Pain Relief

Epidural analgesia: the facts

Epidural and Spinal analgesia/anaesthesia are two of the most effesctive methods of relieving the pain of labour and delivery.

What is an epidural?

It is the use of a local anaesthetic (pain relieving) solution, which is injected through a fine plastic tube which has been placed in the back. The end of the tube lies in the back bone, near the nerves which carry pain sensations during labour. A successful epidural can result in an almost pain free, awake state throughout the labour and delivery of your baby.

Can anyone have an epidural?

Most women can have an epidural, but if you have severe back problems or have problems with bleeding, you may be advised not to have one.

Should everyone have an epidural?

No, epidural analgesia may not be necessary for the pain of labour. Other less complex methods of pain relief may work very well for you. If previous labours were fast, or if the labour is progressing very quickly, the epidural may not have time to be effective and other methods of analgesia may be better.

Who gives it?

It is administered by a specially trained doctor (anaesthetist) and you will be supervised closely by a midwife until your baby is delivered.

When can I have it?

We have a 24 hr service available so once you are getting sore it can be administered. If you are in advanced labour and just about to have the baby it may be too late as the epidural needs time to be inserted and to work

Can I always get an epidural?

Yes usually, but if the anaesthetist is very busy you may have to wait a while.
Other methods of pain relief are always available.

How is it done?

Before starting an epidural, a drip is set up in your arm. You will be positioned either on your left side or sitting up. The area of your back around and just below the waist will be washed with a cold antiseptic solution to reduce the risk of infection. A small area of skin will be numbed using a tiny needle, and a larger needle is passed through this numb area into the epidural space. A fine plastic tube (catheter) is threaded through this needle, and the needle is then removed and the tube taped to your back. As it is so thin, the tube cannot be felt, and it does not restrict movement. A small dose of local anaesthetic is injected through the tube to make sure that it is in the right place, and then larger doses can be given until you start to feel less pain.

How long does it take to work?

It may take up to 30 minutes to relieve your pain completely, but very strong contractions will start to feel less painful in 5 – 10 minutes.

How long does it last?

As long as is required. Once the epidural has started to work, an infusion pump will be
connected to give the anaesthetic drug slowly for the rest of the labour.
A top up of more local anaesthetic can be given at any time if you feel pain.

Will it affect labour or delivery?

The epidural can slow the labour and may make the contractions less effective. If this happens you may be given medication to strengthen the contractions. The epidural may make it harder to push the baby out, and you may need assistance with forceps or vacuum if this happens.

Does it always work?

No, epidurals are 90 -- 95% effective. The epidural space may be difficult to locate, especially if you have put on a lot of weight or have problems with your back. Even if the epidural can be sited, it may not work properly. Sometimes only one side of your body will be numbed, and the contractions will be strong and painful down the other side. This cannot always be fixed, and another type of pain relief may be needed.

If your labour is progressing very fast, the epidural may not have time to work properly before delivery.

What else will happen after I have an epidural?

Usually you will have to stay in bed, as your legs may start to feel heavy and it would not be safe for you to move. Your blood pressure will be measured regularly. As you can not feel when your bladder is full you will usually need a catheter to pass.

Is it safe for the baby?

Epidurals are generally regarded as safe for both you and your baby, but as with any procedure, there are some risks involved. The commonest problem is a fall in your blood pressure, which can make you feel sick and faint. This is easily treated with fluid through the drip.

Are there any other problems associated with epidural?

About one person in every 100 may get a severe headache after an epidural, which may take a few days to go away. If this happens, you will have to stay in bed and drink plenty of fluids. It may go away with paracetamol and resting, but if it persists, you will need further treatment. There is a very small risk of backache or nerve problems after the epidural, but you can discuss any concerns with your anaesthetist.

What will happen if I need a Caesarean delivery?

If there is time, the epidural can be increased to allow you to stay awake during the delivery of your baby. Although it is best to remain awake during the delivery, it is occasionally necessary to give a general anaesthetic. If this happens an anaethetist will discuss the situation fully with you.

Remifentanil Pain Relief for Labour at the Ulster Hospital

• What is remifentanil?
  
  Remifentanil is a very short-acting pain relieving drug like pethidine. Its pain relieving effect comes on very rapidly, and also wears off very quickly afterwards.

• Who can use remifentanil?

If you wish to use remifentanil pain relief you can ask for it at any time in Labour Ward. If you have an allergy to morphine, pethidine or other related drugs we would advise you not to use remifentanil. Remifentanil may be useful if you have been advised not to have an epidural by your midwife or doctor. (If you try remifentanil and then decide to change to another method of pain relief all other options are still open to you.) Having tried remifentanil does not limit your choice.

• How is it given?

To use remifentanil you will need to have an IV cannula (commonly know as a “drip”) placed in a vein, usually on the back of your hand or arm. The drip is connected to an electronic pump, which delivers a small dose of the drug once you press the hand-held button. The pain relieving effect is felt usually within 20 to 30 seconds, and wears off again within a few minutes. As part of our routine observations with remifentanil your midwife will measure your oxygen level using a sensor (like a clothes peg) on your finger, as well as your level of pain relief and drowsiness at regular intervals. Otherwise all observations and treatment are the same as for any other woman on labour ward.

• What are the potential benefits of remifentanil?

You are in control and you get the drug only when you need it and not in between contractions. This means that you may be more alert and mobile throughout your labour. There is a safety feature built into the pump so that you can only get a safe amount of the drug. You can use the pump at any time right up to your delivery (and for any stitches if needed) and the effects will still wear off very quickly when you stop.

• Are there any unwanted effects of remifentanil?

Some women can still get sleepy between contractions, as tends to happen also with pethidine. However, even if you are drowsy, this will wear off very quickly after you stop using the pain relief. Remifentanil has been shown to be safe for babies, with no other effects seen that don’t already occur with pethidine. We are very happy to discuss any questions you have about remifentanil.

• How long has remifentanil been used for pain relief in labour?

We have been using remifentanil in labour ward at the Ulster Hospital since 2004 with favourable results and good feedback. Demand for this type of pain relief is steadily growing. It is now proving as popular as epidural which have gone down by 50%

Pain Relief in Labour (PDF)

http://www.womens-health.co.uk/pain.asp

http://www.babycentre.co.uk/pregnancy/labourandbirth/painrelief