10 things every pregnant mum should know about epidural

Planning to get an epidural to ease the pain of labour, but worried about the side effects?

Here are 10 things you need to know about this procedure.

IT IS THE MOST COMMONLY USED METHOD TO EASE LABOUR PAIN 

As many as four in five mums ask for an epidural during labour at Gleneagles Hospital, Mount Elizabeth Hospital and Mount Elizabeth Novena Hospital.

Over at KK Women's and Children's Hospital (KKH), it is the most preferred pain-relief choice for first-time mums, says Dr Sng Ban Leong, head and senior consultant of the department of women's anaesthesia at KKH.

IT IS A LOCAL ANAESTHETIC 

The drug is injected into your epidural space - just outside the membrane that surrounds the spinal cord and spinal fluid - numbing you from the waist down, shares Dr Yvonne Lim, an anaesthesiologist at Gleneagles Hospital Singapore.

But it won't prevent you from pushing when your baby is ready to make his appearance.

Wang Baoling found that being able to stay alert and in control - without having to grapple with labour pain - was a huge bonus. The first-time mum had an epidural when she delivered her baby.

"I got to enjoy the whole procedure, and was relaxed enough to joke with the nurses and doctor during the pushing stage," she recalls.

NOT ALL EPIDURALS ARE THE SAME 

The most common type is known as an epidural analgesia, which limits your movement.

If you prefer the option of being able to move around, ask for a walking epidural. But, this low-dose option doesn't provide as much pain relief as other forms, says Dr Lim.

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She adds that with a walking epidural, mums also risk falling and injuring themselves when moving around during labour, so they should always be supervised by a nurse or midwife.

Some hospitals also offer patient-controlled epidural analgesia. This allows you to control the amount of pain-relief you need. Ask your doctor which is the most suitable option for you.

IT'S NEVER TOO EARLY TO HAVE ONE

Previously, it was thought that when given too early, an epidural could prolong labour or increase your chance of a caesarean birth. But recent research suggests otherwise.

A review published in The Cochrane Library in 2014 looked at nine studies involving over 15,000 first-time mums. It found that the early administration of epidurals doesn't have an impact on labour and delivery.

These studies were carried out with researchers from KKH, Duke-NUS Graduate Medical School, Singapore Clinical Research Institute and a medical student from the NUS Yong Loo Lin School of Medicine.

"The right time to give the epidural is when the woman requests pain relief," says Dr Sng of KKH, who was the study's lead researcher.

The bottom line: If you want to have an epidural as soon as labour starts, you can.

IT TAKES TIME FOR PAIN RELIEF TO KICK IN

Don't expect the pain to go away immediately after the injection. You may still need to wait 10 to 30 minutes for the drug to take effect, says Dr Lim.

Before that, your anaesthetist may take an additional 30 minutes to arrive and insert the epidural.

So if you have a low threshold for pain, you should ask for intervention early, before the contractions become too intense.

YOU MIGHT STILL FEEL MILD PAIN 

When first-time mum Carine Tan felt some pressure from her contractions after getting an epidural, she panicked.

"I calmed down after my doctor assured me that it was normal," she recalls.

According to Dr Lim of Gleneagles, an epidural usually helps eliminate about 90 per cent of labour pains, but it doesn't numb all sensation.

This ensures that you'll still be able to feel your contractions and push your baby out effectively.

Dr Lim shares: "Some mothers are terrified of pain and they ask for the dose to be increased throughout their labour. But feeling totally numb is not necessarily good, as it will affect the mum's ability to push."

IT IS SAFE FOR YOUR BABY

Contrary to what drug-free birth advocates claim, having an epidural won't make your baby drowsy after delivery, says Dr Chow Kah Kiong, a specialist in obstetrics and gynaecology at Raffles Hospital.

"All studies have shown that babies whose mothers used epidurals are more awake, and less 'sleepy' compared to mums who used opioids, such as a pethidine injection," says Dr Lim.

The latter is a jab into the muscles, usually in the bum or top of the leg. Occasionally, Baby's heart rate might fall temporarily after the epidural kicks in. But it usually recovers on its own or with medication, and has no permanent effects for both mother and baby, adds Dr Lim.

BUT MUMMY MIGHT EXPERIENCE SOME SIDE EFFECTS

You may shiver, itch, feel nauseous, or get a fever or headache after an epidural.

However, these side effects are usually temporary.

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Some mums experience aches in the lower back. But this is likely to be mild, only lasts a few days and can be fixed with pain-relief medication, according to Dr Chow.

What about the persistent backaches that some mums get after the jab? Dr Chow says these have nothing to do with the epidural.

"The annoying chronic backache that some mums develop after delivery is often due to poor posture during the last few months of pregnancy and after birth. It can affect anyone, whether she has had an epidural or not," he explains.

SERIOUS COMPLICATIONS ARE RARE 

Horror stories about epidural injections gone wrong are a rarity rather than the norm, given stringent safety standards. For instance, permanent nerve damage from an epidural occurs in one in 50,000 to 100,000 cases, says Dr Lew.

IT'S NOT FOR EVERYONE 

You shouldn't have an epidural if you have bleeding or clotting problems, severe infections or are allergic to local anaesthetic drugs, says Dr Lim.

If you've had a spine operation to have metal rods inserted, or have spine problems like slipped discs, be sure to let your doctor know beforehand so he can decide if you're a suitable candidate.

Read up on other pain-relief drugs, such as laughing gas or pethidine, so you can make an informed choice.

You may also want to consider drug-free techniques to manage labour pain.

For instance, breathing exercises, relaxation techniques and gentle back massages - which you and your husband can pick up during antenatal classes - can also help you cope.

This article was first published in Young Parents.