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Q: Very few people appear to have information on the use of the ambulatory epidural. What are the dangers associated with it and how is it different from the regular epidural? Should the anaesthetist be on hand at all times?
A: The ambulatory or walking epidural is applied in exactly the same spot on your lower spine as the regular epidural. However, the dosage of anaesthetic given is far less, allowing for more control of one’s motor nerves. The effect is that you are still able to walk around and do not need to make use of either a drip or a catheter. It is not an ideal solution when you are having a long hard labour, but is particularly effective if you have previously given birth. The anaesthetist should be available at all times.
Q: When does the mother know when to push? Does the anaesthetist time the effectiveness of the epidural so that she can feel enough to push?
A: The epidural block, unlike other regional anaesthesias is the only form of pain relief suitable for almost the entire labour. There are two types of administration: the constant infusion drip and the Bolus. The Bolus is usually administered as a single-dose block and cannot be “adjusted”.
The constant infusion mechanism enables the patient or doctor to be in control of the mother’s dosage, turning it up or down when necessary. However, trials comparing regular top-ups of epidural analgesia with top-ups on maternal demand showed that episodes of severe pain were reported by only 4% of women who received that regular top-up compared with over 30% of the women who have top-ups on demand. Also, the increased risk of instrumental deliveries associated with an epidural block may be reduced by careful timing of the top-up doses.
With a good and well-timed epidural, the mother will feel the urge to “bear down” and push.
Q: Does it affect your ability to emotionally bond with the child if your body has not been through the trauma of a labour and thus not really “prepared”.
A: In my opinion that is a completely unjustified belief.
Q: I’ve heard that you may be left with patches of numbness, particularly in your legs for many days following the delivery. What can be done to prevent this?
A: This may have a variety of causes such as malposition of the legs in the stirrups or “nerve damage” during the epidural. It will almost certainly resolve completely.
(Dr Martin Puzey, registered gynaecologist)
