Epidurals were first implemented in the early 1900's, but were not used for labour and birth until the 1940's. From this time until the 1960's they were used sporadically and did not gain wide popularity for pain relief in labour until the 1970's.
Up until the last 20 years or so, many epidurals were given via the sacral area (or near the woman's tailbone). These were known as 'Caudal Blocks'. Caudal blocks are rarely used these days as they require much higher doses of anaesthetic, tend to be technically more difficult to insert and hold the possible risk of accidentally inserting the needle (and the anaesthetic) into the baby's head. Epidurals today tend to be inserted into the lumbar (or lower back) area of the woman's spine.
The epidural catheter was first used in 1931. This was a fine, hollow tube that could be left in place after the needle was removed to give further medications. It was this discovery that saw the epidural as an attractive alternative to the use of spinal anaesthesia.
The popularity of epidurals in the 1970's came about initially due the introduction of many other forms of childbirth technology, making obstetricians feel more comfortable with managing the side effects of the epidural if they eventuated. This led to epidurals being more frequently recommended by caregivers and eventually gaining popularity through women requesting them for pain relief.
Factors that led to the wider acceptance and use of the epidural included:
- The discovery and increased use of oxytocin (Syntocinon) through a drip in the vein to augment the labour. This could be used if the contractions slowed or stopped after the epidural was given. In the early days, this was about 40% of the time.
- The increased safety and use of Caesareans. If complications arose from the use of the epidural and / or oxytocin drip (such as the baby becoming distressed), the doctor felt more comfortable with performing a Caesarean.
- The discovery of continuous fetal monitoring. This made many caregivers feel more relaxed about detecting distress of the baby, when using an epidural or oxytocin drip.
- Word of mouth. Once the use of epidural became more widespread, other women started to ask about using an epidural for pain relief in their own labours.
Up until the 1990's, the medications used for epidurals in labour were mainly 'local' types of anaesthetics, such as lidocaine (known as Xylocaine) and bupivacaine (known as Marcaine). At the time they were used in higher concentrations (for example 1% Xylocaine), similar to doses given when performing surgical operations, such as Caesareans. In recent years it has become apparent that these doses were too strong for women in labour. While they were effective at providing good pain relief, they also numbed the woman's sensations to the extent that she could not feel ANYTHING and therefore less likely to be able to push her baby out.
The trend now is to give lighter doses of 'local' anaesthetic (such as 0.25% lidocaine or 0.125% bupivacaine) and in many cases mix them with narcotic medications such as Fentanyl, Morphine or Pethidine. This is aimed at reducing some of the side effects of the earlier epidurals.
Last revised: Tuesday, 4 December 2012
This article contains general information only and is not intended to replace advice from a qualified health professional.