Information about Epidural Analgesia

Information about Epidural Analgesia
What is Epidural Analgesia and how does it work?
An epidural analgesia is a method of pain control used during the childbirth process to control the mother’s discomfort without causing total loss of feeling or movement.
The epidural space is outside the spinal canal and is normally filled with fat, connective tissue and blood vessels. The nerves that carry the feelings of childbirth pass through this space as well.
A small plastic tube (called a catheter) is placed into the lower back into the epidural space. A local anesthetic medication (freezing) is given through the catheter and into this space. This drug then affects the nerves and blocks the pain. The catheter is left in place until delivery as more than one dose of the drug may be needed before the baby is born.  In most cases, a small machine is placed at the side of the bed and delivers more freezing continuously.
Does it hurt to have the epidural catheter put in?
It hurts less than a contraction. A local anesthetic (freezing) is used in the skin around the place where the catheter is placed. There is usually some slight discomfort at this spot.  More pain may be felt if a problem occurs while the catheter is being put in.  Sometimes a short, sharp pain is felt if the needle or catheter touches a nerve during insertion.
Will labour be slower because of the epidural?
An epidural has little effect on the early stages of labour. The mother is often more comfortable and less fearful because of the pain relief that the epidural brings. This comfort for the mother may even lead to better coordination of contractions and therefore labour may be faster.
Does the epidural affect the delivery?
An epidural analgesia can affect the amount and strength of the “pushing” during the second stage of labour. Although forceps are not always needed during delivery, forceps are more often required with an epidural. This is because there is decreased feeling in this area and so the mother is not able to “push” as well.
Does an epidural cause backache afterwards?
No, the childbirth process itself usually causes backaches because the ligaments in this area need to stretch for the baby to be born.
If I cannot feel how will I know that I have to go to the bathroom (urinate)?
A catheter is almost always inserted into your bladder when you have an epidural. This is because there is decreased feeling in the area. It is important that the bladder be kept empty as a full bladder can affect labour and may even cause damage to urinary system during delivery.
Can an epidural cause permanent nerve damage or paralysis?
Modern anesthetic drugs given into the epidural space do not cause permanent nerve damage. Bladder problems and leg weakness are sometimes experienced after delivery but this has nothing to do with whether the mother had a epidural or not. These problems are usually due to the pressure of the baby’s head and body on the mother’s bladder and on the nerves to the legs. Problems causing permanent effects are very rare.
Who should not have an epidural?
  1. Anyone who is not willing to accept the risks associated with an epidural.
  2. Anyone who has bleeding problems or who is taking blood thinners (anticoagulant).  This is because of the increased risk of bleeding around the spinal cord.
  3. Anyone with a severe infection in the lower back.  This is because of the risk of spreading the infection into the spine.
  4. Anyone with severe dehydration or low blood volume (severe bleeding).  This is because of increased risk of the blood pressure dropping too low.
Are there other cases where an epidural may be more difficult or risky?
Yes, there are two cases in which epidural analgesia is possible but special care must be taken because of medical reasons.
  1. People who have had previous back surgery or back problems since birth.  This is because the risk of complications is higher and there is a chance that they will not receive good pain control.
  2. People with severe infection such as pneumonia or infections of the uterus.  In these cases, there could be an increased chance of epidural infection.
If you have any other questions about epidural, analgesia please be sure to discuss them with your doctor.
Will I be completely comfortable?
The amount of pain relief provided by the epidural can vary from person to person. This is because every person is different and some people may be more sensitive to the drug. In addition, the placement of the catheter could be slightly different form person to person, and so, the drug may work better in some cases than in others.
Some discomfort may remain and often a feeling of pressure is present a delivery. If the labour is long, the drug may start to wear off and extra doses of the drug may be needed.  Many patients have complete relief of their pain.
Epidural analgesia does not always work. Some people do not get enough pain relief, and even if the catheter is moved to another spot, some pain is still felt.
How long does it take for the freezing to work?
Once the drug is given, it takes about twenty minutes to work. A tingling, warm and numb feeling is felt in the mother’s legs and lower back as the drug begins to work. Weakness is also experienced in these areas. Many mother experience some shivering at this time, which is also an effect of the drug.
Is there a special doctor who looks after the epidural analgesia?
Yes. The doctor who is trained to give an epidural is called an anaesthetist. The anaesthetist cares for all patients in the hospital who require spinal analgesia. The anaesthetist may be in the operating room or with someone else, and so sometimes the start of the epidural may be delayed.
It is very important that certain tests be completed before the epidural is started and this may take a little time. The testing required prior to an epidural, is blood work and starting of an intravenous(IV).

Potential Complications

Is there any danger for the mother?
An epidural analgesia is a relatively safe procedure. If the mother is healthy, there is very little chance of a major problem causing permanent damage. HOWEVER, as with any anaesthetic or procedure there is always a small risk of complications no matter how carefully it is done.

What are those complications?
  • An epidural analgesia can cause the mother’s blood pressure to drop. The mother and baby could be harmed if the blood pressure drops too low. To help prevent this from happening, the mother is given extra fluids by IV (intravenous) when the epidural is started. In addition, the nursing staff who are trained to check for and look after this problem check the mother’s blood pressure often.
  • The blood pressure can also go too low during an epidural because the weight and shape of the uterus can cut off the blood circulation from the legs. To help prevent this the mother must remain on one side or the other during labour.
  • Occasionally during the insertion of the catheter, the membranes covering the spinal canal and nerves can be accidentally punctured.  Some of the spinal fluid can leak out through this hole and this may lead to a “spinal headache.” The drug given in an epidural must not be given into the spinal canal. If a puncture occurs, the catheter will need to be moved to another spot.
  • There is a chance that during the insertion of the epidural catheter a blood vessel (usually the epidural vein) may be accidentally punctured. Usually the blood vessel seals itself off quickly and causes no bleeding problems. In the event that such a puncture occurs, the epidural catheter will need to be moved to another spot. People who take blood thinners (anticoagulants) or have bleeding problems MUST not have epidural analgesia, as there is an increased risk of bleeding.
Is there anything that the mother should do to help prevent these problems from happening?
It is very important for the mother to follow instructions very carefully during the insertion of the catheter. Movement during the insertion of the catheter can cause it to be placed in the wrong spot. The mother must sit as still as possible while the catheter is being inserted.
The mother is to remain on one side or the other until delivery as talked about above. She MUST not attempt to get out of bed.