Having a baby is supposed to be one of the most wonderful experiences one could have in their lives and a moment that should be cherished forever. Unfortunately, there is one big downside – it hurts. It really hurts…

However, there are 3 important points to remember if the big day is approaching and you are feeling a little apprehensive.

1. The pain is not forever – there is an endpoint.
2. There is an awesome reward at the end.
3. There are options for pain relief to help get you through.

The third point is what I want to talk about, in particular the use of epidurals. There is also morphine and Nitrous Oxide (the gas) and several other options for pain relief that don’t include drugs which your treating midwife and GP Obstetrician will go through with you. These all work really well and are important aspects of managing pain during labour.

An epidural is when drugs are injected into what is called the epidural space in your lumbar spine near the spinal cord. A small plastic tube is taped to your back and the drugs are given through this via a pump or injection. The drugs numb the nerves that supply your legs and pelvic region to ease the pain of contractions. Sometimes the epidural is quite strong and temporarily affects the movements in your legs and the use of your bladder and other times it is not as strong, and you can still feel contractions. The goal is to get somewhere in between but it is important to remember that everyone’s experience with epidurals is different and a friend or relatives experience may not be the same as yours.

If you need to have a Caesarean section, then you will most likely have a spinal anaesthetic which is a similar procedure but drugs are injected into the spinal space which is closer to the spinal cord and therefore provides a stronger anaesthetic. Sometimes if you already have an epidural in then the anaesthetist will simply use a bigger dose in the epidural while other times a combination of spinal and epidural will be used. This all depends on the clinical situation and your anaesthetist will talk to you about the most appropriate method to manage the pain.

Epidurals are quite safe, however like every procedure they are not without their risks. Arguably the most important risks include:

1. The epidural not working. Sometimes you get a patch of pain or one side can still be sore. Unfortunately, not everyone’s anatomy is the same and everyone has different experiences.
2. Headache. This is no ordinary headache and can be quite debilitating but is not common and can be treated.
3. Nerve damage to your legs and bladder. Probably the one people worry about the most but extremely rare.

There are other potential side effects which your anaesthetist will talk to you about, but all of these can be managed.

One of the biggest concerns people have with epidurals is keeping still during labour. It is true that you have to be sitting up in a certain position for a few contractions keeping still. This makes it easier for the anaesthetist to perform the epidural and reduces the risks of complications. However, you will be surprised how still you can be if it is for a short period of time knowing that hopefully soon the pain will be gone.

Epidurals are a safe and effective method of pain relief during labour, but they are not without their risks and they are not the answer for everyone. Other less invasive methods of pain relief should be considered first but you should not hesitate to ask your treating doctor about epidurals as a way of managing your pain during labour. Preferably this should be done early in your pregnancy, so you have some sort of plan before the big day.

This article has been written by Dr Clark Wasiun.