Epidural Information

Epidural anesthesia is one way of taking away the pain of labor and delivery.  Like most medical treatments it has its own risks and benefits. It is important that you understand those risks and benefits before deciding if an epidural is right for you.

What is epidural anesthesia?

Epidural anesthesia uses a local anesthetic delivered in continuous doses into the epidural space of the spinal area.  It numbs the nerves from the uterus and birth passage without stopping labor.  A successful epidural gives an almost pain-free awake state throughout the entire process of labor and birth.

An epidural is administered by an anesthesiologist, a physician who specializes in anesthesia.  Your labor is watched carefully before the medication is given.  A specially trained nurse or physician will be near you until the baby is born.

How is it done?

An epidural may be administered when you want it.  You do not have to be a certain number of centimeters dilated to receive it.  Before it is given,  about 1-2 liters of  IV (intravenous) fluids are given.  This will continue throughout labor and birth.  You will be asked to sit with your chin on your chest, curled around the baby.  This is uncomfortable for most women, but it will help enlarge the space between your spinal bones to allow the anesthesiologist more access.

The waistline area of your mid/lower back will be washed with an antiseptic solution to reduce the chance of infection from skin bacteria.  A quarter sized area of skin is numbed with an injection of local anesthetic.  A larger needle is then passes through the numbed area and into the epidural space of your back.  A small tube, called a catheter, is threaded into the epidural space through this needle.  Sometimes you may feel a small pinch when this takes place.  Then the needle is removed, leaving the catheter in place.  The medicine is administered through this catheter continuously by a pump until you deliver your baby.   Your epidural will not ‘wear off’ .

A ‘test dose’ of medicine is injected into the catheter to make sure it is placed properly.  Then it is taped to your back.  You will not feel it.  You can still move from side to side in bed.

After about 15 minutes you will feel the numbing effect in your uterus.

Once the baby is born, the catheter is removed.  The numbness will wear off in about 2 hours.

Are epidurals safe?

Epidurals are thought to be safe for both mother and baby. The most common side effect of an epidural is a sudden drop in the mother’s blood pressure.  This occurs about 1-2% of the time, it can be dangerous to the mother and baby.  Getting adequate IV fluid before the epidural can prevent this problem.  Not sitting up too high after the epidural is placed for the first 15 minutes can also help.  If this were to occur, the medical staff will work to correct the problem.  Your blood pressure will be frequently monitored during the first hour after an epidural.

Does an epidural always work?

If the physician cannot easily locate the epidural space, it may not be possible to use epidural pain relief.  This is rare.  Sometimes labor begins so fast that there is not enough time to use an epidural.  Some epidurals give ‘patchy’ anesthesia, causing relive of pain to some areas of the abdomen and not to others.

Can anyone have it?

Most women can have an epidural, although women who have had back surgery, heart or blood disorders, and those who are allergic to the “-caine” medications should discuss those problems with their physician and anesthesiologist.

Must I remain in bed after I receive the epidural?

Yes, you will be allowed to lie on your side with your head elevated.  The epidural also anesthetizes your legs so that you will not be able to stand or bear weight.  Your cannot go to the bathroom or walk around.  You must have continuous IV fluids and electronic fetal monitoring.

What else will be done?

Because your lower body will be numb, you cannot urinate as you wish.  If your labor lasts more than a few hours you will probably need a urinary catheterization.  This will be a small tube that is put into your bladder to keep your bladder empty.  You will not feel it since you will be numb.  It will be removed before you deliver.

What else can be used for pain relief?

There are other ways of reducing pain in labor.  Many women are helped by techniques from childbirth classes such as relaxation breathing, massage, positioning, distraction and help from a support person. These non-drug techniques will help you use your own strengths and place you in control of your body.

Epidural anesthesia is one method that can give relief from pain and discomfort in labor.  It does require that you give some control to the hospital staff.  The final decision is yours.  Understanding this procedure can help you decide what is right for you.