Epidurals: the pros and cons

What's an epidural?

An epidural is an anaesthetic that is injected into your lower back just outside the dura – the tough sac that surrounds the spinal cord – to numb the lower abdomen. It can be used for some surgery as well as for labour, during which it is effective at numbing the lower part of the body, easing the pain of contractions.

About a third of women who gave birth in an NHS hospital between 2006 and 2007 had an epidural, general or spinal anaesthetic (NHS Maternity Statistics, England: 2006-07).

How do you prepare for an epidural?

The doctors will advise you on eating and drinking before an epidural. You'll also need to let them know about any medication you're on. Remember that you can’t drive for at least 24 hours after an epidural so you'll need someone to take you home from hospital (though it's unlikely you were planning to drive yourself home having given birth anyway).

At what stage of labour should I have an epidural?

You “can” have one at any stage of your labour, but that doesn't mean you can successfully scream for one as your baby's crowning. Most mums who opt for an epidural do so during the active phase of the first stage of labour

If you're in the later stages of transition and almost there, you might find your midwife encourages you to grit your teeth and keep going. Once you're not far off giving birth, an epidural can slow the process down, which would be a step back at this stage.

At whatever point you ask for the epidural, remember they will have to find an available anaesthetist to do it so if you think you might want one, make it known as early as possible so they have you on the radar should you decide to go for it.

How is an epidural done?

An epidural is done by an anaesthetist. First the area is numbed using a local anaesthetic before a hollow needle with a shaped point is inserted. You need to stay really still at this point, which can be tricky in labour, but the midwives and anaesthetist will guide you through it all and try to work between contractions.

Once the needle is sited, a fine tube is passed through it and then the needle is removed, leaving the tube in place.

The anaesthetist then injects the anaesthetic into your back, via the tube. It can take several attempts to site an epidural, but once it's there additional doses can be administered with minimum fuss.

Are epidurals safe?

Yes, it's very rare that anything goes wrong with an epidural. But like all pain-relief methods for labour, while there is an obvious benefit to using them, there are some side effects.

What are the pros of having an epidural?

• More than 90% of women find it completely blocks the pain of contractions, so it's pretty effective.

• If you're getting very tired, an epidural might give you a chance to “rest” and claw back some of the energy you'll need to push out your baby.

• Unlike opiates, an epidural offers total pain relief without the “high” – so you'll still know exactly what's going on.

• An epidural can also help if you've got high blood pressure.

What are the cons of having an epidural?

• You may go numb right the way down to your feet and be unable to stand until it wears off. However, a lot of hospitals make you stay in bed once you've had an epidural anyway, which puts an end to any mobility and is not the best position to labour in.

• Sometimes they don't work completely, in which case you can end up numb down only one side of your body or still have partial sensation in your abdomen.

• It can make you feel sick, shivery, dizzy or itchy.

• Your baby will need continuous monitoring throughout, and you will have to have your blood pressure checked frequently.

• An epidural may slow your labour down, especially in the second stage when you have to start pushing, because it can be very difficult to know if you're pushing correctly.

• It increases your chances of needing a Syntocinon drip to speed your labour up.

• It increases the risk of your baby moving into the wrong position to be born and therefore your chances of needing an assisted delivery using forceps or ventouse.

• You might not know if you need a wee, so you'll need to have a catheter inserted into your bladder to drain urine automatically.

• There is an extremely slight risk you will experience breathing difficulties, infection or nerve injury.

• All the tubes and monitoring – added to the fact you're partially paralysed – can make you feel a bit like things are out of your control.

• You can't have one if you're having a home birth as they are only available in hospital.

And after the birth:

• You might have difficulty doing a wee afterwards.

• If the spinal cord membrane sheath is accidentally punctured, you can suffer a whopping headache (caused by cerebro-spinal fluid leaking out once the needle is removed) that can sometimes persist for several weeks.

• You might find you have a sore back where the tube was sited.

Will an epidural affect my baby?

Unlike with pain relief such as pethidine, an epidural won't make your baby drowsy, which can cause problems getting breastfeeding started. However, it can increase the risk of your blood pressure dropping, which in turn can affect the amount of oxygen your baby gets. As a precaution you'll have a cannula (a small, hollow tube), sited in the back of your hand or arm connected to a drip so that, in an emergency, a drip can be administered quickly.

It also increases your risk of needing a ventouse or forceps delivery, which again, carries an attached risk to your baby.

None of the associated risks are anything for you to panic about but they are there, so it's worth knowing what they are so you can make an informed decision.

How long does an epidural last?

The pain relief usually starts to wear off after one to two hours. You can then be given a top up, each of which will last around an hour, too.

What is a mobile epidural?

Mobile epidurals are administered in the same way as a traditional epidural. The main difference is that it’s a slightly different, lower dosage of drugs.

The upside of a mobile epidural is that you retain some feeling in your legs, so you may be able to move about a bit – although how much depends on how you react to the drugs. You may still need help – and you definitely won't be running any marathons (not that marathons were likely to have been on your birth plan anyway).

It's worth remembering:

• Not all hospitals offer mobile epidurals (check beforehand if yours does).

• There is still an increased risk of a longer labour and the need for an assisted delivery, although the risk is less than that associated with a traditional epidural

• As with traditional epidurals, you may find you get very itchy or have trouble passing urine

What is a spinal block?

A spinal block is a one-off injection of an anaesthetic (sometimes mixed with a pain-killing narcotic) directly into your spinal fluid, similar in principle to an epidural. It completely numbs you from the waist down but wears off over a few hours. It's not usually used in labour itself, but is sometimes used for forceps and C-section deliveries. Potential downsides are that you:

• Can only have the one injection.

• Are usually immobile and confined to bed.

• Might feel shivery, sick or even itchy.

• May find it hard to wee.

• May get a bad headache.

What is a combined spinal epidural (CSE)?

A CSE is basically a combination of a spinal block and an epidural in that you receive a combination of painkiller and anaesthetic, the difference is in how these are administered.

First up, you'll have a spinal injection of a fast-acting opiate painkiller. Meanwhile, an epidural tube will be sited in the usual way – but you won't be given any anaesthetic via the tube until the effect of the painkiller starts to wear off (usually in an hour or two).

CSE is particularly suited for use in late, rapidly progressing labours as relief is virtually instantaneous (yippee) and is often used for a last-minute Caesarean. Unlike a spinal block, it can be topped up when the initial spinal injection wears off. Plus, until you have the epidural anaesthetic, you'll be able to walk around. The cons are similar to those associated with mobile epidurals.

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