Childbirth pain is not something expectant moms look forward to and – fortunately – there is epidural analgesia, one of the most effective ways to relieve labor pain. While epidurals are readily accessible in private hospitals, one cannot be guaranteed in public hospitals. We asked anesthetist and soon-to-be father for the third time, Dr. Assad Hussain 程浩生醫生, to give us the lowdown on the epidural and its availability in Hong Kong.
Here are some exclusive excerpts from Healthy Matters’ The Hong Kong Maternity & Baby Book followed by an assessment of the costs of the epidural in public and private sectors.
Why is the availability of epidurals not guaranteed in public hospitals?
In some public hospitals, due to personnel constraints, there may be a quota on the number of epidurals allowed at the same time. Furthermore, during emergency hours, such as overnight and on weekends, there is a limited number of anesthetists on-call. The anesthetist may be engaged in other emergency operations and not able to attend to epidurals when requested.
What pain management options are provided in public hospitals? Are those options effective compared to the epidural?
TENS machine. Transcutaneous electrical nerve stimulation is a drug-free pain- relief method used in early labor. It consists of a battery-powered, handheld device connected to four pads that are placed on the lower back. The machine sends small, safe electrical impulses to the skin and muscles, which feel like a gentle buzzing sensation. The intensity of the buzzing can be adjusted.
Nitrous Oxide. Often referred to as laughing gas, nitrous oxide is mixed with oxygen and administered through a mask held over the mouth and nose. The gas takes a few seconds to work, therefore it is administered just before each contraction. Nitrous oxide does not eliminate pain from contractions, but eases the intensity of the contractions. Drawbacks of nitrous oxide include nausea, vomiting, confusion and disorientation, and a lack of effective pain relief in 30%–40% of women.
Pethidine. A narcotic and strong pain reliever, pethidine is administered every few hours into the muscle. Pethidine is associated with several side effects, including nausea, dizziness, disorientation, breathing suppression and lack of adequate pain relief in some patients. Respiratory depression after birth is a potential problem for the baby, as pethidine can pass through the umbilical cord to the baby, particularly if the baby is delivered soon after a dose of the medication.
With an epidural, can I still feel something and push?
Depending on the epidural technique performed by the anesthetist, a woman should still be able feel the contractions and push without pain. This is commonly referred to as a walking epidural.
If I have an epidural, am I more likely to need a C-section?
There is no evidence that epidurals during labor increase C-section rates. But when an epidural is used before active labor is established, it may increase the risk of a C-section.
Can an epidural leave a woman paralyzed?
Severe neurological injury leading to permanent paralysis is a rare complication of labor epidurals. Though difficult to accurately calculate, general figure risks for permanent neurological injury after labor epidural range from 1:100,000 to 1:250,000. There are three ways in which permanent neurological injury can occur: direct injury, spinal hematoma or epidural abscess.
What are the side effects of an epidural?
Most epidural side effects are transient, including low blood pressure, which can result in nausea. If necessary, fluids and medications can be used through the drip to keep your blood pressure normal. Other possible side effects include loss of bladder control requiring a catheter, itchy skin and a postural headache. Postural headaches can be severe and carry this name because they subside when the patient lies down. Postural headaches occur when the bag of fluid surrounding the spinal nerves is accidentally punctured. Specific treatments can be provided for this condition.
Is it ever too late to get an epidural?
Most anesthetists believe it is never too late to get an epidural, unless the baby’s head is crowning. As it takes 15–20 minutes for the epidural to be inserted and take effect, it may not work quickly enough to provide pain relief in this scenario. Another option for pain relief in late labor is a single spinal anesthetic, which can provide analgesia in around five minutes. The effect of a spinal may only last one or two hours. Your obstetrician may urge you not to request pain relief if you are going to deliver your baby soon, out of concern that reduced sensation may make it harder for you to push the baby out or increase your risk of having an instrumental delivery. Finally, when epidurals are sited at a late stage of labor, they may increase the risks of complications, as the laboring woman may not be able to stay still between contractions, especially when they occur close together.
Healthy Matters’ Guide to Epidural Costs in Hong Kong
Public hospitals: epidurals are included in hospital fees
While epidurals are not guaranteed in public hospitals, the good news is that if you do get one, it is included in the nominal fee. In other words, you will not have to pay any extra charges for an epidural in a public hospital.
For eligible persons (holders of valid HK ID), the estimated nominal fee for staying 3 days and 2 nights is HK$435 [HK$75 (admin fee) + HK$120 (room fee per day)].
Some public hospitals have private rooms to which you can upgrade for more comfort. In acute public hospitals, private charges are HK$6,650 per day (1st class), HK$4,430 per day (2nd class). More information here.
For non-eligible persons (no valid HK ID), the same delivery package: 3 days and 2 nights including delivery care services, will cost HK$39,000 if you book in advance. Without a booking, the delivery package will cost HK$90,000.
Private hospitals: epidurals are subject to additional charges
In a private hospital, you can always request an epidural but it comes with two additional charges: the hospital epidural fees + the anesthetist’s fees. The hospital charges for an epidural itself can range from HK$4,500 to HK$10,000 depending on the hospital, the type of room you choose, and epidural duration. For instance some hospitals may charge every extra hour if you have an extremely long labor. Apart from this, the anesthetist’s fees will also be charged and these professional fees may be fixed or correlated to the obstetrician’s fees. It is always best to discuss pricing with your medical providers beforehand.