Carley
Mama to one and pregnant
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Taken from https://www.babycenter.com.au/pregnancy/labourandbirth/painrelief/
Epidural:
What is it?
It's an injection into the small of your back, using a curved, hollow needle. The needle goes between the vertebrae of your back, and into the space outside the coverings that surround your spinal cord. A fine tube is passed through the needle and then the needle is removed. The tube is taped up your back and over your shoulder. The anaesthetist injects a local anaesthetic (similar to what you would have at the dentist) into the tube to numb the lower part of your abdomen. Generally, your legs and feet go numb as well. You can't feel your contractions any longer. Sometimes, the tube is attached to a small pump, which allows you to control how much local anaesthetic you have, or the pump may be primed to release a small dose of the anaesthetic every so many minutes.
How does it work?
Advertisement
It works in just the same way as a local anaesthetic works when the dentist numbs your mouth before extracting a tooth. The anaesthetic deadens the nerves which are carrying pain signals from your womb and cervix.
When should I have it?
Theoretically, you could have an epidural at any point in labour, even in the second stage when you are pushing your baby out, although a spinal anaesthetic would probably be offered in that situation. Most people, however, choose to have an epidural when the cervix is about five to six centimetres dilated and the contractions are getting pretty strong. If you are as much as eight or nine centimetres dilated, your midwife might say that it's too late for an epidural and advise you to manage without because your baby should be born soon.
What are the advantages of epidurals?
• More than 90% of women get complete pain relief
• Your mind remains totally clear
• Can help to control high blood pressure
• Can put you back in control of your labour, and restore your confidence
• Epidurals are more sophisticated than they used to be and you might find that your legs and feet are not completely numb
What are the disadvantages?
• May find that you are numb down only one side of your body or that a small part of your tummy has not been anaesthetised
• May make you feel very shivery
• You have to stay in bed
• You need to have a drip in your arm. This is because epidurals make some women's blood pressure drop which seriously affects the flow of oxygen to the baby. The drip is a safety precaution so that, in an emergency, the volume of your blood can be quickly boosted to bring your blood pressure back to normal again.
• You will probably have a catheter into your bladder. An epidural means you can't tell when you need to empty your bladder, so this has to be done automatically for you.
• You might feel very out of control. You have three tubes going into your body and you have to be told when to push if the anaesthetic hasn't worn off by the second stage of labour. Your midwife and doctor effectively manage your labour for you.
• Epidurals can increase the length of labour, especially the pushing stage.
• Your baby's heartbeat will be monitored continuously, using a transducer strapped to your abdomen, or a smaller transducer clipped onto his scalp.
• There's a greater chance of needing to have a forceps or ventouse delivery because epidurals often prevent the baby moving into the best position to be born.
• If the epidural needle goes beyond the epidural space, there will be a leakage of cerebro-spinal fluid after the tube is taken out. This fluid buffers your brain and even a very small leak will give you a terrific headache. This is usually treated by taking a small amount of blood from your arm, perhaps the day after your baby is born, and injecting it into your back to seal the hole made by the epidural needle.
• Some women have problems passing urine after having an epidural.
• You might not be able to have an epidural! Not every hospital in England and Wales offers a 24-hour epidural service. Rates vary from 100 per cent of hospitals providing the service in the Oxfordshire region to 58 per cent in the West Midlands, 64 per cent in the South West and 28 per cent in Wales.
• Not available for a home birth.
Any useful tips?
• Keep very still while the anaesthetist is setting up the epidural. You will be on your side or sitting on the edge of the bed, leaning forward. Concentrate on your breathing. Breathe in deeply through your nose and sigh out slowly through your mouth. Hold your companion's hand and keep eye contact with him or her.
• Discuss with your doctor and midwife the possibility of letting the epidural wear off for the second stage of labour when you are going to deliver your baby. Being able to feel the contractions will help you push more effectively.
Mobile or mobilising or ambulatory epidural:
What is a "mobile" epidural?
