The following is a step by step guide to what is usually involved with having an epidural anaesthetic for labour. We have included information indicating which practices are accepted as routine and which may vary between hospitals and anaesthetists.
Requesting the epidural and time frames
Epidurals are normally given at the request of the woman. The caregiver may suggest you have one but it is still up to the woman to accept or decline an epidural. Just a reminder that not all delivery suites offer epidurals for pain relief, check with your caregiver about what is available at your birthplace.
Before the anaesthetist is called to insert an epidural, your caregiver will probably want to perform an internal vaginal examination to check how far the cervix is dilated. If you are nearly fully dilated (10 cms), they may advise that it is too late to have an epidural, as it could inhibit the pushing phase of the labour and birth.
Once you have decided to go on with having the epidural, the anaesthetist is then contacted and will arrive as soon as possible. On average, this is usually in a matter of minutes, but depending on the time of day and how busy they are they may be delayed.
Realistically, (all going smoothly) the time frame from requesting an epidural to starting to have some level of pain relief can be around half an hour to 45 minutes or more. This takes into consideration the vaginal examination to confirm that you need an epidural, the anaesthetist being called and arriving, the preparations to set up for the procedure, the actual insertion of the epidural and the time lag (10 to 20 minutes) for the medications to take full effect.
Emptying your bladder
Epidurals can temporarily affect the functioning of the woman’s bladder, making it difficult for her to pass urine while the epidural is still effective (and sometimes for a period afterwards). In many cases a urinary catheter will need to be passed to empty the woman’s bladder. Having extra fluids given through a drip (routine with epidurals) can compound the problem of having an overfull bladder.
It is important that you try to empty your bladder before having the epidural inserted (if you haven’t done so in the previous hour). This will help alleviate the necessity for a catheter (in the short term anyway). If you can avoid (or delay) a catheter you can eliminate (or reduce) your chances of developing a urine infection (an occasional side effect of having the catheter). Your caregiver will hopefully remind you to empty your bladder while you wait for the anaesthetist to arrive.
Having a drip
It is a routine requirement to have a drip inserted into the woman’s vein before an epidural is administered. This enables extra fluids to be given quickly into the woman’s system to counteract a possible drop in her blood pressure (a potential side effect associated with the ‘local’ epidural medications) or if other medications are needed.
The drip may be inserted by the resident doctor or your caregiver before the anaesthetist arrives, or by the anaesthetist who is inserting the epidural. If you already have a drip in place then a second drip will usually be connected (or ‘piggy-backed’) to the existing one, without the need to insert a second needle.
About half a litre of fluid will be infused within a few minutes as a ‘pre-load’ before the epidural medications are inserted. A further 1 to 2 litres will continue to be given more slowly over the following couple of hours after the epidural is inserted, depending on how the woman’s blood pressure reacts. The drip remains in until the epidural is removed after the birth. Extra fluids can be repeatedly given in this way, each time the epidural medications are ‘topped up’ (if it is an intermittent epidural) or just dripped through over a longer period of time if the epidural is continuous or self-administered.
Talking with the anaesthetist
Once the anaesthetist arrives you may wish to discuss the type of epidural you would prefer (if given the choice). You may wish to leave this decision up to the anaesthetist, bearing in mind that this may be the case anyway if there are health concerns that would constrain your choices.
The anaesthetist will usually ask you (or your caregiver):
- About the progress of your labour and if this is your first or subsequent baby;
- If you have any allergies to any medications;
- If you have had any anaesthetics before (especially epidurals or spinals);
- If you have any specific health problems or are taking any regular medications;
- If you have already had a narcotic injection for pain relief; and
- If you have had any previous major back injuries or problems.
They will then usually run through the epidural procedure verbally and advise you briefly of the potential risks that can be involved with having an epidural. You should also be given an opportunity to ask any questions.
NOTE: Be aware that the woman can be quite stressed and in pain at this point in time and may not be very receptive to long winded explanations. That is why it is important for you to read about your pain relief options in pregnancy and be informed about what the possible side effects can be. There are ethical and legal dilemmas surrounding ‘consent under duress’ when women ask for epidurals (and other pain relief) whilst in labour, but are not really in a position to give true informed consent for accepting the procedure. It is really up to the woman to inform herself about her options in pregnancy, even if the epidural is never required.