Pain relief-epidural
What Causes Labour Pain?
Labour begins when your uterus (womb) begins to contract. In the days before labour starts, you may experience tightening of the uterus which causes discomfort rather than pain.
Labour is said to start when you get regular contractions. Contractions increase in frequency and intensity throughout labour and can become painful in a similar way as you may experience pain in other muscles in your body when you do vigorous exercise.
At the same time, the opening into the uterus (the cervix) is stretching to eventually allow your baby to pass through into your birth canal.
When the opening to the cervix is fully open (dilated), you begin what is known as the second stage of labour, when your baby is born. The baby passes through your birth canal and is born by a combination of the continuing contractions of your uterus and your conscious effort to push your baby out by using the muscles of your lower abdomen.
During your pregnancy, changes happen in your body to prepare for these events. The ligaments of your pelvis loosen to permit your pelvis to relax and allow your baby to come out. Other changes occur to adapt your body to accommodate childbirth. Unfortunately, despite these changes, it is likely you will feel pain. First labours are probably more painful than subsequent ones.
Sometimes when it is necessary to start off labour, or stimulate it if progress is slow, your labour may be more painful.
Every person's appreciation of pain is different, and what one person can accept another may find extremely painful.
Epidural Analgesia
The nerves from the uterus (womb) and birth canal go to the brain through part of your lower back (see the diagram). It is possible to bathe these nerves with local anaesthetic using an injection.
A fine tube is placed in the region of the nerves so that painkiller can be injected. This can be repeated or 'topped up' when needed during your labour. Positioning of this tube is done by an anaesthetist. Once the tube is in position you will be almost unaware of it's presence.
For the second stage of labour, the 'top up' is usually injected with you sitting up. This stops the pain from the lower nerves. This top up will also allow a doctor or midwife to deliver your baby painlessly if assistance is required. Any stitching can be done while the epidural is still working. An epidural will leave you pain free, but you may still have some sensation of pressure, particularly as your baby is born.
When?
This type of analgesia can be started at any time during labour. For the greatest benefit it needs to be done early enough to be useful. The normal dosage of the painkillers used will not make the baby sleepy or slow to breathe at birth as some of the others
Advantages & Disadvantages of Epidurals
- An epidural gives much more complete relief from discomfort in labour than any current alternative.
- Normally epidural analgesia is straightforward and very effective, with little risk of harmful effects.
- Epidurals may cause low blood pressure and a drip is routinely set up before they are commenced.
- These methods may not always work in a satisfactory way. In this case it may be possible to switch from the mobile epidural dose to a standard epidural, but it may be necessary to reposition the epidural.
Recent research has demonstrated that you are no more likely to get backache after having an epidural for labour than if you have your baby without an epidural.
Very rarely a slow leak of spinal fluid can occur afterwards and may cause a headache, meaning you have to lie flat for a day or so until the leak seals itself. Very occasionally a second injection has to be used to seal the leak.
Despite the few disadvantages most women find that an epidural makes their labour much more enjoyable.
