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What about the epidural effect on the duration of labour?
The epidural does not reduce the strength or frequency of contractions. Therefore, it does not influence the length of the first stage of labour one way or the other.
There is, however, irrefutable evidence that it tends to prolong the second stage of labour. Ironically, this is a direct result of its effectiveness in controlling pain.
When the cervix is fully dilated and the leading part of the baby has descended low enough to allow for pushing and delivery, with an effective epidural, the labouring woman may not actually feel the urge to push. This may cause a lengthening of this (second) stage of labour.
This is overcome by the attending midwife supervising the second stage where, by palpating the uterine activity, she can encourage the woman to push whenever there is a contraction. This works well, in most cases. However, in a few cases, the absence of the painful urges to push removes the only effective motivating factor. In such a situation, the exhortations of the midwife may not be enough to make the woman push effectively to achieve delivery. This is the situation where an instrumental delivery in the form of ventouse or forceps becomes more likely.
Are there any other delayed unwanted effects from an epidural?
Bruising may occur around the injection site and this may be sore for a day or two.
In a few instances, especially if catheter insertion involved several attempts before eventually succeeding, there is a small risk of a haematoma (blood-clot) forming and, even more rarely, an abscess. This will present in the form of worsening low backache (within one to three days). Appropriate treatment will be required.
Backache and epidural analgesia
It is widely believed -that backache is common following an epidural. Is this true?
This is one of the most unfortunate myths. Backache does occur after an epidural, but is by no means common.
Apart from the potential causes described above, there are a few other possible causes. Probably the most common cause of prolonged low-intensity low backache following an epidural is bad posture.
When an epidural is very effective, the labouring woman may assume a posture that puts considerable strain on her back for several hours. Because she is pain-free, she will remain oblivious to that strain. Once the epidural wears off, she will start feeling the effect of that posture. It may take several weeks before she is completely free of pain. Understandably, this will be blamed on the epidural.
What about headache following an epidural?
Again, in a few instances, headache soon after delivery may be a direct consequence of an epidural. This normally results from what is known as a "dural tap". This simply means the needle had extended into another space (the sub-arachnoid), causing the fluid in this space to leak.
The headache is usually frontal but may also be felt at the back. It is normally felt on rising from a lying position or on standing up. She will also complain of nausea and/or vomiting, occasionally sensitivity to light (photophobia) and neck stiffness.
Maintaining a flat position is very effective in keeping her free of pain but is normally not a practical solution for a new mother. In such a case, treatment using a ‘blood patch’ is very effective and quick. This involves injecting the patient's own blood (about 10-15 ml) into the site of the epidural puncture. This complication is very uncommon but can be quite distressing.