Pregnancy App Article: "Planning ahead: Epidurals"

Week 36
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Comfortably numb
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Pain relief in its various forms is likely to be firmly at the forefront of your mind in the later stages of pregnancy. More than one in three women plumps for an epidural, which speaks volumes considering it involves a very big needle.

An epidural can be administered once labour is properly established. A hollow needle is inserted in between the vertebrae of your back and into the space outside the coverings that surround your spinal cord; a fine tube is then passed through the needle and the needle is removed.

You need to keep very still while this happens (which isn’t as easy as it sounds in full-blown labour). The tube is then left in your spine (usually taped to your shoulder) and the anaesthetic is injected through it. The anaesthetic can be ‘topped up’ as necessary. An anaesthetist is required to set up an epidural and it takes around 20 minutes to administer. (And possibly a lot longer to find an anaesthetist!)

Epidural numbs the pain signals from your uterus and cervix (those contractions) and usually numbs your lower body too. Your anaesthetist might have a cold spray that he or she will squirt on various parts of your body to ascertain how well (or not) the anaesthetic is working.

You will probably need a urinary catheter, which will restrict your mobility, although the fact that you can’t feel your legs is likely to have a similar effect. You will also need constant foetal monitoring, usually with a small monitor attached to your belly with a big elasticated strap. But, hey, with a bit of luck it should block out the pain. It allows you to remain lucid and shouldn’t affect your baby as much as pethidine and diamorphine.

Epidurals sound great, and it is easy to think of them as the last miraculous resort if everything gets too much. But around 10 per cent of epidurals do not offer the magical dead-from-the-waist-down experience and don’t work completely.

Some hospitals offer a low dose or ‘mobile epidural’ which, while dulling the pain, is intended to leave you more mobile with movement in your legs and (hopefully) the feeling of being able to push.

Unless the epidural wears off towards the end of your labour, which is what some women want so that they get to feel those final contractions, it can be hard to know when to push – although your midwife should be able to tell you. There is also an increased risk of an assisted delivery by ventouse or forceps after an epidural. Its critics would say that without sensation, you are essentially a back-seat driver and that’s when events sometimes start to spiral out of control. The idea of being a back-seat driver when it comes to pushing a baby out, however, does appeal to many women, understandably.
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Like all forms of pain relief during labour, an epidural might help, or it might not.
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My epidural only worked on one side! What’s the point of that? I remember one midwife reassuring me that I was only feeling windows of pain – not the kind of consolation they’d give to someone in theatre having their legs removed, is it? 'Oh don’t worry, it’s just windows of pain…'
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