When I shared my recent birth story, I mentioned that I received a low-dose epidural, which allowed me to mobilise during labour. I was inundated with questions so I thought I would tackle some of these here!
Epidural analgesia is the most effective labour pain relief but is associated with increased rates of instrumental vaginal delivery. New techniques that allow users to stay mobile could reduce obstetric intervention. This provides pain relief without dense numbness or ‘heavy legs’. This is called a ‘mobile epidural’.
What is it?
Epidurals are widely used for pain relief in labour and involve an injection of a local anaesthetic into the lower region of the back close to the nerves that transmit pain.
Epidural solutions are given by either:
- Bolus injection (a large, rapid injection)
- Continuous infusion
- Using a patient-controlled pump where the user presses a button when they want another dose of the medication.
Lower concentrations of local anaesthetic, when given together with an opiate, allow women to maintain the ability to move around during labour and to actively participate in the birth. Although some women can walk to a chair or the bathroom, many find after a few hours the legs can become quite heavy and you may have to stay on the bed.
Benefits of low-dose rather than traditional epidural:
- Being able to move promotes contractions
- Can get into more positions during pushing stage
- Associated with lower rate of instrumental delivery
- Lower dose of medication used so reduced effects of drowsiness and nausea whilst still effectively relieving pain
Lower rates of instrumental delivery
The COMET trial from 2001 showed a low-dose mobile epidural increased the spontaneous vaginal delivery rate from 35·1% in the traditional epidural group to 42·9% in the low-dose infusion group (1·39 [1·01–1·90]; p=0·04). These differences were accounted for by a reduction in instrumental vaginal delivery.
A subsequent sub-group analysis from a recent Cochrane review (2018) also demonstrated that lower dose regimens showed reduced rates of instrumental delivery.
Risks of low-dose epidural:
The following risks are similar with traditional epidurals as well:
- Nausea
- Itch and Shivering
- Ringing in the ears
- Backache
- Localized pain at the catheter insertion site
- A sudden drop in blood pressure
- Difficulty urinating
- As with all epidurals, it may increase length of second stage of labour.
- 1 in 100 experience severe headache caused by the leakage of spinal fluid
- 1 in 2000 experience numbness or tingling that resolves over time
- In extremely rare cases there may be nerve damage where the catheter was inserted
The low-dose mixture does not have any impact on reducing risk of caesarean section.
How do I receive one?
The options for what type of epidural you can receive is decided by your anaesthetist who may be following the protocol for your hospital.
If you are keen to mobilise in labour, but want the relief of an epidural it is definitely worth asking your anaesthetist if you can receive a low-dose mixture to try to stay mobile. Remember that many women end up needing to stay in bed later anyway.