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Clinical Specialties - Maternity

Birthing Information Resources

Frequently Asked Questions: Epidural / Spinal Analgesia During Birth


What is an Epidural Anaesthetic?

An epidural anaesthetic is an injection of drugs into the lower region of the spine, in order to block the passage of painful nerve impulses from the uterus and the lower body.

Who performs the epidural?

Epidurals are performed by specialist anaesthetists who have had specific training and experience in this technique.

How is an epidural anaesthetic performed?

  • An intravenous ‘drip’ (small fine tube called a cannula placed into a vein, through which fluid is then given) is commenced into the hand or arm before epidural insertion
  • An antiseptic solution is applied to the skin on the lower back and a small injection of local anaesthetic is administered prior to insertion of the epidural needle.
  • The epidural injection may be performed with you lying on your side or sitting up. You will be asked to ‘round’ your back by drawing up your knees and flexing your neck to ‘open’ the space between the bony vertebrae; this position allows easier access to insert the epidural
  • It is important that you stay as still as possible while the injection is in progress
  • A fine plastic catheter is inserted through the epidural needle into the epidural space and the needle is withdrawn.
  • Pain-relieving drugs are then introduced through the epidural catheter
  • Epidural catheter is securely taped into place


How long does it take for the epidural to work?

Epidural drugs may take up to twenty minutes to take full effect; although your labour contractions will continue they should not be painful. You may notice a loss of sensation (anaesthesia) and/or a loss of pain (analgesia) in your legs.

How effective is an epidural in relieving pain?

Epidural analgesia is an effective method of relieving pain during labour while maintaining the mother’s consciousness and participation in the birth. Epidurals may sometimes give inadequate analgesia and require an extra top-up of drugs to alleviate residual pain.

Does an epidural anaesthetic affect labour?

An epidural can occasionally slow the progress of labour; more commonly a very prolonged and painful labour may progress more rapidly following an epidural. The urge to push baby out may be reduced; an option of decreasing the epidural will allow some return of sensation to push.

Are there any women who cannot have an epidural?

Women who have had previous spinal surgery, are very overweight, have severe infection or who have impaired blood clotting may not be suitable for an epidural.

When do I need to make a decision about whether to request an epidural?

If you decide to have an epidural your midwife will contact your obstetrician and anaesthetist to discuss and arrange this option. Please take this into account and talk to your midwife early if you anticipate that you may want an epidural.

Is an epidural possible for a caesarean section?

Yes, in most circumstances an epidural or spinal anaesthetic (block) is possible for a caesarean section.

If delivery of the baby is required urgently there may be insufficient time to insert and establish an adequate epidural block. In this case the need for a slightly different ‘spinal’ injection or the need for a general anaesthetic will be discussed.

Is a spinal anaesthetic different to an epidural anaesthetic?

Yes, spinal anaesthesia involves a single injection of drugs into the spinal fluid with a rapid onset of anaesthesia. In some situations a combination of spinal/epidural pain management may be the most appropriate option.

Are epidurals safe? What are the risks?

Epidurals are very safe for both mothers and babies; nevertheless as with all medical procedures side effects and complications can occur.

Common side effects of epidurals are:

  • Shivering or tremor and, less commonly, dizziness and nausea
  • Tenderness at the site of needle insertion
  • Fall in maternal blood pressure, readily corrected by fluids or drugs given through the intravenous drip. In rare instances the low blood pressure may affect the baby requiring urgent intervention.
  • Loss of bladder sensation requiring a catheter to empty bladder
  • Severe headache lasting a few days or weeks (in about one in a hundred epidurals), due to the epidural needle penetrating the membrane containing the spinal fluid allowing spinal fluid to leak.


Potential (but much less common risks) include:

  • Inadvertent injection of the local anaesthetic into an epidural vein, causing temporary convulsions or a high ‘spread’ of the anaesthetic which may cause temporary difficulty with breathing or even loss of consciousness


Rare but potentially serious complications associated with epidural anaesthetics include:

  • Infection and bleeding in or around the spine
  • Bruising or scarring of the nerve roots leading to permanent weakness and numbness (or paralysis) in the legs, bladder or bowel
  • Heart rhythm irregularities, cardiac arrest, fitting and even death


It is important to realise that the risk of these major complications occurring is extremely small.

When should I seek medical support post epidural?

Seek medical support immediately if you have any concerns or develop any of the following unusual symptoms:

  • Persistent back pain
  • Tingling or numbness in any part of the lower half of your body
  • Bladder or bowel symptoms
  • Fever


Does an epidural affect baby?

Epidural solutions can cross the placenta and in rare instances may make baby drowsy and may disturb the initiation of breastfeeding.

What will it cost?

The anaesthetist will send you an account for attendance and insertion of the epidural/spinal; the amount reimbursed by Medicare and your private Health Fund may not cover the full anaesthetic fee, leaving a ‘gap’ amount determined by the individual anaesthetists.


References:

  • Anim-Somuah M, Smyth RMD, Jones L. Epidural versus non-epidural or no analgesia in labour. Cochrane Database of Systematic Reviews 2011, Issue 12, Art. No.:CD000331. DOI: 10.1002/14651858.CD000331.pub3.
  • Australian & New Zealand College of Anaesthetists and Faculty of Pain Medicine. Acute Pain management: Scientific Evidence. 3rd ed (2010) National Health and Medical Research Council
  • Costley PL, East CE. Oxytocin augmentation of labour in women with epidural analgesia for reducing operative deliveries. Cochrane Database of Systematic Reviews 2013, Issue 7. Art. No.: CD009241. DOI: 10.1002/14651858.CD009241.pub3.
  • Erikson LM, Nohr EA, Kjcergaard H (2011). Mode of Delivery after Epidural Analgesia in a Cohort of Low Risk Nulliparous. Birth, 38 (4): 317-326.
  • Jones L, Othman M, Dowswell T, Alfirevic Z, Gates S, Newburn M, Jordan S, Lavender T, Neilsen JP. Pain management for women in labour:an overview of systematic reviews. Cochrane Database of Systematic Reviews 2012, Issue 3. Art. No.: CD0009234. DOI: 10. 1002/14651858.CD009234.pub2.
  • Kemp E, Kingswood CJ, Kibuka M, Thornton JG. Position in the second stage of labour for women with epidural anaesthesia. Cochrane Database of Systematic Reviews 2013, Issue 1. Art. No.: CD008070. DOI: 10.1002/14651858.CD008070.pub2.
  • Simmons SW, Taghizadeh N, Dennis AT, Hughes D, Cyna AM. Combined spinal-epidural versus epidural analgesia in labour. Cochrane Database of Systematic Reviews 2012, Issue 10. Art. No.: CD003401. DOI: 10.1002/14651858.CD003401.pub3.
  • Sng BL, Leong WL, Zeng Y, Siddiqui FJ, Assam PN, Lim Y, Chan ESY, Sia AT. Early versus late initiation of epidural analgesia for labour. Cochrane Database of Systematic Reviews 2014, Issue 10. Art. No.: CD007238. DOI: 10.1002/14651858.CD007238.pub2.
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