The epidural anesthetic was first used in 1884, so it has been in existence for more than a hundred years. It follows the same principle as the local anaesthetic administered by a dentist. The nerves that carry the pain originating in your uterus and your pelvis are numbed by an anaesthetic substance to block the transmission of painful sensation.

When you are giving birth, the epidural will block off this transmission from the parts of your body below the navel. This technique is named “epidural” because the place where the local anaesthetic is injected is called the epidural space.

If you request it, epidural pain relief will be considered, but its administration must be discussed first with the obstetrics anaesthesia team.

If you wish to have an epidural during labour and giving birth, you can ask the midwife who is caring for you and who will be with you during labour. The midwife will call the anaesthetist, who will consult your medical records, the results of the blood test performed during the last month of your pregnancy and he will above all check that there is no reason for not having the anaesthetic.

There are few reasons for not having an epidural but they are imperative:

However intense the pain is, until the midwife is certain that labour has started, it is not advisable to administer an epidural in case it turns out to be a « mock labour ». In pratical terms the midwife is sure that labour has begun when the contractions become regular and the cervix is dilated to about 3 cm.

If the cervix is already well dilated (8-9 cm), the decision to administer an epidural will depend on whether the midwife and/or the obstetrician thinks that you will give birth quickly or whether you might need a forceps delivery or a Caesarian section.

An epidural is administered by a lumbar puncture between two vertebrae in your lower back. You will either be in a sitting position or lying on your left side according to what your anaesthetist thinks is best.

To determine the exact point for the lumbar puncture; the anaesthetist will palpate your backbone. It is very important to find the right spot to administer the epidural and this may be difficult if the patient is obese or has become overweight during pregnancy. The usual point for the lumbar puncture is between the second and third lumbar vertebrae or between the third and fourth lumbar vertebrae.

Because a local anaesthetic will be applied to the skin before the needle for the epidural is put in place, this injection is less painful than taking a blood sample.

The local anaesthetic must penetrate several nerves in order to relieve the pain caused by contractions. The effect is not immediate; it takes between 10 and 20 minutes.

A total absence of feeling is not always best for the baby or for you. Although the pain you feel will be much less you will still be aware of contractions and you will be aware when the midwife or the obstetrician examines you. According to the circumstances and according to the state of the baby, the anaesthetist may make adjustments to the degree of anaesthesia. You may notice that your legs feel stiff, or heavy, or maybe even weak.

The epidural can be prolonged for as long as necessary. The appropriate doses of local anaesthetic will be administered continuously via the epidural catheter using an automatic syringe. When the baby has been delivered, the catheter will be removed before you return to your room and your will recover all normal feeling within a few hours.

The adequate dose of local anaesthetic injected in the correct place provides the same results for every patient. If pain relief is not effective enough you can ask the anaesthetist who will adapt the dose or make a technical adjustment to solve the problem. Sometimes it is necessary to start the epidural procedure again from the beginning. However, even with a perfectly administered epidural, some patients are not completely satisfied. 80% of women say that they feel no pain, 15% do not feel complete relief and 5% consider the technique to be a failure.

Each woman reacts differently to an epidural. After the epidural has been set up, the frequency of the contractions may be reduced for a short time. Then in most cases the more or less total pain relief allows the woman to relax and labour speeds up.

The epidural will mean that you can rest during the most tiring part of labour while the cervix is dilating. When the cervix is completely dilated and it’s time to « push » you will have some energy in reserve…

In the absence or reduction in pain, you will not always feel the need to « push », but you will be able to do so when the midwife or the obstetrician asks you. Therefore a delivery that would have been spontaneous can also be so with an epidural.

If the use of forceps should prove necessary to guide your baby through, the epidural will be strong enough for this to be done without your feeling any pain.

No, but if an epistiotomy is necessary, it can be carried out with much less discomfort for the patient.

Extensive scientific research has shown that an epidural is risk free for you and for your baby. The only possible indirect side effect could be the possible consequences of a drop in your blood pressure. This is can be foreseen and is easily dealt with by the anaesthetist. An epidural is therefor a very safe procedure for the baby.

Even if you are under careful observation and the anaesthetist has taken all the necessary precautions, occasionally a certain discomfort may be felt or certain complications can arise while the epidural is being set up: an electric shock sensation when the catheter is put in place, a « pins and needles » effect in the legs and sometimes a feeling of nausea.

Shivering is frequently observed during labour and delivery even without an epidural.

An epidural may cause a lowering of your blood pressure. To prevent this you will be given an intraveinous injection through a tiny catheter in your arm and you will remain lying down throughout labour. Your blood pressure will be monitored regularly and automatically as soon as you arrive in the labour room and this will continue until you are taken back to your room, usually about two hours after the birth of your baby.

Occasionally an epidural can affect the chest muscles and cause difficulty in breathing. If this arises the patient is given oxygen through a mask. This helps the patient to breathe and the discomfort is relieved.

Even in expert and practised hands, it may be impossible to carry out an epidural. It may be difficult to perform a lumbar puncture due to excess weight, a malformation or previous spinal surgery.

Sometimes headaches can occur after an epidural. These can be caused by a slight leak in the cerebro-spinal fluid if needle is injected a little too deep when the lumbar puncture takes place. If this does happen you will be informed by the anaesthetist. The lumbar puncture is a delicate manoeuvre and if you keep calm and still while it is being carried out, this discomfort can be avoided.

It often goes unnoticed and it is only 6 to 12 hours after the birth that headaches occur. These generally disappear within a few days with bedrest, increased fluid intake and analgesia tablets. If the headaches continue and are a handicap, another epidural is prescribed in order to inject a small amount of your own blood to stop the leak in the cerebro-spinal fluid. In very nearly every case, this has the effect of stopping the headaches completely and rapidly.

Paralysis, due to compression of the spinal cord or the nerves, can be caused by bruising to the dura mater (lining of the spinal cord) if there is a problem with coagulation. It may also occur in the case of septicaemia if an abcess appears on the dura mater, causing meningitis.

This has become extremely rare as long as the reasons for not having an epidural, as described above, are respected.

If the decision for a Caesarian section was taken before the onset of labour, we will decide with you, during the anaesthesia consultation, the best technique to be used.

Caesarian section with an epidural:

The quantity of local anaesthetic necessary for a Caesarian section is greater than that administered for a normal delivery, in order to make an incision. The lower half of the body is under anaesthetic. If you already have the epidural catheter in place this type of anaesthetic is achieved by an additional injection of local anaesthetic.

Caesarian section with a spinal anaesthetic:

A spinal anaesthetic is similar to an epidural and is carried out when an epidural catheter is not already in place.

Caesarian section with a general anaesthetic:

A general anaesthetic is used when it is not possible to use either an epidural or a spinal anaesthetic and when a general anaesthetic appears to be the best possible choice for medical reasons.