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Epidurals

Written by Sarah Buckley, MD   
Friday, 01 December 2006 00:00
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Epidural pain relief is an increasingly popular choice for Australian women in the labour ward. Up to one third of all birthing women have an epidural,1 and it is especially common amongst women having their first babies.2 For women giving birth by caesarean section, epidurals are certainly a great alternative to general anaesthetic, allowing women to see their baby being born, and to hold and breastfeed at an early stage; however, their use as a part of a normal vaginal birth is more questionable.3

There are several types of epidural used in Australian hospitals. In a conventional epidural, a dose of local anaesthetic is injected through the lower back into the epidural space, around the spinal cord. This numbs the nerves which bring sensation from the uterus and birth canal. Unfortunately, the local anaesthetic also numbs the nerves which control the pelvic muscles and legs. So, with this type of epidural, a woman usually cannot move her legs and, unless the epidural has worn off, cannot push her baby out, in the second stage of labour.

EpiduralsMore recent forms of epidurals use a lower dose of local anaesthetic, usually combined with an opiate, such as pethidine, morphine or fentanyl (sublimaze). With this low-dose or combination epidural, most women can move around with support; however, the chance of a woman being able to give birth without forceps is still low.4 Another form of epidural, popular in the United States, is the CSE, or combined spinal-epidural, where a one-off dose of opiate, with or without local anaesthetic, is injected into the spinal space, very close to the end of the spinal cord. This gives pain relief for around 2 hours, and if further pain relief is needed, it is given as an epidural. These forms of “walking epidural” may seem advantageous, but being attached to a cardiotocograph machine to monitor the baby, and hooked up to a drip which is also a requirement when an epidural is in place, can make walking impossible.