What is an Epidural?
An epidural is the most common and effective type of anesthetic used for pain relief during labour.
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How is an epidural inserted?
When your obstetrician has determined that you are in labour, or is planning to induce your labour, you can request for an epidural to be inserted by an anaesthetist. An epidural insertion involves the insertion of a needle into your back and a tiny tube, called a catheter, is introduced into your lower back. The needle is removed and the catheter left in place for delivery of the medication through the tube as needed. The catheter is taped securely to your skin. You can lie on your back with this catheter in place, and can move in your bed.
Does it hurt when the epidural is administered?
The anaesthetist will numb the skin where the epidural is administered by injecting local anaesthetic using a very small needle. This may cause a momentary stinging or burning sensation. After the numbness has set in, there is very little pain associated with an epidural injection. Instead, most patients will feel some pressure as the needle is inserted.
How does an epidural work?
An epidural anesthesia creates a band of numbness from your bellybutton to your legs. Depending on the technique used, sometimes it may take up to 30 minutes for the full onset of numbness after the epidural is inserted. Having an epidural allows you to be awake, alert and pain-free throughout labor, even as the contractions are on-going. Sometimes when you are ready to deliver your baby, the epidural infusion may be tailed down to enable you to feel pressure. The ability to feel second-stage labor pressure enables you to push when it’s time to give birth to your baby.
Do epidurals increase risk of a cesarean delivery (C-section)?
Older studies suggest that women using epidural analgesia may be more likely to require instruments to assist with the birth when compared with opioid drugs, however this effect has not been seen in newer studies using modern epidural techniques. An epidural does not increase the risk of cesarean section.
Do epidurals slow down labour?
An epidural may reduce the urge to push at the second stage of labour, when the cervix is fully dilated, resulting in slightly prolonged second stage.
Should an epidural be administered in early or late labour?
Large scale studies have shown no differences in outcome whether an epidural was administered in early or late labour. We can place your epidural at the beginning, middle, or even toward the end of labour – we have placed epidurals in women who were dilated to 10cm, however, you must be able to remain still for 5-10min during the insertion, which might be tough if you're close to delivering. Hence, we advice our patients to have an epidural before they reach that stage!
Can epidurals harm the baby?
The amount of medication that reaches the baby from the epidural is very small, and there is no evidence that it causes any harm.
Are there risks and side effects?
Epidurals are generally very safe; serious complications are fortunately extremely rare. Common side effects encountered:
Shivering, itch over the upper body while on epidural infusion - This is self-limiting, and will usually resolve spontaneously.
Decrease in blood pressure – The medication may lower your blood pressure, which may slow your baby’s heart rate. Hence, your blood pressure will be closely monitored immediately after the epidural is inserted to monitor for this occurrence. To treat the drop in blood pressure, you will be given extra fluids through a tube in your arm (IV), and may be requested to lie on your side. Additional medications may also be administered to maintain your blood pressure.
Sore back – Your lower back may be sore where the needle was inserted to deliver the medication. This soreness should last no more than a few days. There is no evidence that an epidural can cause permanent back pain.
Headache – On rare occasions, the needle pierces the covering of the spinal cord, which can cause a headache that may last for a few days if left untreated. This headache is characteristically worse when you get up and about, and better when you lie down. If this situation arises, discuss the treatment options with your anaesthetist.
Incomplete numbness - Occasionally, pain relief may not be complete as there are various other factors at play.
Permanent nerve injury - the risk of permanent injury is reported to be 1 in 23,500 to 50,500 epidural injections. The nerves in your back may be damaged through the following mechanisms: Direct injury caused by the needle or the catheter, hematoma (a blood clot) or infection. Hence, your anaesthetist will screen your health thoroughly to look for risk factors that may increase the risk of nerve injury, before performing the epidural.
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Who shouldn’t get an epidural?
Epidurals may not be recommended for patients with certain health conditions, such as:
Conditions that require blood thinners
History of severe brain or spine problems
Your anaesthetist will assess you carefully before recommending an epidural for labour pain relief.
Choosing your preferred pain relief method for labor and delivery is a personal decision. Our team of profession and experienced doctors are available 24/7 to provide labour epidural service.
Anim-Somuah M, Smyth RM, Jones L. Epidural versus non-epidural or no analgesia in labour. Cochrane Database Syst Rev. 2011 Dec 7;(12):CD000331. doi: 10.1002/14651858.CD000331.pub3. Update in: Cochrane Database Syst Rev. 2018 May 21;5:CD000331. PMID: 22161362.
Sng BL, Leong WL, Zeng Y, Siddiqui FJ, Assam PN, Lim Y, Chan ES, Sia AT. Early versus late initiation of epidural analgesia for labour. Cochrane Database Syst Rev. 2014 Oct 9;(10):CD007238. doi: 10.1002/14651858.CD007238.pub2. PMID: 25300169.
Anim-Somuah M, Smyth RMD, Cyna AM, Cuthbert A. Epidural versus non-epidural or no analgesia for pain management in labour. Cochrane Database of Systematic Reviews 2018, Issue 5. Art. No.: CD000331. DOI: 10.1002/14651858.CD000331.pub4