What is an epidural?
An epidural is where painkilling drugs are passed into the small of your back via a fine tube. It is called a regional anaesthetic, which means the drug is injected around the nerves that carry signals from the part of your body that feels pain when you're in labour. The result will be that your belly feels numb, giving you very effective pain relief.
How is an epidural put in place?
Your anaesthetist will give you an injection of local anaesthetic in your lower back. She then guides a hollow needle between the small bones in your spine.
The needle goes into the space between the layers of tissue in your spinal column, called the epidural space. A fine tube, or catheter, is then passed through the needle.
Once the tube is in place, the needle is removed. The tube is taped up your back and over your shoulder.
Epidural painkillers are given in several ways:
- Injection with top-ups: Your anaesthetist will inject a mixture of painkillers into the tube to numb the lower part of your tummy. If the epidural is working well, you should no longer be able to feel your contractions. As the epidural begins to wear off, you can have top-ups which last between one and two hours.
- Continuous infusion: Your anaesthetist will set up an epidural catheter. The other end of the tube is attached to a pump, which feeds the pain-relieving epidural solution into your back continuously. You can have stronger top-up doses of local anaesthetic as well, if you need them. Sometimes the pump is under your control. This is called patient-controlled epidural analgesia or PCEA, but is only available in some hospitals.
- Combined spinal epidural (CSE): You'll be given an injection which contains a low dose of pain-relieving drugs (a mini spinal), which works more quickly than an epidural alone. At the same time, the anaesthetist will insert a catheter without passing any drugs down the tube. When the effect of the mini-spinal injection starts to wear off, your anaesthetist will pass the epidural solution through the tube to give you ongoing pain relief.
How does an epidural work?
It works in just the same way as a local anaesthetic. The anaesthetic deadens the nerves which are carrying pain signals from your uterus (womb) and cervix to your brain.
When should I have an epidural?
You can have an epidural at any point in labour, but most women choose to have an epidural when their contractions are getting pretty strong, which is often when their cervix has dilated by about 5cm or 6cm.
You'll also be offered an epidural if your labour has to be speeded up with a Syntocinon drip. This is a synthetic version of the hormone oxytocin, which makes your cervix dilate and contractions intensify. You may need extra pain relief, because this can make your contractions difficult to cope with.
Once your epidural is in place, it should stay in until after your baby is born and your placenta delivered. It can also provide pain relief after your baby is born if you need stitches.
