Birth educator Janine Gard.

Janine Gard is a diploma qualified birth educator and founder of Bellies to Babies. She has taught more than 2900 parents to feel confident, informed, supported and prepared. This week Janine talks about epidurals.

Epidurals are the most popular form of pain relief used in labour. Throughout New Zealand about 40 per cent of women giving birth at hospital will have an epidural at some stage during their labour. Although epidurals were invented about 1860, it wasn't until the mid-1900s that they were used during childbirth to help with pain.

Early use of the epidural showed around 40 per cent of women would experience a reduction in contractions, making labour a much longer and difficult process. During the 1970s synthetic oxytocin was discovered, which meant doctors were able to speed up contractions if this side effect occurred. There are many reasons why an epidural seems like an attractive idea, so it's a good idea to know the risks and benefits of this procedure well before your labour begins.

What is an epidural?

Epidural anaesthesia blocks pain in a particular part of the body by blocking the nerve impulses from the lower spine. During labour, epidurals aim to provide pain relief rather than a complete lack of feeling in the lower part of the body (usually from your belly button, down). This anaesthetic usually blocks the pain from labour contractions and during the birth very effectively.

How are epidurals given?

Epidurals are administered by an anaesthetist. In preparation for the epidural you will need to either lie on your left side or sit up, curling your back in a fetal position as much as you can (tricky with a belly) to open the spaces between your vertebrae. A local anaesthetic will be injected into a small area of your lower back to numb it.

The anaesthetist will ask you to sit very still while a hollow needle is inserted between the small bones of your spine. Your anaesthetist will insert the epidural needle in between your contractions, so it is important that you tell them when you have one. The needle will go into the epidural space between the layers of tissue in your spine. A very fine plastic tube called a catheter is inserted into the needle and when it is in place, the needle is removed. The medication will be given via the catheter and usually takes between five and 30 minutes for your pain to be relieved. The catheter is taped to your back and over your shoulder. This allows the medication to be top-upped pain medication can be injected into the catheter, which should last between one to two hours. Hospitals and anaesthetists will differ on the dosages and combinations of medication, but epidurals will contain a local anaesthetic and a narcotic or opioid.

Advantages of an epidural:

When epidurals work, they are the most effective pain relief available.

Epidurals allow you to be alert and awake for your baby's birth.

If you require a C-section an epidural allows you to be conscious and aware during your baby's birth and provides effective pain relief after surgery.

Providing relief from suffering (intense physical and emotional response to pain) can allow you to have a more positive birth experience.

If labour is prolonged and you are exhausted, an epidural can give you time to rest and recover your strength so you can continue to actively labour.

Disadvantages of an epidural:

For medical reasons, not everyone can have an epidural.

You will need to have fluids given to you through an IV in your arm, and will need to have your blood pressure monitored.

Because you can't feel anything from your belly button, down, you will also lose feeling in your bladder, so you will require a catheter (tube) in your bladder to help you pass urine.

You may lose feeling in your legs for a few hours after - this will slowly return.

It may slow down the second stage of labour, therefore increasing the likelihood of further interventions.

You might not be able to push effectively or be able to feel where to push and need help to give birth.

You and your baby will need to be closely monitored during your labour.

Epidural side effects and risks:

You may only have partial pain relief.

Your blood pressure can suddenly drop which can mean IV fluids, medications and oxygen will be needed.

Continuous fetal monitoring is necessary to track baby's heart rate

Lying in one position can slow labour or cause it to stop, possibly requiring synthetic oxytocin.

Around 1 per cent of women experience severe headaches from spinal fluid leakage. This may require a "blood patch" which is an injection of your blood into the epidural space.

Side effects from epidurals include shaking, nausea, backache, maternal fever.

Baby may be unable to find an optimal birth position, increasing the risks of an assisted birth with forceps, vacuum or c-section.

The risk of severe tearing in the perineal area is increased substantially and potential pelvic floor problems after birth are more likely after an epidural.

You will be unable to move for a few hours after the birth and will need assistance.

Permanent nerve damage is rare but can happen in the area where the catheter was inserted.

Epidural haematoma (where the epidural causes a clot, which compresses the spinal cord) is rare but does happen.

During labour babies may experience reduced blood and oxygen supply, causing fetal distress and leading to instrumental birth (forceps or vacuum).

Babies whose mothers developed fever during labour are more likely to be born with low APGAR scores and require assistance such as resuscitation and time in a special care unit.

Babies may have difficulties latching or may be less alert, leading to early breastfeeding difficulties.

Should I have an epidural?

Only you can answer this question so it's important you understand your options.

In many cases, people believe labour is going to be so painful they will not be able to cope and are afraid of the pain of contractions when they first begin. Some may want to try natural labour but are constrained in their movements or become exhausted trying to get things going, Others may be induced and find the contractions much more intense than expected. The decision to have an epidural is a very personal and individual one. It should always be your choice and one you make with as much information available.

• For information about antenatal classes near you, check out From Bellies to Babies or phone 022 637 0624. I'd love you to join me, Sign up today!

Medical disclaimer: This page is for educational and informational purposes only and may not be construed as medical advice. The information is not intended to replace medical advice offered by physicians.

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