A mobile, or low dose infusion, epidural is a fairly new technique, which gives excellent pain relief but also allows you to retain some sensation in your legs. However, you have to remember that the primary aim of this kind of epidural is to relieve pain; keeping you mobile is only a secondary concern, and some women find that they're not really mobile at all.
A mobile epidural is set up in the same way as an ordinary epidural, with a tube passed through a hollow needle into the lower part of your back. The other end of the tube is attached to a pump, which sends a combination of anaesthetic and pain-killing drugs (usually bupivacaine and fentanyl) into your back throughout your labour. Sometimes the pump is under your control - this is called Patient Controlled Analgesia or PCA. This method of "continuous infusion" makes it less likely than with an ordinary epidural that you will need forceps or ventouse to give birth to your baby.
How does it work?
Advertisement
In the same way as an epidural, only the combination of drugs maximises pain relief while limiting the loss of sensation in your legs.
When can I have a mobile epidural?
During the first stage of labour when you feel you can't cope with contractions any longer, or early on in labour if you have decided you don't want to have any pain at all.
What are the advantages of a mobile epidural?
• Excellent pain relief for most women
• Depending on how you, as an individual, respond to the "cocktail" of drugs that the anaesthetist uses, you should still be able to move about
• You can push more effectively in the second stage of labour
• You are less likely to need forceps or ventouse than if you have a traditional epidural
What are its disadvantages?
• You may find that the amount of movement you retain is very limited. Some women can manage to move from the bed to a chair, and a few can walk with help.
• Itching
• Difficulty in passing urine
• Will probably increase the length of labour
• You are still more likely to need forceps or ventouse than if you don't have an epidural
Any useful tips?
• Check whether your hospital offers mobile epidurals - many don't.
• Keep very still while the epidural is being set up. This is very important to help the anaesthetist position the tube correctly in your back. You will be on your side or sitting on the edge of the bed, leaning forward. Concentrate on your breathing. Breathe in deeply and sigh out slowly through your mouth. Hold your companion's hand and keep eye contact with him or her.
Combined Spinal Epidural (CSE)
This is a technique that is popular in some hospitals. In the first stage of labour, you are given a spinal injection of a drug such as pethidine or fentanyl to give you pain relief. At the same time, an epidural is set up, but no drugs are passed down the tube. When the effect of the spinal injection wears off, an anaesthetic drug such as bupivacaine is given through the epidural tube to give you ongoing pain relief.
The spinal injection gives you rapid relief from pain, but you should be able to remain at least a little mobile as well.
Entonox (gas and air):
When should I use it?
Advertisement
You can have "gas and air" whenever you want in labour. Simply put the mouthpiece between your lips or teeth and breathe deeply and evenly. This will operate a two-way valve that releases the Entonox for you to breathe in and takes away the carbon dioxide you breathe out. Continue to breathe deeply until you start to feel a little light-headed. Your hand will then drop away from your face and you will stop breathing in the Entonox. Within a few seconds, you will feel perfectly normal again.
What are the advantages of Entonox?
• Easy to use
• Under your control
• Doesn't stay in your system
• Takes the edge off contractions
• Contains oxygen that is good for your baby
• Can be used for a home birth
• If you want to labour in water, you can use "gas and air" while in the pool.
What are its disadvantages?
• Only a mild pain-killer
• May make you feel sick
• Dries your mouth out
Any useful tips?
• Start breathing the Entonox the very second you feel a contraction beginning. It takes at least 20 seconds for the gas to build up in your blood stream to a sufficient level to give you some pain relief, and 45-50 seconds before it reaches it's greatest effectiveness. If you wait until the contraction really hurts, and then start breathing the Entonox, it will be taking effect in between contractions!
• If you're offered "gas and air" through a rubber facemask, and the rubber makes you feel queasy, ask for a mouthpiece. It's easy to swap the mask for a mouthpiece.
• Have lots of sips of water in between contractions to keep your mouth moist.
• When you're pushing your baby out in the second stage of labour, women usually find it easier to concentrate without using the "gas and air" but a few women like to have a little "gas and air" at the beginning of each contraction, but then put the mouthpiece to one side, and PUSH!
Meptid (meptazinol):
What is Meptid?
