Epidural

In Nigeria there is now an increased awareness and acceptance of available safe and effective methods of reducing pain during labor. The most popular of these is epidural analgesia.

An epidural is a method of relieving pain in pregnancy which involves putting a drug (a local anaesthetic) into the space around the spinal cord called the epidural space. This causes a blockage in the sensation of pain from the lower abdomen and the legs, thus making you unable to feel the pain of the contractions. A thin tube is introduced into the lower back and extended into the space, and the drug is given at regular intervals. Having an epidural greatly improves the experience of delivery, creating a less unpleasant experience for mothers. It also helps to prevent exhaustion on the part of the mother.

The decision to have an epidural during labour is entirely up to you, provided there are no medical contraindications that have been identified by your doctor. This would be discussed with you by the time you get to the third trimester, and it is important for you to ask any questions you might have, so that you understand the process clearly and make a choice that you are comfortable with.

The procedure of placing an epidural is performed by an anaesthetist, who has the skill and experience to perform it. On that day, he or she would come in to see you (after reviewing your notes and agreeing that it is safe for you to have it done) and explain to you what is about to happen. You will be asked to sit up and lean forwards after your lower back has been exposed. The area is cleaned first, then an injection of a local anaesthetic given, to numb the area. After this a thin tube (called a catheter) is introduced into the space with the aid of a special needle. The catheter is then secured in place by taping it to the back with a plaster. It takes about 10 to 20 minutes for the effects to set in. You will experience a feeling of heaviness or numbness in your legs, thus you won’t be able to get out of the bed. A tube will be passed into your bladder and attached to a bag to drain urine. The pain of the contractions become greatly reduced; you might just experience a painless tightening of the uterus with each contraction. The effect of the medication wanes after a while, and so it is usually given every 2 hours, until the baby is delivered. Once the labour is done, the catheter in your back and the urine bag will both be removed.

Giving epidural pain relief can cause your blood pressure to drop, so you will be connected to a monitor to continually measure your blood pressure; if it drops significantly, medications will be given to correct it. You will also be connected to a CTG machine (cardiotocograph) which gives a continuous measurement of your baby’s heart rate, and your contractions in labour.

Epidurals can cause labour to take a little longer, because in the absence of pain there might be a reduced effort to push during the second stage of labour. This means there’s a slightly higher chance of having an episiotomy or an assisted delivery (e.g. with a forceps). Sometimes after inserting an epidural, you may experience a bout of shivering, which usually stops after a while. An epidural cannot be used for women who are taking medications for thinning blood, have a low platelet count, a blood infection, or an infection on the skin around the lower back.

Rarely, an epidural might not work, if there’s some difficulty in locating the epidural space, or if the drug does not disperse uniformly around the space.