Epidural

An epidural is a procedure where a needle is inserted into the space around the spinal nerves in your lower back. Local anaesthetic is administered in this region. This anaesthetic  is the most effective at managing the pain from labour contractions and during the birth. 

A cannula (a drip) is inserted into your arm before you are given the epidural. 

It will take about 5 minutes to set up and a further 5 to 15 minutes for you to feel the relief from the pain medicine. 

You are positioned in a sitting up position, and asked to lean over a pillow with your feet on a chair.

Your back is swabbed with an antiseptic solution (that will feel cold) to clean your back.

A local anaesthetic injection is given in the area the epidural needle will be inserted. This will sting.

It is important to maintain communication throughout the procedure.

A needle is inserted between your contractions, and the epidural space is located.

A small flexible plastic tube is inserted through the needle into the epidural space.

The needle is not left in your back during labour, only the very small plastic tube which gives you the pain medication.

The tube is removed after the birth.

Epidurals are extremely safe and well tolerated during labour.

An epidural does not increase the risk of intervention during labour, however they are associated commonly with assisted delivery- usually because the individual requires pain relief because of a difficult delivery.

Epidurals are very safe; serious complications are extremely rare.

However, as with all medications and medical procedures, there are potential side effects:

• Decrease in blood pressure – The medication may lower your blood pressure, which may slow your baby’s heart rate. To make this less likely, you will be given extra fluids through a tube in your arm (IV), and you may need to lie on your side. Sometimes, your  anaesthetist will give you a medication to maintain your blood pressure.
• Sore back – Your lower back may be sore where the needle was inserted to deliver the medication. This soreness should last no more than a few days. There is NO evidence that an epidural can cause permanent back pain.
• Headache – On rare occasions, the needle pierces the covering of the spinal cord, which can cause a headache that may last for a few days if left untreated. This is called a Postural Dural Puncture Headache. There is management of this condition which is called an Epidural Blood Patch. Further information will be discussed with you if this was to occur.
• Infection around the skin- it is very rare for this to extend beyond the skin. Management can include antibiotics and extremely rarely surgery

Permanent nerve damage

In rare cases, an epidural can lead to permanent loss of feeling or movement in one's legs .The causes are:

• Direct damage to the spinal cord from the epidural needle or catheter
• Infection deep in the epidural area or near the spinal cord
• Bleeding in the epidural area, causing pressure on the spinal cord

These are extremely rare events, and anaesthetists have extensive training to reduce the chances of these complications.

Nerve damage can also happen for other reasons during delivery, which are unrelated to the epidural.