Patient Information

Epidural Analgesia and Childbirth FAQ

If you are pregnant, you probably have a lot of questions about pain relief for childbirth. This section provides links to definitions of special terms, as well as answers to frequently asked questions (FAQ). If you have any further questions about pain relief or anesthesia during childbirth, your doctor or midwife can arrange an individual consultation with an anesthesiologist.

Glossary Definitions:

• Analgesia versus anesthesia
• Epidural analgesia
• Combined Spinal-Epidural (C.S.E.)
• Walking epidural
• Patient Controlled Epidural Analgesia (PCEA)
• Epidural side effects and complications

FAQs:

Answers to these frequently asked questions are given below.

• Must I have an epidural?
• Is it painful having an epidural?
• Will the epidural slow my labour?
• When should I have my epidural?
• What other methods of pain relief are available?
• Are there any patients who cannot have an epidural?
• What type of anesthetic should I have if I am going to have a caesarean section?
• What side effects and complications can happen with an epidural?
• What are the risks of headaches after an epidural or spinal anesthetic?

Q: Must I have an epidural?

A: No. Epidural is one of several pain relieving methods available during labour. It is usually done at your request. In the unusual instance that an epidural is necessary for medical reasons, it would be done at the request of your doctor or midwife, but only if you consent.

Q: Is it painful having an epidural?

A: Local anesthetic ("freezing") is injected under the skin before the epidural. This stings for about 5 seconds, but makes having an epidural less uncomfortable. Some women experience a feeling of "pressure in the back" during insertion of the epidural. Most women say that they find the pain of their contractions worse than having an epidural inserted.

Q: Will the epidural slow my labour?

A: Not necessarily. The dose and timing of epidural medication are carefully tailored to suit your labour. In fact, an epidural can improve the descent of your baby by relieving pain and relaxing the pelvic muscles.

Q: When should I have my epidural?

A: Your epidural is typically begun when you are in established labour (determined by your doctor or midwife) and provided you are having regular, painful contractions. If you are having an induced labour, you may have an epidural for the induction. Even late in labour, it may be appropriate to receive an epidural, although pushing may be delayed.

Q: What other methods of pain relief are available?

A: Alternative or complementary methods such as massage and breathing techniques may be adequate for some women. Others may wish to try transcutaneous electrical nerve stimulation (TENS). Equipment for this is available through the Physiotherapy Department and can be arranged at your request by your family doctor, obstetrician or midwife. This must be arranged before you go into labour, as you must learn how to use the machine most effectively.

Narcotic drugs such as meperidine (Demerol®), nalbuphine (Nubaine®) and morphine are also available, although pain relief may be less complete than with epidural analgesia. The nurse usually injects these drugs into a muscle, but they may be given intravenously by a physician or, in special circumstances, by a patient controlled device. Your doctor can administer injections of local anesthetic to the birth canal at the time of delivery.

Q: Are there any patients who cannot have an epidural?

A: Patients with medical conditions such as bleeding disorders and infections at the site of epidural insertion may be advised not to have an epidural. Any woman with a history of back problems or disease of the nervous system should discuss her problem with the anesthesiologist, although it is usually still possible to have an epidural.

Q: What type of anesthetic should I have if I am going to have a caesarean section?

A: The choice of anesthetic depends on the reason for the operation, your wishes, and the advice of your anesthesiologist and obstetrician. Caesarean sections are usually done under epidural or spinal anesthesia. This means that you are frozen from the level of the nipple line down, but remain awake during the birth of your baby. Your partner is encouraged to be present as well.

General anesthesia (going to sleep) is sometimes necessary for medical reasons that would rule out epidural or spinal anesthesia, or if the baby must be delivered quickly. In about 2-5% of patients, epidural or spinal anesthesia fail to work adequately for caesarean section, and then a general anesthetic is offered.

Q: What are the risks of headaches after an epidural or spinal anesthetic?

Headache after an epidural or spinal anesthetic after childbirth are common. Many postpartum headaches go away on their own in days to weeks, but some are more severe and will need assessment and treatment.

Typical symptoms of epidural or spinal headache can include:

• Severe headache at the front or back of your head that worsens when sitting or standing and improves when lying flat
• Neck pain
• Sensitivity to bright lights
• Ringing in the ears
• Nausea and vomiting

While the headache can be severe, it is not life threatening.

What causes the headache?

Your brain and spinal cord are contained in a protective bag (the ‘dura’) surrounded by fluid (‘cerebro-spinal fluid’ or CSF). During an epidural or spinal a needle is used to deliver pain medications for your labour. The needle can puncture the dura causing CSF to leak out.

If too much fluid leaks out through the hole caused by the epidural or spinal needle, the pressure around your brain and spinal cord is reduced. If you sit up, the pressure around your brain drops causing a headache.

What can be done about the headache?

• Lying flat and taking simple pain relief drugs (acetaminophen and ibuprofen) can help
• Drinking caffeinated drinks such as tea, coffee or cola can also be helpful
• Avoid heavy lifting and straining In most cases, the headache will go away by itself within 7-10 days.

If the pain is severe and interferes with you taking care of your baby, an epidural blood patch is an effective treatment.

What is an epidural blood patch?

This procedure is done by the Anesthesiologist in the same way that your spinal or epidural was performed.

1. You sit or lie on the edge of bed, the skin on the lower back is cleaned, and some numbing medicine is placed in the skin.
2. Blood is drawn from your arm.
3. This blood is then injected into the epidural space, which will clot and “plug” the hole caused by the needle.

After the procedure, you will lie flat for an hour to allow the patch to form.

What are the risks of an epidural blood patch?

The most common side effects are mild pain or pressure in your back or buttocks after the blood is injected. Soreness in your back may last a couple of days. Most women get good relief from the epidural blood patch, however, about 1 in 10 women require a 2nd patch for relief.

Serious side effects are very rare and include: infection, bleeding, nerve damage or making another hole in the bag of fluid.

What happens after an epidural blood patch?

You will be asked not to exert yourself or lift anything heavier than your baby for 6 weeks. If your headache returns please contact the Birthing Unit, you may need a repeat blood patch.

Please contact the Anesthesiologist if you have any ongoing concerns related to your headache, if your headache gets worse, or if your headache is no longer relieved by lying down.

If you think you have an epidural/spinal headache, please call the Birthing Unit at 416-480-6995 to speak with the Charge Nurse or Anesthesiologist. They will speak to you about your headache and will arrange for you to come back to the hospital for assessment.

If you develop a fever, leg numbness or weakness, or any worsening back symptoms after your epidural blood patch, please go the nearest Emergency room to be assessed immediately.