Can I eat and drink during labour?
Based on the best available evidence, the Australian and New Zealand College of Anaesthetists suggests that:
- If you are not in established labour and are not likely to require a surgical procedure, you may eat and drink normally.
- If you are in established labour, you may have water and clear fluids, including energy drinks (eg Gatorade or Staminade) to maintain your energy and fluid balance. You should not eat during this time. The reason for this is that if you eat solid foods during labour, you are more likely to vomit, and may be more likely to regurgitate stomach contents into your lungs (“aspiration”) if you require a surgical procedure to deliver your baby.
How common is it for women to have an epidural in labour?
Regional anaesthesia (epidural, combined spinal-epidural or spinal) is used in approximately one third of labouring women to provide pain relief.
Twenty five per cent of women in the United Kingdom and 66 per cent of women in the United States receive epidural analgesia in labour. In some European countries the epidural rate is as high as 98 per cent.
In terms of providing pain relief for labour, how do epidurals compare with other options?
Epidurals are by far the most effective pain relief available to women in labour, although other options are available when an epidural is contraindicated or otherwise unavailable.
Will an epidural affect the progress of my labour?
Epidurals are associated with:
- a longer second stage (the pushing and delivery stage) of labour
- more instrumental deliveries (eg, forceps assisted)
Epidurals are not associated with more caesarean deliveries, nor are they associated with an adverse outcome for your baby.
Does an epidural cause back pain?
Back pain is common in pregnancy for a variety of reasons. There is no evidence that epidurals are associated with long term back pain.
Does having pain relief affect breastfeeding?
Small amounts of oral/intravenous/subcutaneous pain relief and only trace amounts of epidural or spinal anaesthetics are transferred to the baby through breast milk; this is generally of no significance to the baby.
It is important for you to be as comfortable as possible after labour and/or caesarean section in order for you to look after your baby. There is an anaesthetist on site 24 hours a day to help optimise your pain management.
Some mothers will have difficulty with breastfeeding regardless of the type of delivery or the pain management used, and there are midwifery lactation consultants available to help with this.
What are the risks associated with having an epidural?
In at least 90% of cases, epidurals are straightforward to insert and work well. You may still feel your contractions, but they will be much less painful than before.
Common issues
All women having an epidural require intravenous cannula insertion prior to placement of the epidural.
Your legs might feel numb and heavy; thus, it is usually not possible to walk around while the epidural is working.
You will require a urinary catheter after the epidural is placed. This is inserted after the epidural is working, thus, it is not a painful procedure.
Shivering is very common; it is due to the epidural medication and is of no medical consequence.
Itch is a common side effect of the epidural medication.
Sometimes epidurals can be difficult to insert, and insertion may require more than one attempt.
5-10% of the time, the epidural will be inserted easily, but will not work at all, or will be “patchy” – some areas will be numb, while other areas continue to be sore. If this is the case, sometimes changing the medication used in the epidural will fix this, but sometimes a new epidural will need to be placed.
Uncommon risks
Epidural medications cause your blood pressure to fall as an expected side effect. This fall in blood pressure is usually mild, and of little consequence. Your midwife and anaesthetist monitor your blood pressure closely after the epidural has been placed. Occasionally the blood pressure can fall to a greater extent than predicted, but this can be easily treated with intravenous medication.
About 1 in 100 women who have an epidural will develop a severe headache within a day or two. In some cases, this headache requires a treatment called a “blood patch”. This involves performing a procedure similar to an epidural in order to improve the headache.
About 1 in 5000 women will have some temporary nerve injury, such as numbness, tingling, pain or weakness in their legs. If this occurs, it usually resolves within days to weeks, although sometimes complete resolution may take many months; it is uncommon for nerve injury to be permanent.
Rare risks
Usually a working epidural will decrease sensation from your legs up to your belly. Very rarely, the anaesthetic can spread to a higher level than predicted.
Very rarely (about 1 in 150000 or less), it is possible for a collection of blood or infection to develop in the back where the epidural was inserted. In some cases, this may require urgent back surgery to prevent permanent nerve injury.