Complete guide: epidural for a painfree labour

What is an epidural?

Epidural is a type of anesthesia that diminishes or suppresses the contraction pain when you are in labour. It suppresses the sensitivity from the top of your abdomen to your feet.

If you are opting for a walking epidural you will be able to move freely but the regular epidural suppresses the motor nerves so you won’t be able to move your hips, legs or feet.

 

Who channels an epidural during labour in Spain?

The anesthetist is the only professional that can channel an epidural. The midwife and gynecologist are not qualified to do this is Spain.

 

How is the epidural inserted during labour?

After ensuring that your vital signs and baby’s are ok, the anesthetist will ask you to adopt an specific position so your lower back will be bended over. This can be either lying on your side or sitting while bending your back forward. Don’t worry, you will always have someone helping you to hold still on this position and you will feel cared for and safe.

The anesthetist disinfects your back with a fresh spray or gauze. Once it is already disinfected the anesthetist will let you know and will give you the local anesthesia. You will feel a bit of stinging for a couple of seconds. Then he uses a bigger needle to insert the epidural catheter. While this happens, you could feel some pressure and discomfort and is also common to feel an electric chock in one of your legs. You will need to be ready for this so you can avoid the common reaction which is jumping.

The epidural catheter is very thin and soft and is left in your back so we can keep toping up till the pain finishes.

Once the catheter is in the correct place it is affixed to your back to immobilize it and, ready to use!

 

Different ways to administer epidural during labour in Spain:

Depending on the clinic you chose for your labour and the anesthetist, the epidural will be administered one way or the other. This way of administration will have an impact on both, the effect of the epidural and the need to be attached to a machine throughout the whole labour.

 

Through the epidural catheter the anesthesia could be administered in 3 different ways:

1. Top up doses: When you notice that the pain is coming back they will top you up. This one is the favorite for walking epidurals as you won’t need to be continuously hooked to a machine.
2. Continuous perfusion: A small dose of drug is continuously administered through a pump. This dose could be too much or too little for you so it is common to need a dose adjustment.
3. You can top up yourself: with pumps called PCA that have a button that will administer a bolus when pressed.

 

How long does the epidural channeling take during labour?

Normally the anesthetist takes around 10 minutes channeling an epidural.

 

How long does the epidural take to work?

From the moment the epidural dose gets into your body, in 10 minutes time you will notice the contractions feel shorter till, at 20 min from the administration you won’t feel the pain.

 

Does the epidural take the pain away completely?

That is the aim of the epidural, to get rid of the pain. Although, sometimes specially in walking epidurals, a feeling of discomfort that comes and goes could be felt. It is due to the pressure of the contraction that shouldn’t be painful but could be uncomfortable. If it is painful you should inform your midwife to get more epidural.

 

When is the epidural administered during labour?

This can vary as the epidural is channeled for 2 reasons, the woman requesting it to stop labour pain or the gynecologist or midwife recommending it.

Both could happen any time as labour pain could vary among women and each gyne or midwife has their own way to assist labours. That is the reason why some women get the epidural close to a fully dilation and others get it when they have only dilated 1cm or none.

 

When should I get the epidural?

If your aim is to have a normal delivery you should wait for your epidural till you are in active labour and the cervix condition is favorable for a normal birth.

Before having an epidural, we perform a vaginal examination to analyze how favorable is your cervix and how low is the baby’s head.

TIP: Remember to ask the midwife that will check you if she believes it is a good time to get the epidural.

 

Can an early epidural be a problem?

This is a very controversial subject. As a midwife, I continuously see problems and complications that early epidurals bring.

When the epidural is set too early the progress of labour can slow down and often the dilation comes to a standstill. In this case you will need a section.

When it is too early your contractions aren’t normally perfect. When we give you an epidural at this point it is very likely to start a drip of oxytocin aiming to help those contractions and, in many cases, this stresses the baby. In this case you will need a section.

As the epidural suppresses the natural movements that help your baby to descent, labour stretches on needing more time and contractions and as a consequence, the baby gets tired (fetal distress). In this case you will need a section.

 

 

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