Epidurals

Sally UnderwoodUncategorizedLeave a Comment

Written by midwife Sally Underwood

Having an Epidural – although not planned – can still be POSITIVE.

I believe that childbirth can be an empowering and positive experience that you treasure for the rest of your life. The skills and techniques you learn within our antenatal KG Hypnobirthing training programme can shorten your labour and reduce your need for pain relief, but sometimes you may well need more and have to embrace a change of plan! 

I recently spoke with a newly delivered mum and dad about their birth experience and heard how they had to do just this. Together they had prepared so well for a calm, drug free birth experience but due to an unexpected complication of late pregnancy, they had needed to amend their intended course of action to embrace hypertension, an induction of labour and consequential brow presentation.  Labour consisted of prostaglandin gels, CTG monitoring, a labour bed and also very uncomfortable uterine surges – within a brightly lit room, attended by a well-meaning attentive obstetric team. This was sooooooo not what they had envisaged – dim lights, music and a birth pool with their midwife. Therefore they had to employ plan B – which included an epidural….. but honestly, they truly needed it and were able to make the best of it. They had a mobile epidural so were able to keep active, moving around and although the birth ended up as an emergency caesarean section – it was largely still a positive experience.

An epidural provides pain management by blocking the nerves carrying pain from the womb and birth canal. This is achieved by injecting local anaesthetic into the space surrounding the spinal cord. The local anaesthetic is injected down a small plastic tube, a catheter, which passes between the bones in the lower back. You become largely pain free. 

When you have an epidural you will need to have an intravenous infusion running – this is to prevent any complications associated with a drop in your blood pressure. 

Epidurals are performed by anaesthetists – only available in obstetric led units. In order to have an epidural sited you will be asked to get into a sitting position and bend forwards. Your back is cleaned with cold fluid and the skin made numb with an injection of local anaesthetic. This stings for a few seconds. A needle is then passed between the bones in your back to find the space surrounding the spinal cord. It is very important to lie as still as possible at this stage to avoid any complications. The anaesthetist will try to work in between your surges and your midwife will help with this. A fine epidural catheter is then passed through the needle and the needle removed. Sometimes the catheter touches a nerve and causes a brief shock or “twinge” that passes into the leg. This is normal and short lasting. Finally, the catheter is taped down onto your back and is ready for use.

This is a technically difficult procedure and it usually takes about 20 minutes to insert the catheter. In people with more difficult backs, it may take longer or not be possible at all. Once the catheter is in, the local anaesthetic will take about 20 minutes to reach its full painkilling effect. 

The epidural will make your tummy feel numb and take away most of the pain of your contractions. You will be aware that you are having surges but they will not feel uncomfortable. Your legs may feel weak and heavy and for this reason you need to discuss your requirements for being as mobile as possible during your labour. A dose of local anaesthetic usually lasts for about one hour – so you can regulate it with your surges. In most women the epidural will be very effective – however, for some the epidural will not provide pain management immediately, and may require adjustment. Sometimes, it may need to be replaced.

What happens if I need an operation?

If for any reason you require an operation such as a caesarean section, the epidural can usually be used instead of a general Anaesthetic which is safer for you and your baby. The epidural may cause a drop in blood pressure, which may make you feel faint and nauseated which is easily treatable. Other effects include shivering or itching, which are usually short term. You may temporarily loose the sensation of a full bladder therefore your midwife will check for this at intervals, and it may be necessary to insert a small tube into the bladder to drain the urine. This is removed as soon as the bladder is empty.

Epidurals may cause temporary bruising. The likelihood of having long-term back problems after delivery is the same whether or not you have an epidural for labour.

Does and epidural effect my baby?

Epidurals have very little effect on your baby. A large drop in blood pressure may temporarily affect the baby but is easily treated. As you will no longer be aware of painful surges, the midwife will feel the strength of your contractions by laying a hand on your tummy. In addition to this, the frequency of your contractions and your baby’s heartbeat will be continuously monitored using a CTG machine. 

The total time course of labour may be prolonged. Epidurals have been associated with a higher rate of intervention but as with my couple discussed above, having an epidural offered them a chance to be able to enjoy a short time of almost normality together – being as if they were ‘low risk’ mobilising together with their relaxations – before they needed to dash for emergency surgery…… and have their little baby…abdominally… but all good. 

So despite being in unplanned territory this couple still felt empowered due to their knowledge and also they felt informed… proving you can still have a positive birth experience. And lastly…three cheers for the epidural!!!

Come and join our next Hypnobirthing Course (this is a full antenatal programme so you will not need to attend another antenatal course) so that you have the tools for a positive birth.

(Photo credit: Eva Rose Birth)

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