be primed to release a small dose of the anaesthetic every so many minutes.
How does it work?
It works in just the same way as a local anaesthetic works when the dentist numbs your mouth before extracting a tooth. The anaesthetic deadens the nerves which are carrying pain signals from your womb and cervix.
When should I have it?
Theoretically, you could have an epidural at any point in labour, even in the second stage when you are pushing your baby out, although a spinal anaesthetic would probably be offered in that situation. Most people, however, choose to have an epidural when the cervix is about five to six centimetres dilated and the contractions are getting pretty strong. If you are as much as eight or nine centimetres dilated, your midwife might say that it's too late for an epidural and advise you to manage without because your baby should be born soon.
What are the advantages of epidurals?
More than 90% of women get complete pain relief
Your mind remains totally clear
Can help to control high blood pressure
Can put you back in control of your labour, and restore your confidence
Epidurals are more sophisticated than they used to be and you might find that your legs and feet are not completely numb
What are the disadvantages?
May find that you are numb down only one side of your body or that a small part of your tummy has not been anaesthetised
May make you feel very shivery
You have to stay in bed
You need to have a drip in your arm. This is because epidurals make some women's blood pressure drop which seriously affects the flow of oxygen to the baby. The drip is a safety precaution so that, in an emergency, the volume of your blood can be quickly boosted to bring your blood pressure back to normal again.
You will probably have a catheter into your bladder. An epidural means you can't tell when you need to empty your bladder, so this has to be done automatically for you.
You might feel very out of control. You have three tubes going into your body and you have to be told when to push if the anaesthetic hasn't worn off by the second stage of labour. Your midwife and doctor effectively manage your labour for you.
Epidurals can increase the length of labour, especially the pushing stage.
Your baby's heartbeat will be monitored continuously, using a transducer strapped to your abdomen, or a smaller transducer clipped onto his scalp.
There's a greater chance of needing to have a forceps or ventouse delivery because epidurals often prevent the baby moving into the best position to be born.
If the epidural needle goes beyond the epidural space, there will be a leakage of cerebro-spinal fluid after the tube is taken out. This fluid buffers your brain and even a very small leak will give you a terrific headache. This is usually treated by taking a small amount of blood from your arm, perhaps the day after your baby is born, and injecting it into your back to seal the hole made by the epidural needle.
Some women have problems passing urine after having an epidural.
You might not be able to have an epidural! Not every hospital in England and Wales offers a 24-hour epidural service. Rates vary from 100 per cent of hospitals providing the service in the Oxfordshire region to 58 per cent in the West Midlands, 64 per cent in the South West and 28 per cent in Wales.
Not available for a home birth.
Any useful tips?
Keep very still while the anaesthetist is setting up the epidural. You will be on your side or sitting on the edge of the bed, leaning forward. Concentrate on your breathing. Breathe in deeply through your nose and sigh out slowly through your mouth. Hold your companion's hand and keep eye contact with him or her.
Discuss with your doctor and midwife the possibility of letting the epidural wear off for the second stage of labour when you are going to deliver your baby. Being able to feel the contractions will help you push more effectively.
