Epidural pain relief in labour

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1 Epidural pain relief in labour Striving for excellence

2 This leaflet has been designed to help you decide whether to opt for an epidural for your pain relief in labour. It is important that you have this information now because when you are in labour you may be in a lot of pain and it may be difficult for us to explain if you have had an injection for pain or gas and air. You do not have to decide now whether to have an epidural, but if you read this leaflet now it will help you to be fully informed if you decide in labout that you want an epidural. You may have heard different stories about epidurals from well-meaning friends or relatives. Epidurals are very safe. There are alternative methods of pain relief which can ease labour pains. However, if you want to be completely pain free there is no doubt that a good epidural is the best option. If you decide that you want an epidural, an anaesthetist will arrive within a few minutes of your decision. An anaesthetist is on labour suite 24 hours a day. What happens? You will have an intravenous tube (drip) put into a vein in the back of your hand. You will then be asked to sit on the edge of the bed with your legs hanging down over the side. Your feet can rest on a little stool and a pillow will be placed on your lap. If you have been using gas and air you may continue to do so, if you need it. Your back will then be sprayed with a very cold antiseptic. This will probably make you jump. The anaesthetist will then feel your back to find the best place to put in your epidural. 2

3 This area will be injected with local anaesthetic so that you don t feel the epidural needle going in. First the epidural needle is put into your back, then a small tube is fed along the needle. The needle is then removed leaving the plastic tube still in place. This usually takes less than minutes. The local anaesthetic, which will make you comfortable, can then be injected down the tube. You will be asked to sit in a comfortable position. A small amount of local anaesthetic is first injected to check that the tube is in the correct place. After 5 minutes the first top-up can be given down the tube. Your midwife will take your blood pressure regularly until your epidural is working properly. It will be minutes before you have the full effect from your epidural. First you will notice a warm feeling in your bottom (as if you were sitting on a hot water bottle!). You will soon notice your contractions getting shorter. Finally the pain at the peak of your contractions will begin to subside. After that you may still be aware that you are having contractions, but they will not be painful at all. Once the epidural is fully effective you may choose whatever position is the most comfortable for you. Modern epidurals don t make you completely numb so you should always be able to move your legs if you wish to move them around in bed, but you will not be able to stand or walk. Your epidural will be attached to a pump, which will continue to deliver the anaesthetic down the tube so that it doesn t wear off. Your contractions are likely to get stronger as your labour progresses. 3

4 Sometimes you will require top-ups, if you begin to feel discomfort. The epidural lasts all the way through labour and the birth. The epidural pump is not switched off before your baby is born, unless you wish to be more aware of the sensation of the birth. When you are ready to give birth you may be aware of a feeling of pressure down below and an urge to push. To take this sensation away requires a stronger dose of local anaesthetic, which would result in your legs feeling very heavy and numb. It is up to you whether you want something stronger at this stage. Many women prefer the sensation of pressure to the numbness in the legs. Your epidural can be used should you require forceps or a caesarean section. We can give a much stronger local anaesthetic which will make you very numb from the top of your tummy right down to your toes. Are there risks and side effects? For many women this is as much information as they wish to know. Others wish to know about the rare problems that can occur with epidurals. Read on if you wish to know more but remember epidurals are very safe and problems are rare. The following is for your information and should not cause you undue concern. Epidurals do not have any direct effect on your baby. In spite of our best efforts only about 85% of epidurals work perfectly. The other 15% tend to be those which are put in too late or are technically very difficult, due to back problems. 4

5 If your epidural does not work very well it can be taken out and put in again. Occasionally (in less than 1% of cases) you can develop a headache. This headache can be severe but can easily be treated. Sometimes to treat the headache we may have to take a sample of your blood and inject this into where the epidural was. The blood forms a clot and the headache is cured almost instantly. This is called an epidural blood patch. Occasionally it needs to be repeated. Occasionally your blood pressure may fall slightly once your epidural is working. If so extra fluid can be given through the drip in your hand. It is normal to have a slight bruise in the small of your back for a couple of days, which may be a little sore. In spite of what you may have read or been told epidurals DO NOT cause or aggravate backache. Women who have babies without an epidural have the same chance of developing backache as those that do. Epidurals are sometimes used to treat backache! Some ladies experience difficulties passing urine after delivery. The cause of this is not always clear but seems to be slightly more common after an epidural. Many people believe that epidurals mean that you have to spend longer time pushing your baby out. The evidence is not clear because women who have difficult labours are often encouraged to have epidurals. If you have an epidural in place you can have it topped up and wait for an hour before you start pushing. This helps the baby to come lower down in the birth canal so you are pushing for less time. 5

6 Many people believe that epidurals mean you have a greater chance of forceps or caesarean delivery. For the same reason as above it is not clear if this is the case. You are still much more likely to have normal birth than any other. There is an increased chance of a venteuse (suction cup) delivery with an epidural (14% instead of 7%)* Some patients notice a patch of numbness in one or other leg, which can last for several days or even a few weeks. This is rarely a problem caused by the epidural. Almost always this is caused by your baby s head squashing the nerves as it passes down through the birth canal. Further information Reliable information can be found at com regarding pain relief in labour. *Ref: Maternal obesity, length of gestation, risk of post-dates pregnancy and spontaneous onset of labour at term.british Journal of Obstetrics & Gynaecology: An International Journal of Obstetrics & Gynaecology. Volume 115, Issue 6, Date: May 2008, Pages: 720 to 725.FC Denison, J Price, C Graham, S Wild, WA Liston. 6

7 For more information please speak to your midwife or contact the labour ward at: Dewsbury and District Hospital Community Midwives: or Antenatal Day Unit: Antenatal Clinic: Bronte Birth Centre: or Pinderfields Hospital Labour Ward: Ward 18: Triage: Pinderfields Birth Centre: Community Midwives: Antenatal Day Unit: Antenatal Clinic: Pontefract Hospital Friarwood Birth Centre: Community Midwives: Antenatal Day Unit: Antenatal Clinic:

8 We are committed to providing high quality care. If you have a suggestion, comment, complaint or appreciation about the care you have received, or if you need this leaflet in another format please contact the Patient Advice and Liaison Service on: or pals@midyorks.nhs.uk 768g Updated July 2017 Review Date 2020 Dewsbury and District Hospital Halifax Road, Dewsbury WF13 4HS Pinderfields Hospital Aberford Road, Wakefield WF1 4DG Pontefract Hospital Friarwood Lane, Pontefract WF8 1PL / TheMidYorkshireHospitalsNHSTrust Created by: The Mid Yorkshire Design and Print Team