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Introduction

Pain experienced in labour may be relieved by a number of methods. These methods include the inhalation of nitrous oxide, the injection of opiates such as Pethidine and the use of Epidural Anaesthesia.

Epidural anaesthesia is one of the most effective methods of relieving pain during labour while maintaining the mother’s consciousness and participation in the birth. It is relatively pain-free to administer and with top-ups or an infusion can last for the duration of labour.

In suitable cases epidurals can provide an alternative method to general anaesthesia for providing anaesthesia for Caesarean Section.

What is an epidural anaesthetic?

An epidural anaesthetic involves the injection of drugs (local anaesthetics and/or opiates) into the epidural space. The epidural space surrounds the spinal cord and is an area through which the spinal nerves must pass to reach the body. When these drugs are injected into this area, close to the spinal nerves, the passage of nerve impulses from the uterus and the lower body are impaired. The lower abdomen and legs may feel quite numb.

How is an epidural anaesthetic performed?

An intravenous ‘drip’ will be started. The epidural injection may be performed with you lying on your side or sitting up. You will be asked to “round” your back by drawing up your knees and flexing your neck. The skin is anaesthetised and thereafter the epidural injection should be relatively painless. It is important that you stay as still as possible while this injection is in progress. This will take a few minutes.

A catheter (fine plastic tube) will be inserted through the epidural needle into the epidural space. The needle is then withdrawn and the catheter is taped in place. Injections of pain-relieving drugs will then be introduced through it. The epidural drugs may take up to twenty minutes to take full effect. You may then notice numbness and a sensation of heaviness or weakness in the legs. Although your labour contractions will continue, they should not be painful. The epidural anaesthetic reduces the urge to urinate and sometimes insertion of a urinary catheter may be necessary.

Each dose of the epidural injection will last from two to four hours, depending on your response and the type and amount of local anaesthetic injected. An infusion of local anaesthetic may be started to give you continuous pain relief during labour. If, however, you begin to feel contractions, ask the midwife for a 'top-up'. This is given through the epidural catheter and should keep your pain under control.

Does an Epidural anaesthetic affect labour?

In early labour, an epidural can occasionally slow the progress of labour. More commonly however, a very prolonged and painful labour may progress more rapidly after an epidural has relieved the mother’s pain. Towards the end of labour, the reduction in sensation may reduce the mother’s urge to push the baby out. In this case assistance may be required by the obstetrician who may use a vacuum or forceps to help you push the baby’s head through the vagina.

Are there any women who cannot have an epidural?

Epidural injections may not be possible in patients who have had previous spinal surgery, are very overweight, have severe infections, or who have defective blood clotting. There may be additional obstetric reasons to avoid epidural anaesthesia and your obstetrician must therefore agree before epidural anaesthesia is performed.

When do I need to make a decision about whether to request an epidural anaesthetic?

During the course of your pregnancy you should discuss this option with your obstetrician. It is very difficult to make a firm decision about pain relief until you are actually in labour. If you are considering an epidural anaesthetic, you must sign the patient consent section at the end of this form. Signing this form does not compel you to have an epidural.

Are Epidurals safe? What are the risks?

Common side effects of epidural anaesthetics are nausea, shivering, urinary retention, temporary weakness of one or both legs, and dizziness. Backache, which may occur after pregnancy, has not been shown to be related to the use of epidural anaesthesia during labour.
Occasionally, because of difficulty in locating the epidural space or because of patient movement during insertion, the epidural needle may penetrate the membrane (the dura) containing the spinal fluid allowing spinal fluid to leak. This can produce a headache which, untreated, may last for days or weeks. The risk of this occurring is approximately 1% (one in a hundred). An anaesthetist can arrange to seal the leak caused by this “dural puncture” by injecting a small amount of your own blood into your epidural space (‘a blood patch’). This ‘blood patch’ is approximately 90% effective in curing the headache.

Other potential (but less common) risks include a fall in blood pressure which may distress the baby, inadvertent intravenous injection of the local anaesthetic causing fitting, or a high ‘spread’ of the anaesthetic which may cause temporary difficulty with breathing or loss of consciousness.

Rare but potentially serious complications associated with epidural anaesthetics include infection and bleeding in or around the spine, bruising or scarring of the nerve roots leading to permanent weakness and numbness in the legs and bladder problems, cardiac arrythmias, cardiac arrest and death. It is important to realise that the risk of these complications occurring is very small and that the primary goal of the anaesthetist is always the safety of you and your baby.

The Cost of An Epidural Anaesthetic.

The doctor who inserts your epidural anaesthetic will be a specialist anaesthetist who will charge a separate fee for the administration of the anaesthetic. You will be responsible for paying the account forwarded to you by your anaesthetist.

You should be aware that the amount rebated by Medicare and private health funds is very low and does not cover the full anaesthetic fee. The unfunded portion of your anaesthetic account for your epidural (the ‘gap’) will depend on a number of factors and in most cases will be higher if an emergency or after-hours call back is involved.

If you wish to you should discuss any likely out of pocket expenses ('gap') with your anaesthetist before your epidural anaesthetic is administered.

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