Epidural

What Is an Epidural?

Pain management is an important point of discussion for pregnant women. The appropriate use of medication can improve the birth experience. In many cases, pain is controlled with an epidural. An epidural is a type of anesthetic that affects a localized area of the body. During labor, the regional anesthetic of the epidural diminishes pain in the pelvic area.

How Does an Epidural Work?

An epidural involves the insertion of a small tube into the epidural space, the area of tissue between the spinal column. Medication travels from a discreetly placed bag positioned near the birthing bed through the tube. While the tube is being inserted, it is necessary to lean forward and sit or lie very still. This position opens the space in which the tube will sit during delivery.

Once the epidural is in place, the anesthesiologist will administer medication that will significantly decrease sensation to the lower abdominal area. Medication may be administered as an initial injection with “top-up” as needed, or it may be delivered as a continuous infusion.

When Will I Receive the Epidural?

Usually, you will receive the epidural at the onset of active labor, but the appropriate time for administration differs from patient to patient.

Are Epidurals Painful?

As much as a woman’s body goes through during labor, the idea of an epidural injection can be very unsettling. Rest assured that this process is conducted with a great deal of gentleness and precision. Most women do not even notice the initial prick of the tiny needle. What may be felt is a slight burning sensation as the medication is introduced into the body. This side effect lasts only a few seconds before the numbing effect occurs.

Benefits of an Epidural

• Pain is significantly reduced with this method of management.
• Localized anesthetic block does not affect mental clarity. This means the birth experience is not diminished by grogginess.
• Once inserted, the epidural can be enhanced with stronger anesthetic should an unexpected cesarean become necessary.

Disadvantages of Epidural Anesthetic

There may be some disadvantages of the epidural anesthetic:

• Shivering or fever may occur, causing fetal distress. We may recommend additional medication to control mother’s and baby’s temperature.
• The regional anesthetic may not provide sufficient pain relief for every woman. Approximately 1 in 8 deliveries needs additional pain relief.
• Having an epidural means that movements will be limited. No walking, due to lower extremity weakness.
• A catheter may need to be inserted to facilitate urination, as the muscles that control the bladder may be affected by the anesthetic.
• In some cases, it can take 30 to 40 minutes for the epidural to take full effect.
• Increased monitoring is typically necessary after an epidural and each top-up of medication.
• There is a very small risk that the epidural can cause nerve damage, leading to leg numbness or tingling. In the rare instance that damage occurs, side effects are typically temporary. Permanent side effects occur in only one of approximately 24,000 epidurals.

Side Effects of Regional Anesthesia

Research suggests that epidurals are safe for mothers and babies, but that medication is not without the risk of certain side effects. There is a chance that blood pressure will drop after an epidural, so a small IV will be set up in the arm or hand to facilitate administration of medication or fluids, should that become necessary. Also, some studies suggest that fetal movement and heart rate may become depressed as a result of anesthetic. The longer labor continues, the greater this risk. If the baby becomes lethargic as a result of anesthetic, latching on for breastfeeding may be inhibited.

Will An Epidural Effect My Ability to Push During Labor?

As the medication in the epidural relaxes pain sensations from the uterus and abdominal muscles, the sensation to push may diminish. This does not necessarily increase the possible need of a cesarean. Your provider and you will discuss management of your options as your needs arise.