Unlike pethidine, this is not a drug of addiction or what is called a 'controlled drug'. It is an ordinary analgesic or pain-killer. A standard dose is 100mg.
When should I have it?
Advertisement
During the first stage of labour when you need some extra help to cope with strong contractions.
What are the advantages of Meptid?
• Same advantages as pethidine
• Doesn't affect your baby's breathing as much as pethidine does
• Can be given at any time during first stage of labour
What are the disadvantages?
• Very likely to make you feel sick
• May make you feel dizzy
• Not available in many hospitals
Any useful tips?
• Check that Meptid is available at your hospital before deciding that this is what you want to have in labour!
• Remember that it will be about 15 minutes before the drug starts working. So use your breathing techniques to help you until it takes effect.
Spinal (local anaesthetic):
What is a spinal?
It is an injection of local anaesthetic into the small of your back, using a very fine needle.
How does it work?
Advertisement
The local anaesthetic numbs the nerves supplying your womb and cervix so that you can't feel contractions any more.
When should I have a spinal?
Spinals are generally given during the pushing or second stage of labour - it provides pain relief quickly if you are going to have a forceps or ventouse birth and you haven't got an epidural in place already. They are sometimes used for pain relief in the first stage of labour in conjunction with an epidural - this technique gives effective pain relief faster and is more popular with women than epidural alone.
What are the advantages of spinals?
• Very effective and rapid pain relief
• A single injection and, unlike an epidural, there is no tube left in your back
What are the disadvantages?
• Limits your mobility because you won't be able to feel your legs
• Short acting (about two hours)
• Can't be given more than once (unlike an epidural, a spinal can't be "topped up")
• You might feel very shivery
• You could get a headache, although the use of modern, finer needles lessen the likelihood of this
• You might feel itchy, sick, and have difficulty passing urine
Any useful tips?
Keep as still as you can while you are having the injection. Concentrate on breathing deeply and evenly. Sigh out and keep your shoulders relaxed. Maintain eye contact with your birth companion.
Epidural:
What is it?
It's an injection into the small of your back, using a curved, hollow needle. The needle goes between the vertebrae of your back, and into the space outside the coverings that surround your spinal cord. A fine tube is passed through the needle and then the needle is removed. The tube is taped up your back and over your shoulder. The anaesthetist injects a local anaesthetic (similar to what you would have at the dentist) into the tube to numb the lower part of your abdomen. Generally, your legs and feet go numb as well. You can't feel your contractions any longer. Sometimes, the tube is attached to a small pump, which allows you to control how much local anaesthetic you have, or the pump may be primed to release a small dose of the anaesthetic every so many minutes.
How does it work?
Advertisement
It works in just the same way as a local anaesthetic works when the dentist numbs your mouth before extracting a tooth. The anaesthetic deadens the nerves which are carrying pain signals from your womb and cervix.
When should I have it?
Theoretically, you could have an epidural at any point in labour, even in the second stage when you are pushing your baby out, although a spinal anaesthetic would probably be offered in that situation. Most people, however, choose to have an epidural when the cervix is about five to six centimetres dilated and the contractions are getting pretty strong. If you are as much as eight or nine centimetres dilated, your midwife might say that it's too late for an epidural and advise you to manage without because your baby should be born soon.
What are the advantages of epidurals?
• More than 90% of women get complete pain relief
• Your mind remains totally clear
• Can help to control high blood pressure
• Can put you back in control of your labour, and restore your confidence
• Epidurals are more sophisticated than they used to be and you might find that your legs and feet are not completely numb
What are the disadvantages?
• May find that you are numb down only one side of your body or that a small part of your tummy has not been anaesthetised
• May make you feel very shivery
• You have to stay in bed
• You need to have a drip in your arm. This is because epidurals make some women's blood pressure drop which seriously affects the flow of oxygen to the baby. The drip is a safety precaution so that, in an emergency, the volume of your blood can be quickly boosted to bring your blood pressure back to normal again.
• You will probably have a catheter into your bladder. An epidural means you can't tell when you need to empty your bladder, so this has to be done automatically for you.
