Reasons for an epidural
Epidurals can be used in labour for many reasons. The following is a list of some of the main reasons you might request an epidural, or your caregiver may recommend you have one.
The most common reason for a woman to request an epidural is for pain relief. Epidurals for this reason are usually given in the active first stage of the labour (when the cervix is opening or dilating past 3 to 5 cms, but before 10 cms).
Some advantages of having an epidural for labour pain relief include:
- The potential to totally relieve the pain (for up to 85% of women).
- It does not sedate the woman, affecting her consciousness or mental clarity, like narcotics and gas.
- It can give the woman a rest.
- For a few women, it helps them to push their baby out, because the pain was lessened.
An epidural is rarely inserted for pain relief in prelabour or in the early 1st stage of labour, because it is likely to stop or slow down the labour. This means that an oxytocin drip to augment the contractions would then be needed. An epidural is also not usually inserted for pain relief after the woman's cervix is fully dilated to 10cms (meaning she is in the 2nd stage or the pushing phase of the labour) as this is likely to inhibit her ability to push her baby out, requiring a 1 to 2 hour delay in the pushing phase or, alternatively, a ventouse or forceps birth.
Forceps, ventouse or Caesarean
Your caregiver may recommend an epidural if you need to have a forceps or ventouse delivery, or a Caesarean birth.
If an epidural is already in place for pain relief during the labour, then more medications can be given through the epidural catheter to provide adequate pain relief for these procedures.
If used for these reasons, the epidural may need to be given during the 2nd stage or pushing phase for the forceps and ventouse delivery (or at any time for a Caesarean).
If the labour has been prolonged and the woman is tired, then an epidural may be needed to enable her to rest. Depending on her body's response to the epidural she may also need to have an oxytocin drip to augment slowed contractions.
Epidurals can be a great tool for women to have some respite from their long labours, but they can also slow things down, so be aware of this if your caregiver starts talking about time limits before intervening to deliver the baby.
Anxious or concerned
For some women feeling concerned about the pain of their labour, or feeling like they are not coping with the pain, can cause anxiety to the point where it is possibly preventing their labour from progressing.
The concerns can be:
- Psychologically based (with mental turning points being typically around the time the woman is 3 to 4 cms or 7 to 8 cms). These times are when the woman's body is preparing to move from one phase or first stage to the next.
- Physiologically based, where the woman's anxiety is causing her to hyperventilate, and release high levels of adrenaline, suppressing her contractions and slowing the labour.
Occasionally an epidural can help with these issues and assist the woman's body to relax and dilate with the labour. If your caregiver is considering augmentation with an oxytocin drip (and you would also like to have an epidural), it is generally good practise to have the epidural inserted first (for at least an hour or two), to see if that will do the trick before starting the oxytocin. This gives the woman's body an opportunity to see if the relaxation is enough to help dilate her cervix, if not, then a drip may still need to be started.
There is some research that supports the fact that an epidural is capable of reducing or reversing the stress-related responses in a woman's body if highly anxious in her labour. She will stop hyperventilating, her muscles will relax, if the blood pressure is raised this will fall and adrenaline levels will decrease. There is also some evidence that the woman's body's oxygen requirements are reduced and blood flow to the placenta may improve (if the blood pressure does not fall too low).