In an epidural, a flexible tube is inserted under local anesthetic between the spinal vertebrae after the mother has begun having contractions. The analgesic, a combination of local anesthetic, opioids, and occasionally steroids that varies between hospitals, is pumped through the tube directly into the epidural space, located just outside the sac surrounding the spinal cord, where it numbs pain signals from the uterus and pelvis.
This relieves the entire lower body of pain within around half an hour. The analgesic is then continuously infused through the tube; with modern epidurals, a laboring mother can safely increase her dose at any time by pressing a button.
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In many developed countries, epidurals are popular, with the majority or a significant minority of laboring women choosing one, especially if giving birth for the first time. Today, 79 percent of American first-time mothers, 64 percent of Irish first-time mothers and just over 50 percent of Norwegian first-time mothers have an epidural. In France, epidurals are even more popular, with 82 percent of all women giving birth vaginally receiving one.
In poorer countries, use of epidurals is often much lower, due to a lack of awareness among women, cost, and a lack of necessary equipment and staff. In China, 70 percent of women deliver with no pain relief, and the government has targets in place to improve access and so make giving birth better for Chinese women. One report suggests that in India, only around 11 percent of women receive pain relief in labor and awareness is low. A study of 200 pregnant Indian women attending one clinic found that 98 percent did not know it was possible to relieve labor pains and that none had ever heard of anyone using an epidural.
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