Epidural Analgesia and Patient Controlled Epidural Analgesia (PCEA)

Pain is a normal part of labour and birth. There are many ways you can soothe your pain. Having helpful and caring coaching, using breathing techniques, using the bath/shower and other comfort measures are all beneficial throughout labour. If labour pain becomes too difficult though, you may need extra help from pain relieving medication. These medications can be given several different ways, such as breathing a special gas (entonox) or by your nurse or midwife injecting a medication into your muscle or vein. If you do not choose these options or they do not provide enough pain relief, an epidural may be suggested.

What is an epidural?

An epidural is a method used to give pain relief. A thin plastic tube (called a catheter) is put into a space outside the lining of your spine called the “epidural space”. A drug that relieves pain is put into the tube. This drug numbs the nerves coming from your womb (uterus) and birth canal. Pain relief begins in 5-10 minutes and is usually working quite well by 20 minutes.

What about side effects and possible problems?

An epidural is usually safe and has few side effects or risks. All medical procedures have some risk.

Side effects for the mother

• Not all epidurals work perfectly. Some epidurals may produce a patchy effect leaving some areas or one side of the body still sore or uncomfortable. Sometimes an epidural may become dislodged or stop working. About 3-5% of epidurals need to be replaced at some point during labour.
• You may shiver as the epidural begins to work.
• Your blood pressure may go down. Your nurse or anesthesiologist will check your blood pressure often.
• You may have local back discomfort and tenderness after an epidural. This is due to bruising around the area and soon goes away. About 50% of women will have generalized low back pain after delivery – the epidural does not cause this.
• You may not be able to urinate on your own. If this happens the nurse will put a small tube into your bladder to empty it.

Risks for the mother

• Rarely (less than 1 in 100), the epidural needle goes into the space where spinal anesthesia is done. If this happens, you may get a headache within a day or two after the epidural was given. Contact your doctor or midwife, if you have continuing headaches after discharge home
• Very rarely there is an excessive spread of local anesthetic. You will be observed for signs and symptoms so you are safely cared for.
• Very rarely (less than 1 in 10,000), a nerve may be damaged. It usually recovers, but there have been a few reported cases of lasting nerve damage (less than 1 in 85,000). Paralysis is extremely rare.
• Very, very, rarely (less than 1 in 200,000) you could develop an infection in your back or bleeding into the epidural space.

Risks for the baby

• Your baby’s heart rate may go down in the first 30 minutes after an epidural. Usually this is because your blood pressure has gone down, and when treated the baby’s heart rate returns to normal. Your nurse monitors your baby’s heart rate closely in the first 30 minutes after the start of your epidural.
• Your labour may slow down a little, especially if it is your first baby and the epidural is given very early in your labour. Your doctor/midwife may need to start medication (Oxytocin) to increase the contractions.
• You may find it harder to effectively push out your baby, especially if this is your first baby. This means you may need help with a vacuum or forceps to deliver your baby.

It is important to remember that epidurals have been shown to be a safe and useful way for women to manage their pain during labour and delivery. Having an epidural does not increase your chance of having a cesarean section birth.

How it is done?

• You will need to have an intravenous (small plastic tube) placed in your arm, before the epidural is placed.
• A specialist doctor called an “Anesthesiologist” will place the epidural catheter in your back.
• While the doctor places the epidural catheter, you will sit on the side of the bed, or lay on your side (usually left side) with your back curved outward. You will be asked to stay still during the procedure.

The Anesthesiologist:

• Cleans your back by washing it with an antiseptic solution.
• Injects “freezing” (local anesthetic) into the skin area where the thin tubing will be inserted into your back. This may feel like a bee sting that goes away quickly.
• Inserts an epidural needle between the bones in your lower back into the epidural space. You may feel an ache or pressure as this is done, but it does not usually hurt.
• Threads a thin plastic tube (catheter) through the hollow epidural needle into the epidural space, and then removes the needle, leaving the epidural tubing in place. It is taped securely to your back and will not be removed until after your baby is born. In some cases, the catheter may move past a nerve. This may cause a brief tingling sensation down one leg.
• Injects numbing medication and/or other medications that relieve pain into the tubing.
• After the first dose is given by the Anesthesiologist, the catheter will be attached to an epidural pump which will continuously infuse the pain relief medication at a steady rate. You may be given a Patient Controlled Epidural Analgesia (PCEA). This allows you to give yourself extra medication when you feel you need it by pushing a button.

The PCEA is your pump.
Only YOU should push the button.
Family members or friends
should NEVER push the button!

What does it feel like when the epidural is working?

• The area between your groin and “belly button” becomes numb.
• Your legs may feel warm, tingly and sometimes a bit heavy.

Do epidurals let me walk?

In consultation with your doctor or midwife and dependent on your condition and your request, your Anaesthesiologist can adjust the medications and pump settings used in order to increase the likelihood of you being able to move well, use the bathroom and perhaps walk.

It is important to note that there are some reasons why you may choose, or be advised, to stay in bed:

• You have too much pain and need more medication than is in a “mobilizing epidural”.
• Your doctor or midwife advises against it because of safety concerns for you or your baby.
• You do not meet the safety checks that are required before you can mobilize out of bed.

If you have an epidural where you need to remain in bed it is still important to change your position every 30-60 minutes.

If you have a “mobilizing epidural”, you need to remain in bed for the first 30 minutes after the epidural is started. Your nurse will do several safety checks including measuring your blood pressure, leg strength, and testing the feeling in your feet to make sure it is safe for you to get out of bed.

If you do walk, there must be someone with you at all times for support.

Your “mobilizing epidural” may allow you to:

1. Move about in bed and use the commode at the bedside.
2. Get out of bed and walk with assistance, use the bathroom or a chair in the room.

Both options will allow you to labour in many positions.

Where can I get more information?

Please feel free to ask questions of your care providers at any time!