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Birth and caesarean section
Birth, whether vaginal or by caesarean section, is prepared for from the start of pregnancy. Here you will find what an epidural is, what to expect from it, and when a pregnancy is classed as high risk.
Epidural anaesthesia
An epidural is a technique for relieving pain. After local anaesthetic is applied to the skin of the lower back, a thin catheter is placed in the spine, through which the drugs are given. It is administered by an anaesthetist. It is used in vaginal birth and caesarean section as well as in vaginal surgery.
For a few hours you lose movement and sensation in your legs. This is expected, although it can sometimes be alarming. Sensation and movement return.
What to expect
The most immediate discomforts are itching, which does not always occur and is treated promptly, and a drop in blood pressure while the drugs are being given, which is managed by changing position and giving fluids. The later complication is a persistent headache, which occurs in about 2% of cases and gradually subsides.
The benefits are several. The risks of general anaesthesia are avoided, so that women with serious heart or lung conditions can also undergo surgery. In labour it helps the cervix to dilate more quickly. The mother takes part in the birth without suffering, holds her baby immediately after delivery and can breastfeed. With a special pump, pain relief is maintained through the first twenty-four hours after the birth or the operation.
If you take anticoagulants
If you take aspirin as anticoagulant treatment, you must stop it 15 days before the birth or the operation. If you have subcutaneous injections of low-molecular-weight heparin, the last one is given 24 hours before. This avoids the risk of a haematoma at the epidural site. Stopping is always arranged in consultation with us.
High-risk pregnancy
A high-risk pregnancy is any pregnancy that carries a greater risk for the baby or the mother. It accounts for about 14% of pregnancies and for about 60% of first caesarean sections. In these pregnancies monitoring is closer and the mode of delivery is planned in good time.
Factors that make a pregnancy high risk include maternal age under 19 or over 35, more than five previous births, and a history of miscarriage, preterm birth, stillbirth or congenital anomalies. The same applies to maternal conditions such as diabetes, anaemia, heart disease, chronic hypertension, infections and endocrine disorders, as well as pre-eclampsia.
Other factors include placenta praevia and placental abruption, twin or multiple pregnancy, premature rupture of the membranes, cervical insufficiency, congenital anomalies of the womb, a history of surgery on the womb, a difficult previous birth or a vacuum-assisted delivery, pregnancy after ovulation induction or assisted reproduction, long-standing infertility and inadequate antenatal care.
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Frequently asked questions
Will I feel my legs with an epidural?
For a few hours you lose movement and sensation in your legs. This is an expected effect of the method and it wears off. If it worries you, discuss it with us before the birth so that you know what to expect.
Can I breastfeed straight after a birth with an epidural?
Yes. One of the benefits of an epidural is that the mother holds her baby immediately after delivery and can breastfeed. If you have particular wishes for the first hours after the birth, tell us in good time.
Will I be in pain after the birth or the caesarean?
With a special pump, the pain relief from the epidural can be maintained through the first, most difficult, twenty-four hours after the birth or the operation. The plan for pain relief is discussed with you and with the anaesthetist.
I take aspirin or heparin. What do I do before the birth?
Aspirin is stopped 15 days before the birth or the operation. The last injection of low-molecular-weight heparin is given 24 hours before. This avoids a possible haematoma. Do not stop the treatment on your own; we will set the timing together at your last visits.
I am over 35. Does that make my pregnancy high risk?
Age over 35 is one of the factors that class a pregnancy as high risk. This means closer monitoring, not that something will go wrong. At your first visit we will go through your full history together and set your monitoring schedule.