Top-ups
If the epidural is intermittent, once the initial dose of medication(s) have worn off (after 1 to 2 hours), the epidural can be 'topped up' if needed, with more medications being administered down the epidural catheter. Your caregiver will normally perform a vaginal examination before a top-up, to check the dilation of the cervix. If the cervix is not fully dilated (10cms) then the epidural will usually be topped up for further pain relief. Top ups can be given every couple of hours for up to 24 hours if necessary.
If the cervix is fully open (indicating that you are ready to push your baby to be born) the epidural is usually not topped up, but allowed to wear off, giving you more sensation to effectively push. Some women will give birth in the first hour or two after the initial insertion of the epidural and not require any top-ups.
The epidural can also be topped up for procedures such as a
forceps,
ventouse or Caesarean birth. This would also be needed if the woman were having a continuous or self-administering epidural, as the pain relief provided by these methods may be adequate for contraction pains but not potent enough for the intended procedure.
Depending on the hospital policy, the top-ups may be given by a midwife trained to administer them, or they may be carried out by the anaesthetist who inserted the epidural. If the latter is expected, then they will need to be called back to the delivery suite to do this.
Letting the epidural wear off
The epidural may inhibit or slow the pushing phase of the labour. It is for this reason that women are normally encouraged to turn the epidural down or off (if continuous) or not have a top-up (if intermittent) when the pushing phase is reached.