Epidural Analgesia for Labour Pain Management 1. Why have an epidural? Epidural analgesia, sometimes called an epidural block, causes some loss of feeling in the lower areas of your body, yet you remain awake and alert. Epidural analgesia is a safe and currently the most effective way of controlling labour pain. It can make the birth experience more satisfying, not only for you but also for any family and friends who may be with you. Women experiencing painful and traumatic labour without a feeling of control are more likely to suffer from post-traumatic stress disorder with sexual avoidance, fear of childbirth, or postnatal depression. Current Australian data suggest that regional analgesia techniques are utilised by approximately one third of labouring women.   2. What is an epidural? It is a specialised procedure performed by anaesthesiologists fully trained and skilled in the technique. The word "epidural" refers to the epidural space: a space between tissue layers in the spinal column, close to the spinal cord. Nerves transmitting pain impulses (messages) from the womb and birth canal to the brain pass through the epidural space. For an epidural, your anaesthesiologist puts a needle in the lower part of your back and uses it to place an epidural catheter (a very thin tube) near the nerves in your spine. The epidural catheter is left in place when the needle is taken out so you can be given painkillers during all of your labour. During the procedure, your midwife will ask you to curl up on your side or sit bending forwards. It is important to keep still while your anaesthesiologist is putting in the epidural, but after the epidural catheter is fixed in place with tape you will be free to move. An epidural catheter entails injection of local anaesthetic (pain killing) drugs into the epidural space, which will block the transmission of pain impulses and therefore the pain sensation. An epidural may take 40 minutes to give pain relief (it usually takes about 20 minutes to set up the epidural and 20 minutes for it to give pain relief). 3. When should you have an epidural? An epidural can be sited at any time once you are in established labour. You will gain most benefit if it is sited early in labour. Once your cervix is almost fully dilated, it may be too late to site the epidural and for it to become effective prior to delivery. Moreover, it may be technically difficult to site the epidural when you are in severe pain and cannot cooperate. 4. Who cannot have an epidural? Most women can have an epidural, but certain medical problems (such as spina bifida, a previous operation on your back or problems with blood clotting) may mean that it is not suitable for you. 5. What may an epidural cause? Serious complications are extremely rare. Epidural analgesia has NO effect on the risk of a caesarean, long term backache, or the immediate status of the neonate. Backache is common during pregnancy and often continues afterwards. You may have a tender spot in your back after an epidural which, rarely, may last for days. The epidural may cause your blood pressure to fall, which may make you feel sick. As a result, we need to monitor your blood pressure frequently. Low blood pressure can easily be treated by increasing the fluid in your drip or putting a special drug into the drip to return your blood pressure to normal. While the epidural is working, your legs may feel weak. You may find it difficult to pass water and will probably need to have a tube passed into your bladder (a urinary catheter) to drain the urine. Having an epidural does not give you a higher risk of a headache. However, around 1 in every 100 women who have an epidural related post-dural puncture headache (PDPH). If this happens to you, you could get a severe headache that could last for days or weeks if left untreated. If you do develop a severe headache, your anaesthesiologist should talk to you and give you advice about the treatment you could have. About 1 in every 13000 women gets long lasting nerve damage after an epidural, causing problems such as a weak muscle or a feeling of tingling or numbness down one leg. Nevertheless, nerve damage after giving birth can happen whether you have an epidural or not and is actually about 5 times more common without an epidural, with 1 in every 2500 women being affected by it. The fact is, no two labours are the same, and no two women have the same amount of pain. Some women need little or no pain relief, and others find that pain relief gives them better control over their labour and delivery.   Your anaesthesiologst is the best person to ask for information about your labour pain management. He/she will be able to talk to you about which type of analgesia might be the best for you and answer your questions. Your obstetrician can put you in touch with an anaesthesiologist for a more detailed conversation.   Most women use a range of ways to cope with labour pain. It is a good idea to have an open mind and be flexible. Don't be afraid to ask for pain relief if you need it.