• You might feel very out of control. You have three tubes going into your body and you have to be told when to push if the anaesthetic hasn't worn off by the second stage of labour. Your midwife and doctor effectively manage your labour for you.
• Epidurals can increase the length of labour, especially the pushing stage.
• Your baby's heartbeat will be monitored continuously, using a transducer strapped to your abdomen, or a smaller transducer clipped onto his scalp.
• There's a greater chance of needing to have a forceps or ventouse delivery because epidurals often prevent the baby moving into the best position to be born.
• If the epidural needle goes beyond the epidural space, there will be a leakage of cerebro-spinal fluid after the tube is taken out. This fluid buffers your brain and even a very small leak will give you a terrific headache. This is usually treated by taking a small amount of blood from your arm, perhaps the day after your baby is born, and injecting it into your back to seal the hole made by the epidural needle.
• Some women have problems passing urine after having an epidural.
• You might not be able to have an epidural! Not every hospital in England and Wales offers a 24-hour epidural service. Rates vary from 100 per cent of hospitals providing the service in the Oxfordshire region to 58 per cent in the West Midlands, 64 per cent in the South West and 28 per cent in Wales.
• Not available for a home birth.
Any useful tips?
• Keep very still while the anaesthetist is setting up the epidural. You will be on your side or sitting on the edge of the bed, leaning forward. Concentrate on your breathing. Breathe in deeply through your nose and sigh out slowly through your mouth. Hold your companion's hand and keep eye contact with him or her.
• Discuss with your doctor and midwife the possibility of letting the epidural wear off for the second stage of labour when you are going to deliver your baby. Being able to feel the contractions will help you push more effectively.
Mobile or mobilising or ambulatory epidural:
What is a "mobile" epidural?
A mobile, or low dose infusion, epidural is a fairly new technique, which gives excellent pain relief but also allows you to retain some sensation in your legs. However, you have to remember that the primary aim of this kind of epidural is to relieve pain; keeping you mobile is only a secondary concern, and some women find that they're not really mobile at all.
A mobile epidural is set up in the same way as an ordinary epidural, with a tube passed through a hollow needle into the lower part of your back. The other end of the tube is attached to a pump, which sends a combination of anaesthetic and pain-killing drugs (usually bupivacaine and fentanyl) into your back throughout your labour. Sometimes the pump is under your control - this is called Patient Controlled Analgesia or PCA. This method of "continuous infusion" makes it less likely than with an ordinary epidural that you will need forceps or ventouse to give birth to your baby.
How does it work?
Advertisement
In the same way as an epidural, only the combination of drugs maximises pain relief while limiting the loss of sensation in your legs.
When can I have a mobile epidural?
During the first stage of labour when you feel you can't cope with contractions any longer, or early on in labour if you have decided you don't want to have any pain at all.
What are the advantages of a mobile epidural?
• Excellent pain relief for most women
• Depending on how you, as an individual, respond to the "cocktail" of drugs that the anaesthetist uses, you should still be able to move about
• You can push more effectively in the second stage of labour
• You are less likely to need forceps or ventouse than if you have a traditional epidural
What are its disadvantages?
• You may find that the amount of movement you retain is very limited. Some women can manage to move from the bed to a chair, and a few can walk with help.
• Itching
• Difficulty in passing urine
• Will probably increase the length of labour
• You are still more likely to need forceps or ventouse than if you don't have an epidural
Any useful tips?
• Check whether your hospital offers mobile epidurals - many don't.
• Keep very still while the epidural is being set up. This is very important to help the anaesthetist position the tube correctly in your back. You will be on your side or sitting on the edge of the bed, leaning forward. Concentrate on your breathing. Breathe in deeply and sigh out slowly through your mouth. Hold your companion's hand and keep eye contact with him or her.
Combined Spinal Epidural (CSE)
This is a technique that is popular in some hospitals. In the first stage of labour, you are given a spinal injection of a drug such as pethidine or fentanyl to give you pain relief. At the same time, an epidural is set up, but no drugs are passed down the tube. When the effect of the spinal injection wears off, an anaesthetic drug such as bupivacaine is given through the epidural tube to give you ongoing pain relief.
