Epidurals

How is an epidural given?

You will be asked to sit at the edge of the bed while hugging a pillow in front of you and flexing your head forward. This will cause your back to curl. It will also open the space between the bones (vertebrae) in your back. This position will make it easier for the anaesthesiologist to insert the epidural in your back.

This is a sterile procedure. Because of this, your support person may be asked to leave the room during the procedure. At this point, your lower back is cleaned with an antiseptic solution. The anaesthesiologist injects a small amount of freezing into the skin over the lower back. It will sting, but only for a second.

You will feel pressure in your back while the anaesthesiologist carefully guides the needle into the epidural space (a space between the layers of “skin” around your spinal cord). Your nurse will ask you to stay very still and to let them know when you feel a contraction starting.

When a plastic tube (catheter) is inserted through the epidural needle, you may feel a sudden tingling down one leg. If this happens, the catheter has brushed against a nerve. This feeling is similar to what you feel when you hit your funny bone. It does not last long and does not cause any harm.

The needle is removed and the plastic catheter left in place and securely taped to your back. Medication used for pain relief is injected through the catheter. During the first injection, you may feel a cool sensation over the skin on your back.

Will the epidural harm my back?

Back pain is not usually a problem caused by an epidural. Studies have not shown an increase in long-term backaches after having an epidural.

After your baby is born, you may have some soreness or bruising at the needle site for several days. Pregnancy and childbirth may also cause backache as your pelvic ligaments stretch and posture changes. This may occur whether or not you have an epidural and usually goes away on its own.

What are the risks of an epidural?

• A drop in blood pressure: Decreased blood pressure can occur after an epidural. To prevent this, you will be given fluids by an intravenous (IV) before and during the epidural. Your nurse will check your blood pressure often after you first receive the medication. You are encouraged to lay on your side, as direct pressure from the uterus on the blood vessels can cause your blood pressure to drop.

• Shivering: Shivering is very common during labour and birth. This may happen even if you do not have an epidural.

• Itching: You may feel itchy if narcotics are used. This usually goes away after a few hours.

• Difficulty emptying your bladder: Try to empty your bladder often during labour. This will decrease your discomfort. If necessary, a tube (catheter) will be placed into your bladder to drain the urine.

• Headache: Headaches occur in about one in 200 cases. You can help reduce the chance of a headache by remaining still when the anaesthesiologist inserts the needle. Headaches can be treated with fluids, over-the-counter medication and bed rest. Sometimes patients may also need extra treatment if the headache continues.

• Accidental injection of medication into a vein: This is rare, but may occur. Medication injected into a vein may cause ringing in the ears, dizziness, a funny taste in the mouth or blurred vision. If this happens, seizures may also occur; however, they are rare.

• High block: This is very rare epidural side effect. If “high block” happens, you will notice numbness in your arms and difficulty breathing for a brief time. Oxygen will help with breathing until the medication wears off.

• Rare complications: Nurses and anaesthesiologists are available to treat any complications that may occur from an epidural procedure. The most severe complications are also the rarest. The most serious of these is death. This is extremely rare and may occur in less than one in 1,000,000 cases. Another serious rare complication is severe permanent nerve damage. It occurs in approximately one in 1,000,000 cases.

How is epidural medication given?

Medication can be given continuously through a plastic tube (catheter) attached to a pump. The anaesthesiologist or nurse will set the pump to ensure you receive the correct amount of medication.

If you have patient-controlled epidural analgesia, you will be instructed on how to use it. This method allows you to press a button to give yourself an extra dose of medicine if needed. The pump is set up to prevent you from getting too much medication.

You will be asked to spend equal time lying on each side so that the pain relief is even across your abdomen.

Will an epidural slow down labour?

Contractions may slow down for a little while after the epidural is first inserted. They will soon return to normal. Labour is not usually longer with an epidural. Many women are surprised that after their pain is relieved, they are more relaxed and their labour progresses faster. Your blood pressure, baby's heart rate and labour progression will be checked often.

Please note that if you are not in established active labour, there is the possibility of your labour slowing down. If this occurs, you may receive a medication to bring your contractions stronger and/or closer together.

Can an epidural harm my baby?

An epidural has little to no direct effect on the baby. However, your baby may be impacted if your blood pressure decreases. Rest assured that highly qualified anaesthesiologists use their skills and judgment to ensure the safety of both mother and baby.