An epidural anaesthetic is a procedure that is performed by a specialist doctor known as an anaesthetist. Epidural anaesthetic is where an injection of local anaesthetic (sometimes mixed with an opiate such as pethidine or fentanyl) is given into the epidural space (an area located around the spinal cord). An epidural anaesthetic is given to relieve pain in labour, to help reduce high blood pressure (if it is a problem in labour) and prior to a caesarean birth. The effects of the epidural anaesthetic on the woman depend on the type of medication used. A woman may be numb from the waist down and unable to move or she may be able to move her legs but not feel the pain of the contractions. An epidural anaesthetic takes between 10 to 20 minutes to be put in place and then the medication takes around 5 to 20 minutes to become effective. An epidural catheter is left in place after the procedure is completed. It is through this catheter that regular doses of medication can be given to help keep the woman comfortable (Robertson, 1999).
Firstly the anaesthetist places a needle in the woman’s hand and attaches a bag of intravenous fluids. These fluids are to help counteract any drop in blood pressure that can occur. The woman is then positioned either lying on her side or sitting up in bed in a curled up position. An area of the woman’s back is swabbed with an antiseptic solution such as betadine. The woman is given a local anaesthetic to numb the area where the epidural catheter will be introduced. A special needle is inserted into the appropriate space and the very fine epidural catheter is passed into the needle. The epidural catheter is left in place and the special needle is removed. The epidural catheter is then taped carefully in place so that it cannot move. The appropriate medication is given into the epidural catheter.
The advantages of an epidural anaesthetic include: The most effect form of pain relief available, mother can see the birth of her baby during a caesarean, provides adequate pain relief if a forceps or vacuum birth is indicated, helps control high blood pressure (Robertson, 1999).
The disadvantages of an epidural anaesthetic include: Being confined to bed, increases chance of a caesarean birth, increases chance of forceps or vacuum extraction by three times (around 50% of first time mothers will need this type of assistance - statistics between hospitals can vary), approximately 1:100 women will experience a severe headache afterwards, 1:550 women will experience small numb patches on their legs that persist after birth for up to three months, 1:4000 women will experience a life threatening emergency from an epidural (paralysis is extremely rare), labour can be longer (approximately three times more likely to need medication to speed labour up), more likely to need a catheter to help pass urine, some women experience itchy skin (as a result of some of the medication used), some women do not achieve adequate pain relief or partial relief on one side, mothers temperature can rise resulting in the need to give the baby antibiotics after birth (Enkin, Keirse, Renfrew & Neilson, 1995; MIDIRS and The NHS Centre for Reviews and Dissemination, 1997; Robertson, 1999).
Remarkable there has been little research done on short or long term effects of epidural anaesthetics. So the effects on mothers and babies remains unknown at this stage. All research can say at this stage is that epidural anaesthetic provides the most effective form of pain relief to date but it substantially increases the risk of operative births ie. caesarean section, forceps and vacuum extraction (Enkin, Keirse, Renfrew & Neilson, 1995).
(20th January 2000)