What are the pros and cons of an epidural?

What is an epidural? And how is it administered? Here we explore the pros and cons of an epidural.

What is an epidural?

Epidural anaesthesia is a local anaesthetic that’s injected between two vertebra in your back. It usually removes all pain and most feeling from the waist down.

The epidural anaesthetic numbs the nerves that carry the pain impulses from the birth canal to the brain. It shouldn’t make you sick or drowsy.• For most women (around 90%), an epidural gives complete pain relief. For the other 10%, women may still feel patches on one side from their contractions. And out of these 10%, a further 10% of women will have their epidural resited for it to work effectively.

What happens when you get an epidural?

An anaesthetist is the only person who can give an epidural, so it won’t be available at home or on a midwifery led unit. It’s only available on a consultant led unit.

While you sit up in a curled position (think banana back or like an angry cat!), an anaesthetist will clean your back with antiseptic (this spray is COLD ? !). The anaesthetist will then use a small needle to numb the area where the epidural will be inserted, with some local anaesthetic.

The anaesthetist will then site the epidural by putting a needle in your back, and the passing a small tube through the needle. The small tube will then stay in your back and the needle comes out. The small tube is then taped securely to your back.

The epidural drugs are then carried down this tube to the space in your back. This provides most women with total comfort.

A couple of things to note…

• You may feel mild discomfort, pressure or tingling when the epidural needle is positioned.
• Let your anaesthetist know if you’re having a contraction, and they’ll pause for it to finish.
• It can take about 15-20 minutes to put in. Sometimes, it can take longer if the anaesthetist has trouble finding the correct space in your back. The angry cat position really helps speed up the process!
• It can take a further 15-20 minutes for the drugs to start making a difference.
• It’s advisable for baby’s heart rate to be continuously monitored for at least 30 minutes after. This means having a belt around your abdomen and possibly a clip attached to the baby’s head. This is because having an epidural can make your blood pressure drop.
• You’ll be advised to have a cannula put in prior to your epidural for the same reason.

Pros of an epidural

• It is the only drug for pain relief in labour that is an anaesthetic, which means that in 90% of epidurals, total relief from contractions is achieved.
• It doesn’t effect how you feel compared to the other drugs. You are fully “with it” with an epidural. Other pain relief can make you feel woozy ?

Cons of an epidural

1. Side Effects

You may find it difficult to empty your bladder with an epidural on board. If so, a small tube called a catheter may be put into your bladder to help you. This would be an “In/Out” catheter so won’t need to stay in.

• Drop in blood pressure, this can make you feel nauseous.
• Itchy skin
• An epidural may make your legs feel heavy, depending on how strong the block is. This can mean that movement is limited. I would encourage you to use a peanut ball to help keep your pelvis open.

2. Risks

• 1 in 100 women have a dural tap headache post natally from an epidural. It can be extremely painful, but it can be treated.
• 1 in 10,000 women can have nerve damage from an epidural.

Other things to consider

• Epidurals can prolong labour, for an average of 2 hours.
• If you can no longer feel your contractions, the midwife will tell you when to push.
• There is an increased chance of having an instrumental birth with an epidural. Because of a contribution of the things outlined above (lack of movement, prolonged pushing, unable to feel contractions)

My top tips

When you have an epidural, your midwife will advise you to wait for 2 hours from the time you are fully dilated. This is to allow baby’s head to come down through the pelvis just from your contractions and not pushing. This means that when you start pushing, your pushing baby from a lower point in your pelvis. This is done to reduces the higher chance of an instrumental delivery that having an epidural brings.

I’d also really recommend a peanut ball to help open your pelvis in labour. You can also still change positions regularly with an epidural even if you can’t walk or stand on your legs. Think, lying on your side, sitting right up, or leaning over the back of the bed. This will help baby’s travels through your pelvis.

Want to read some epidural birth stories? Head here to read about Becca’s Positive Birth; induction, epidural and forceps here or Elisabete’s Positive Induction here.

All pain relief options are covered in The Birth Chapter online course. Covering all antenatal education birth topics & Hypnobirthing with midwife Beth, to help you prepare for a positive birth in all birth situations.