Your epidural during labour - Alfred Hospital

Temporary numbness and weakness can occurafter childbirth. This is often unrelated to theepidural. Sensation and strength will usually returnto normal after a few weeks or sometimes months.Permanent nerve damage is very rare.Please refer to the patient information brochureentitled “After your spinal or epidural anaesthetic”for further information and please ask to speak toan anaesthetist in clinic if you are worried about therisk of serious problems.INFORMATION FOR PATIENTSYOUR EPIDURALDURING LABOURAny questions?If you would like to speak to an Anaesthetist aboutepidurals and whether one will be appropriate foryou, a clinic appointment can be arranged atSandringham Hospital while you are pregnant.Please write down any questions. You can alsodiscuss the options with the midwife who cares foryou while you are in labour and of course theanaesthetist performing your epidural. A staffmember from the Anaesthetic Department will visityou the day after the birth of your baby to check onprogress.Contact numbers forconcerns and emergency help:Obstetric team or Anaesthetist via: Sandringham Hospital9076 1000This leaflet is intended as a guide only– if you need further informationplease speak to your Anaesthetic doctor, Obstetrician or MidwifeBased on the following publications:It's your labour (Australian & New Zealand College ofAnaesthetists)Epidural anaesthesia during labour (Australian Society ofAnaesthetists)Pain relief in labour (ObstetricAnaesthetists’Association – UK)®Medical Illustration Copyright 2011: Nucleus Medical Media,All rights reserved.www.nucleusinc.comVCS G10725 02-11

What is an epidural?An epidural is a very effective way to relieve labourpain. Epidurals in labour have an excellent safetyrecord and have been used by millions of women.Your epidural is performed by an Anaesthetist (adoctor trained in anaesthesia).First a needle is inserted between two vertebrae inthe lower back into the epidural space. Then a fineplastic tube (called a catheter) is threaded into theepidural space and the needle is removed. Thecatheter is then taped in place and pain relievingmedication is administered through the catheter.The pain relief is tailored to your needs using thecatheter for as long as necessary during (and after)your labour.Usually the procedure takes around 15-20minutes, with a further 15-20 minutes before theepidural medication becomes fully effective.Occasionally a one-off injection is also given intothe spinal fluid which results in faster onset of thepain relief. This is called a combined spinalepiduralanaesthetic.Low doses of anaesthetic are generally used sothat the sensation of your contractions is retainedwithout the pain and without causing too muchnumbness or leg weakness. You should be able tofeel enough to push effectively when required.You will need an intravenous drip and additionalmonitoring with an epidural, such as regular bloodpressure measurements and continuous fetalheart monitoring.Epidural services are available 24 hours a day atSandringham Hospital.AnAnaesthetist is availableat all times but may be on-call from home, meaninga short delay is possible on some occasions.Why have an epidural?© Nucleus Medical Media ®There are many ways to deal with labour pain. It is agood idea to have an open mind and be flexible.An epidural provides more effective pain relief thanany other method. This may make the experienceof labour and delivery more satisfying for you andyour birth partner. Side-effects of other methods ofpain relief can also be avoided by having anepidural (such as nausea and sedation frombreathing gas and air or pethidine injections).An epidural may be recommended by yourObstetrician in combination with medication tomake your contractions stronger. There are alsomedical reasons for having an epidural whichinclude high blood pressure, diabetes and twinpregnancy. An epidural can usually be topped upand can be used for a Caesarean section or otheroperations if required.When should you not have an epidural?In some situations an epidural may not be safe –when there is an increased risk of bleeding orinfection in the spine, for example. If you have amedical condition including heart disease,previous back operations and blood clottingproblems, you should have a consultation in thePre-Anaesthetic assessment clinic during yourpregnancy, well before you go into labour. Pleasealso tell us if you have any allergies or have had abad reaction to an anaesthetic.If you are overweight an epidural is often moredifficult and takes longer to put in place, but once it isin you will have all the usual benefits.What side-effects can an epidural cause?An epidural may cause one or more of the followingside-effects: Amild to moderate drop in blood pressure Temporary weakness in your legs Shivering, although you won't feel cold Itchiness, which can be treated if severe Trouble passing urine Some tenderness at the site of insertion Failure of the epidural requiring replacementAn epidural makes a suction cap or forceps deliverymore likely (especially if this is your first labour),although Caesarean section is not more commonwith an epidural. There is no evidence that anepidural will have any significant effect on your baby.Headache occurs in around 1 in 150 epiduralsowing to accidental puncture into the spinal fluid.The headache is usually treated effectively with a“blood patch” which is like another epidural.