10 things you need to know about epidurals

An epidural is an effective form of pain relief, doesn't affect your baby and allows you to be awake throughout the birth - no wonder more and more women are choosing to have one.
But earlier this year the Royal College of Midwives hit the headlines when it said women should pay for epidurals if there's no medical reason to have one. The Department of Health ruled this out, but the controversy highlighted that although one in five women currently has an epidural, it's not necessarily the best option for every labour.
Jean Carpenter, a midwife from Nottingham City Hospital, says, ‘An epidural may sound great, but remember it's an invasive procedure and has risks.'

Q What happens?
A You'll lie on your side or sit leaning forwards. Your back will be cleaned with a cold liquid then a special, hollow needle will be inserted between the vertebrae in your lower back. A thin tube will be passed through the middle of the needle and then the needle will be taken away, leaving the tube in place. Anaesthetic will be administered slowly through the tube to numb the lower part of your abdomen, so you won't be able to feel the contractions.

Q Does it always work?
A Nearly always - it provides complete pain relief for more than 90% of women. ‘The majority work well, but occasionally it doesn't stop all pain and in very rare cases it doesn't work at all. If yours doesn't work, the anaesthetist can resite it. In most cases slight adjustments are all that's needed and changes in position and top-ups help reduce the pain,' says Jean.

Q Any side effects?
A Yes, you could experience a severe headache, numbness, shivering or a sudden drop in blood pressure. If your blood pressure drops, you'll need a drip in your arm. But try not to worry; if you have an epidural you'll be monitored closely so there can be a swift response if necessary. Serious side effects are rare.

Q Does every hospital offer them?
A No, some don't and others do only in certain circumstances. So if you want an epidural check well in advance.

Q Does an epidural lead to a longer labour?
A It might because it can slow down your contractions or even stop them altogether if you have one too early. Your midwife will be able to advise you though.

Q Will I be less likely to have a normal birth?
A Yes, the numbness means you may not be able to push so well and if this happens you may need assistance to deliver your baby. ‘You're more likely to have a forceps delivery if you have an epidural,' says Jean. An epidural also increases the likelihood of having a ventouse delivery or a Caesarean.

Q With a mobile epidural, can I still move around?
A Probably not. ‘Mobile epidural' is a misleading term - most women can move their legs but aren't able to walk.

Q Can I go to the loo?
A No. An epidural causes numbness, which means you won't know when your bladder is full. The midwife will probably have to insert a catheter to drain the urine.

Q Does an epidural cause backache?
A It's possible. Some women lie in an awkward position during labour because of the numbness. This puts pressure on their backs and may lead to back pain later on.

Q When can't I have one?
A ‘There are some medical conditions where an epidural wouldn't be suitable, such as certain types of back surgery.
And they're not appropriate in all labours. In short labours, for example, fast, short-acting pain relief may be more appropriate,' says Jean.

• If you want an epidural, write it in your birth plan - you can still change your mind on the day. Talk to your midwife if you're worried as she may be able to arrange for you to talk to an anaesthetist before labour starts.
  

For more information, visit www.netdoctor.co.uk/.

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