If you are pregnant and nearing childbirth, you may be getting anxious about your impending labour pain, especially if this is your first pregnancy.

Take comfort in knowing you will be able to get some respite with an epidural analgesia (EA), the most effective method for labour pain relief. “An epidural analgesia is the gold standard for labour pain relief,” says Dr Sng Ban Leong, Deputy Head and Senior Consultant, Department of Women’s Anaesthesia, KK Women’s & Children’s Hospital (KKH), a member of the SingHealth group. “At KKH, epidural analgesia is the most preferred choice of labour pain relief for first-time mothers.”

It’s important to note that an epidural analgesia, often referred to as an epidural, reduces labour pain considerably but may not totally eliminate it.

“Some degree of discomfort may still be felt, for example, when ‘pushing’ the baby,” says Dr Sng.

An epidural analgesia is a local anaesthetic injected into the epidural space, which is in the outermost part of the spinal canal, in the lower back. It numbs the nerves so there is decreased sensation.

A catheter (fine small plastic tubing) is inserted into the epidural space so that anaesthetics can be delivered throughout labour.

“An epidural analgesic provides pain relief with minimal or no sedation to the mother,” says Dr Sng.

A combined spinal-epidural analgesia (CSEA) and a patient-controlled epidural analgesia (PCEA) are variations of the epidural analgesic.

• CSEA: An initial dose of the drug is injected into the spinal space, also within the spinal canal. This results in faster pain relief.
• PCEA: A pre-programmed device allows the pregnant woman to self-administer drugs into the epidural space.

“PCEA has advantages over conventional EA/CSEA that use continuous infusion of medications. With the PCEA, the pregnant woman may potentially consume fewer pain medications than with the other two methods,” says Dr Sng.

An anaesthesiologist will decide what type of epidural to administer, based on the stage and progress of labour.

When is the best time to give epidural analgesia? What other options are available for mothers-to-be? Read on to find out.

Ref: R14