Question: Please I need an education on epidural analgesia. I am considering it for pain relief during labour as I am almost due (EDD 10/1/16). However, I have heard some disturbing stories about it.
Doctors response: Epidural analgesia is the most reliable means of providing effective analgesia in labour. Failure to provide an epidural has been shown to be one of the most frequent causes of anxiety and disappointment among women in labour.
The decision to have an epidural sited should be a combined one between you, your midwife, the obstetric team and the anaesthetist. The risks and benefits must be explained to you and the final decision in most cases rest with you unless there is a definite contraindication. It is important to warn that you may temporarily lose sensation and movement in your legs, and that intravenous access and a more intensive level of maternal and foetal monitoring will be necessary, for example with continuous electronic foetal monitoring (CTG).
The effect of epidural analgesia on labour and the operative delivery rate has been a controversial issue. The evidence is now clear that epidural analgesia does not increase caesarean section rates. However, second stage is longer and there is a greater chance of instrumental delivery, which may be lessened by a more liberal use of oxytocin infusions during second stage in primiparous women with epidural.
The main indication is for pain relief. Other maternal and foetal condition requiring epidural analgesia in labour include prolonged labour, maternal hypertensive disease, multiple gestation, certain maternal medical conditions and a high risk of operative intervention.
The contraindications are coagulation disorders, local or systemic sepsis (infection), hypovolaemia and insufficient numbers of trained staff (both anaesthetic and midwifery).
An epidural will limit mobility and for this reason is not ideal for women in early labour. However, women in severe pain, even in the latent phase of labour should not be denied epidural. Neither is advanced cervical dilatation necessarily a contraindication to an epidural.
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