Epidurals - what, when, where, why, how?

Epidurals. You need to know about them. Whether it is your plan to avoid one at all costs, you are open to one if necessary or you are going straight in for it, you need information.

I feel it is my duty to discuss all aspects of birth and epidurals have their place too.

What? An epidural is a plastic tube which is placed between the vertebrae (bones) in your lower back, using a needle. The needle is removed and you are given medication through the tube.

When & Why?

You may opt for an epidural if you have tried all other comfort measures, during labour and also during a caesarean birth, have a high blood pressure or pre-eclampsia as epidurals can lower your blood pressure. Essentially, the majority of people will be able to have an epidural if requested and are aware of the pros and cons. Epidurals can be used throughout the labour process from the point that you are in established labour, although they may be less beneficial in the 2nd stage of labour.

Where?

You must be in an obstetric unit, where there is an anaesthetist, to have an epidural. They are not available at home or in midwifery led units. It can take some time from requesting an epidural to actually having it placed, due to other events going on and the availability of staff/equipment.

How? To have one placed, you need to sit like this woman, very still on the edge of the bed, with your back hunched over. You'll sometimes be given a pillow to hug and your feet placed flat on a chair. The anaesthetist will then do the procedure which can take between 5 minutes and an hour (this is rare, but it can be tricky sometimes). Your blood pressure will be carefully monitored following this, as the epidural can cause it to drop. You'll be given fluids through a cannula to counteract this, with your blood pressure checked regularly for the remainder of labour. You will be recommended to have your baby continuously monitored and you will be restricted to the bed, as you are unlikely to have full control of your lower body. You won't really be able to move, although should still have some sensation in your legs. Sometimes (very rarely), the epidural is uneffective and may need replacing.

You will have a catheter placed to empty your bladder. Every hour the midwife will check how effective your 'block' is using a cold spray, to see how much you can feel. You will be able to control how much medication is in your system using a button which can be pressed every 20 minutes (may vary in each hospital) to top up. Although it can brilliantly control the discomfort, it will not always be entirely removed, especially low down in your pelvis.

Labour can slow with an epidural. The mistake many women with an epidural make is that although you can't feel anything, doesn't mean you can forget about your hormones! You still need to produce that lovely oxytocin to keep labour going. Don't just play on your phone, chat with your birth partners etc, keep calm and in the zone. Dim the lights, keep conversation minimal, have on some relaxing music and change position onto your side regularly. Occasionally, it may be recommended that you have the oxytocin drip to support your surges and encourage labour to progress. When it comes to the 'pushing' stage, you may struggle to feel the urge and it can take longer. You will be given some time for the baby to descend further into your pelvis once it has been determined that your cervix is fully dilated. This is to give you the best chance of an unassisted vaginal birth. Some women like to let the epidural wear off towards the end of labour, so there are more sensations felt during the pushing stages. You are more likely to require forceps or ventouse (suction cup) to help baby to be born. Perineal trauma (tears) are sometimes more common too.

Some other things that you may experience with an epidural are itchiness, shivering or fever, nausea and vomiting, headaches and rarely, nerve damage. Following the birth, you will have to wait for the epidural to wear off before getting out of bed and the midwives will keep a close eye on your bladder control after the catheter is removed.

I hope this is helpful! If you have any questions, feel free to head on over to our facebook group or send me an email :)