Pain is a normal part of labour and birth and there are many methods available to your to soothe your pain. Breathing techniques, comfort measures and supportive coaching are essential throughout. If labour becomes difficult, extra relief may be needed from medication. This can be given in several different ways such as breathing a special gas (entonox) or by injecting a medication into a muscle or vein. If these options are not chosen or do not provide enough pain relief, an epidural may be suggested.

What is an epidural?
An epidural is a method of providing pain relief. A thin plastic tube (called a catheter) is put into a space outside the lining of your spine called the “epidural space”. Pain medication is put into the tube which numbs the nerves coming from your uterus (womb) and birth canal. Pain relief begins in 5-10 minutes and develops fully by 20 minutes.

How is it done?

• An anesthesiologist performs this procedure.
• You are positioned on your site, or sitting, in bed.
• You have an intravenous in your arm.
• Your back is washed with a cleansing solution.
• The skin area where the tubing is inserted is made numb by injecting some local anesthetic (freezing). This feels like a bee sting.
• An epidural needle is inserted between the bones in your lower back into the epidural space. You may feel an ache or pressure as this is done but this does not usually hurt.
• A thin plastic tube (catheter) is threaded through the hollow epidural needle into the epidural space. The needle is removed and the epidural tubing is left in place and taped to your back.
• Local anesthetic and/or other pain medication is injected into the tubing. • The area between your groin and “belly button” becomes numb. Your legs may feel warm, tingly and sometimes a bit heavy.

What is a walking epidural?
A low dose of pain medication is injected into the epidural tubing providing pain relief from contractions but leaving enough strength in your legs to allow you to walk. With this “light anesthesia”, your legs will feel a little bit numb but they can be moved very easily. You may get out of bed, use the bathroom, sit in a chair and walk in your labour room. Occasionally, a variation of the epidural technique, called the combined spinal epidural (CSE) technique is used. Specific safety checks will be done by your caregiver after you receive the pain medication to make sure that it is safe for you to stand and walk. Your blood pressure, leg strength and the feeling in your feet will be checked. There must be someone with you at all times when you are up walking. Being able to change positions and be up and walking in labour may improve your birth experience. Walking seems to promote good contractions, especially in early labour.

Why doesn’t everyone choose a walking epidural?

• Your doctor/midwife may advise against walking in some situations, for example if you are having any unusual bleeding from your vagina, or your baby’s head is not low (engaged) in your pelvis.
• You may require stronger pain medication in order to achieve the pain relief you desire – this may prevent you from meeting the safety requirements for being up and walking. For example, your legs may not have enough strength to stand. You may prefer to rest in bed.
• You may not meet the safety requirements even with a light dose of pain medication. Every woman is different and that is why safety checks are done on everyone.

What about side effects and possible problems?
An epidural procedure is usually safe and has few side effects on you or your baby. The benefits of pain relief far outweigh the risks of having the procedure. All medical procedures have some risk; fortunately, serious problems are very rare.

• Shivering may occur as the epidural begins to work. Warm intravenous fluids and warm blankets are used to increase your comfort
• Your blood pressure may go down as the epidural causes blood vessels in your legs to dilate (open up). Your nurse/anesthesiologist will check your blood pressure frequently. The fluids given through your intravenous will be adjusted to manage this problem.
• Local back discomfort and tenderness after an epidural is experienced by some women. This is due to bruising around the area and soon goes away. About 50% of women experience generalized low back pain after delivery – this is not caused by the epidural.
• Occasionally (less than 1% or less than 1 in 100), the epidural needle goes into the space where the spinal anesthesia is done. If this happens, it is possible to get a headache, called a “spinal headache” a day or two after the epidural procedure.
• Very rarely, a nerve may be damaged (1 in 10,000). It usually recovers, but there have been a few cases of lasting nerve damage BC Women’s Hospital & Health Centre would like to stress that most epidurals have been shown to be a safe and effective way to manage pain during labour and delivery.

Where can I get more information?

• Your doctor or midwife
• Ask your nurse to have an anesthesiologist speak with you

BC Women’s Hospital & Health Centre
BCW #532
Revised January 1999