The spinal injection gives you rapid relief from pain, but you should be able to remain at least a little mobile as well.
Entonox (gas and air):
When should I use it?
Advertisement
You can have "gas and air" whenever you want in labour. Simply put the mouthpiece between your lips or teeth and breathe deeply and evenly. This will operate a two-way valve that releases the Entonox for you to breathe in and takes away the carbon dioxide you breathe out. Continue to breathe deeply until you start to feel a little light-headed. Your hand will then drop away from your face and you will stop breathing in the Entonox. Within a few seconds, you will feel perfectly normal again.
What are the advantages of Entonox?
• Easy to use
• Under your control
• Doesn't stay in your system
• Takes the edge off contractions
• Contains oxygen that is good for your baby
• Can be used for a home birth
• If you want to labour in water, you can use "gas and air" while in the pool.
What are its disadvantages?
• Only a mild pain-killer
• May make you feel sick
• Dries your mouth out
Any useful tips?
• Start breathing the Entonox the very second you feel a contraction beginning. It takes at least 20 seconds for the gas to build up in your blood stream to a sufficient level to give you some pain relief, and 45-50 seconds before it reaches it's greatest effectiveness. If you wait until the contraction really hurts, and then start breathing the Entonox, it will be taking effect in between contractions!
• If you're offered "gas and air" through a rubber facemask, and the rubber makes you feel queasy, ask for a mouthpiece. It's easy to swap the mask for a mouthpiece.
• Have lots of sips of water in between contractions to keep your mouth moist.
• When you're pushing your baby out in the second stage of labour, women usually find it easier to concentrate without using the "gas and air" but a few women like to have a little "gas and air" at the beginning of each contraction, but then put the mouthpiece to one side, and PUSH!
Meptid (meptazinol):
What is Meptid?
Unlike pethidine, this is not a drug of addiction or what is called a 'controlled drug'. It is an ordinary analgesic or pain-killer. A standard dose is 100mg.
When should I have it?
Advertisement
During the first stage of labour when you need some extra help to cope with strong contractions.
What are the advantages of Meptid?
• Same advantages as pethidine
• Doesn't affect your baby's breathing as much as pethidine does
• Can be given at any time during first stage of labour
What are the disadvantages?
• Very likely to make you feel sick
• May make you feel dizzy
• Not available in many hospitals
Any useful tips?
• Check that Meptid is available at your hospital before deciding that this is what you want to have in labour!
• Remember that it will be about 15 minutes before the drug starts working. So use your breathing techniques to help you until it takes effect.
Spinal (local anaesthetic):
What is a spinal?
It is an injection of local anaesthetic into the small of your back, using a very fine needle.
How does it work?
Advertisement
The local anaesthetic numbs the nerves supplying your womb and cervix so that you can't feel contractions any more.
When should I have a spinal?
Spinals are generally given during the pushing or second stage of labour - it provides pain relief quickly if you are going to have a forceps or ventouse birth and you haven't got an epidural in place already. They are sometimes used for pain relief in the first stage of labour in conjunction with an epidural - this technique gives effective pain relief faster and is more popular with women than epidural alone.
What are the advantages of spinals?
• Very effective and rapid pain relief
• A single injection and, unlike an epidural, there is no tube left in your back
What are the disadvantages?
• Limits your mobility because you won't be able to feel your legs
• Short acting (about two hours)
• Can't be given more than once (unlike an epidural, a spinal can't be "topped up")
• You might feel very shivery
• You could get a headache, although the use of modern, finer needles lessen the likelihood of this
• You might feel itchy, sick, and have difficulty passing urine
Any useful tips?
Keep as still as you can while you are having the injection. Concentrate on breathing deeply and evenly. Sigh out and keep your shoulders relaxed. Maintain eye contact with your birth companion.
very interesting I still want an EPI but still scared of a needle going into my back lol
. They had it set up and waiting but I had given birth by the time the Dr came to give it to me
.
. Shite....it was all too fast for me
