
Once the medication is administered, it blocks the nerve signals responsible for transmitting pain, resulting in reduced sensations in the lower body. PHOTO/HEALTHLINE.COM
With advancements in medical treatments around the world, childbirth no longer has to mean enduring overwhelming pain, thanks to epidural analgesia. An epidural is a form of pain relief that specifically targets the lower half of the body, making it highly effective during labour and delivery.
Dr Emmanuel Byamugisha, an anesthesiologist at Kisubi Hospital, explains that the reason it is classified as a regional analgesic is that it blocks pain in a specific region rather than throughout the entire body. He notes that this approach allows the birthing parent to remain alert and involved in the birth process without experiencing intense pain. While it does not eliminate all sensations, it significantly reduces the perception of pain, making labour more manageable.
“We administer a dose of bupivacaine, a local anaesthetic drug, to block pain signals from reaching the brain during an epidural. There are no pain perceptions in the brain because the drug interferes with the nerve impulses that would otherwise be transmitted and interpreted as pain signals,” he says.
How does an epidural work?
The epidural procedure begins with a careful injection of a combination of anaesthetic and pain-relieving medication into the epidural space, which is the fluid-filled area surrounding the spinal cord. Once the medication is administered, it blocks the nerve signals responsible for transmitting pain, resulting in reduced sensations in the lower body.
“Typically,” Dr Mugisha says, “an epidural takes about 10 to 20 minutes to start working fully, providing a gradual numbing effect that keeps the birthing parent comfortable. In most cases, the anesthesiologist will insert a small catheter to deliver a steady, controlled amount of medication throughout labour. This can, however, be adjusted as needed based on the progression of labour and the patient’s feedback.”
Timing and administration
Deciding when to administer an epidural is typically a collaborative process involving both the healthcare team and the patient. Generally, an epidural can be requested and administered once active labour begins, which is usually around four to five centimetres of cervical dilation.
Since the epidural placement takes some time to take effect, healthcare providers often recommend against waiting until the last minute, as this could delay effective pain relief. Before labour begins, it is beneficial to discuss these considerations with an obstetrician or anesthesiologist to understand any individual risks involved.
What happens on the day of labour?
Before your epidural procedure, a healthcare provider will likely insert a cannula into a vein in your arm. This allows for a medical drip to be attached if needed, serving as a safety precaution in case your blood pressure drops during the epidural. If this occurs, your provider can quickly access the cannula to administer medication that helps stabilize your blood pressure.
When labour begins, you will go to the hospital, where your gynaecologist will check the dilation of your cervix. If it is four centimetres dilated, you will be ready to receive the epidural injection, and the anaesthesia team will take over.
“You are required to sit upright with both legs on the bed and slightly bend forward to enable the anesthesiologist to identify the appropriate injection site for the epidural,” Dr. Mugisha explains. You will receive an injection to numb the area, after which the epidural injection will be administered and an epidural catheter inserted and taped to your back, extending up to the shoulder area. The catheter will remain in your epidural space, allowing your provider to give you additional medication if needed.
You may experience sensations of pressure, tingling, a burning feeling, or shooting pain when the epidural is injected, although some individuals may not feel anything at all. If you experience any discomfort during the injection, it usually subsides once the procedure is completed.
So, how do you feel?
If you have had an epidural with anaesthetic medication, it will take a few minutes for your pain relief or loss of feeling to take full effect. You must inform your doctor if you still feel intense, sharp pain during or after your epidural procedure.
Your baby will need to be closely monitored during your labour, according to Dr. Ndozire Jr., an Ob/gyn at Mildmay Hospital, because the risks and complications that apply to a normal delivery also apply after the use of epidural analgesia. After the injection, you will feel the pressure of the contractions but not the pain.
Many people fear that the analgesia takes away the contractions, but Dr. Ndozire says this is not true. “The pain is managed, but the contractions remain intact. It is the contractions that push the baby out and not the pain.”
If the mother in labour fails to achieve continuous dilation of the cervix while on an epidural, she can be induced with a small dose of oxytocin.
Who should not get an epidural?
Dr Mugisha notes that due to certain medical conditions, not everyone can have an epidural. “If one is allergic to anaesthetic drugs, has low blood pressure, is critically ill, has haemophilia, low blood platelet levels, has an infection or wound at the site where the epidural injection is administered, or has poorly managed diabetes, they cannot have an epidural,” he warns.
Myths busted
Epidurals increase the likelihood of a C-section: Studies show that epidurals do not necessarily raise the risk of a C-section, but the relief they provide can help a birthing parent conserve energy and remain calm, potentially contributing to a smoother delivery.
Epidurals cause permanent back pain: Research indicates that persistent back pain after childbirth is more likely due to normal physiological changes during pregnancy than to epidural administration.
You do not feel anything: While an epidural reduces pain, the mother will still feel some pressure and a sense of when to push.