Epidurals

Epidural Diagram

There are 2 types of epidurals; traditional epidural and CSE (walking epidural). Both have their risks, but you need to weigh up the pros and cons with your medical providers and create a plan that best fits your needs. Statistics suggest that over 60% of labouring mothers choose epidurals as their choice of pain relief. If you have any questions or concerns regarding an epidural, let your provider know prior to labour and arrange a consultation with the anaesthetist. You are not required to use any form of medicated pain relief, but it is useful to know all the details about them in case you feel you need to use them during labour.

What is the difference between a traditional epidural and a walking epidural?

Traditional epidurals and walking epidurals are very similar in procedure, however the walking epidural is placed deeper within the spinal column than traditional epidurals. Traditional epidurals and walking epidurals also differ in the medication used. Traditional epidurals use only local anaesthetic (lidocaine and bupivacaine), whereas walking epidurals use a combination of morphine/fentanyl, a low dose local anaesthetic and epinephrine. The aim of a walking epidural is to provide pain release with analgesia compared to a traditional epidural that numbs from the catheter down.

What are the benefits of a traditional epidural?

• pain relief

• present and alert

• ability to rest

• can prevent you from resisting what your body is naturally trying to do

What are the risks of a traditional epidural?

• complete numbness

• decreased ability to move

• failed placement

• decreased blood pressure

• continuous foetal monitoring

• urinary catheter

• nausea

• shivering

• continuous IV fluids

• increased risk of assisted delivery (vacuum/forceps)

• longer second stage labour

• can stall labour

• post-birth numbness

• infection

What are the benefits of a walking epidural?

• pain relief

• present and alert

• ability to rest

• ability to continue moving during labour

• allows for gravitational positions to assist with optimal foetal position

• can prevent you from resisting what your body is naturally trying to do

What are the risks of a walking epidural?

• decreased blood pressure

• failed placement

• continuous foetal monitoring

• continuous IV fluids

• increased chance of requiring a urinary catheter

• decreased risk of requiring an assisted delivery (vacuum/forceps)

• difficulty urinated (may require a urinary catheter)

• nausea

• shivering

• longer second stage labour

• can stall labour

• post-birth numbness

• infection

What are the long-term risks of epidurals?

• infection in the spinal space

• post-dural puncture headache

• maternal hypotension

• pain/bruising around entry site

• nerve damage

• paralysis (extremely rare)

Who administers epidurals and how is it done?

Epidurals are administered by an anaesthetist trained in the procedure. Epidurals are inserted in the small space surrounding your spinal cord, therefor you must stay very still during the procedure. You will sit on the bed facing one side slumped over a pillow to arch your spine allowing the anaesthetist to feel along the spine. When they have established where the best and safest spot along the spine is, they will insert a needle between 2 vertebrae into the epidural space. Once the catheter has been fed into this space, the needle is removed, and the medications are delivered through the catheter. Epidurals can be topped up or a continual low dose infusion.

Just be aware that majority of hospitals do not allow photography of this procedure.

Does getting an epidural placed hurt?

The answer to this question all depends on who you ask. Some women don't notice any pain and others report a sharp 10-15 second sting similar to a bee sting.

How long does an epidural take to start working and how long do they last?

Epidurals can take up to 15 minutes to have the desired effect. Epidurals have a catheter inserted during the procedure which allows continuous mediation to be administered throughout labour.

Are there circumstances that will prevent me from having a epidural?

• leaving it until the last minute: once you are into transitional labour, an epidural is generally not allowed due to the possibility of delivering during the procedure or shortly after

• medications: the most common medication preventing the ability to have an epidural is blood thinners

• blood work: if you have a low platelet count or if you have haemophilia or other anti-clotting blood disorder

• weight: being overweight makes it a lot more difficult for the anaesthetist to find the correct space in the spine

• spine issues (prior spinal injury, spina bifida or scoliosis): depending on the severity of the spinal injury or defect, you may not be able to have an epidural or the anaesthetist will have to administer the epidural at a higher entry point in the spine that carries greater risks

• uncontrolled bleeding or shock: excessive bleeding and/or shock decreased blood pressure which is dangerous when an epidural (also causes decreased blood pressure) is administered

• infection on the back: piercing a hole in an area that already has an infection significantly increases the risk of the infection entering the spinal fluid and causing systemic infections, usually meningitis

• anaesthetist unavailable: some hospitals only have a trained anaesthetist during set hours or is on call out of set hours requiring extra time to travel into the hospital. Some anaesthetists cover the whole hospital with many patients requiring urgent attention or scheduled surgeries

• stage of labour: some hospitals don't allow an epidural before a certain stage of labour (Generally 4cm is when active labour is considered to start) and won't allow you to have an epidural after a certain stage of labour (generally 8-10cm during transition)