Understanding epidurals

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Whilst an epidural is the most effective way of ensuring a pain-free labour, it’s not without drawbacks. So, it’s important to be informed and make the choice that is right for you. Even then, you should still be prepared to change your mind, as labour can be quite easy for some women while others are surprised at how challenging it can be.

How does it work?

In the basic procedure, the nerves that feed the pain signals from the uterus and the surrounding muscles to our brains are “blocked” using a local anaesthetic and sometimes pain-relieving drugs.

To get the drugs to the nerves, a very fine, soft plastic tube (a catheter) is threaded through a small hollow needle that has been carefully inserted into your lower back. The area is first numbed, so you shouldn’t feel any pain from the needle. Once the catheter is in position, the needle is removed and the catheter is taped in place.

Anaesthetic and pain-relieving drugs, if you’re using them, are then fed through the catheter in one of three ways:

  • continuously, which is the standard for Hong Kong public hospitals;
  • through top-ups on request, which is the standard for Hong Kong private hospitals;
  • through a special drip which you control yourself. This is not common in Hong Kong.

Once the epidural is in place, it takes about 10 to 20 minutes to work.

Why wouldn’t you?

The main disadvantage of having an epidural is that, because your mobility is restricted and because you may not feel the urge to push, labour can take longer and there is an increased chance that medical interventions – such as drugs to speed up labour or the need for forceps or a ventouse to help deliver the baby – might be needed.

However, there are ways around these drawbacks.

  • Your midwife can suggest stopping the epidural when it’s time to push.
  • Some maternity units offer women low-dose (mobile) epidurals, which allow women, with help, to walk around during their labour.
  • Even if you are not very mobile, moving about in the bed and making sure to pee regularly may help.

The epidural options in Hong Kong’s private hospitals depend a lot on your obstetrician; in the public hospitals, you will usually get a standard dose that gives you enough mobility to move around in your bed, but not much more than that.

Currently, about one in four women in labour do choose to have an epidural, and many say they would have one next time. Only a small number of women find that epidurals give little or no pain relief. As far as we know, epidurals have no long-term effects on the baby.

The choice is yours, so prepare well and know how to respond to different situations. This article provides only a brief overview, so please discuss your particular case with your midwife or obstetrician.

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