Epidurals in labor

What is an epidural?


An epidural is anesthesia used during labor or for a cesarean section. It delivers continuous pain relief to the lower part of your body while allowing you to remain fully conscious in labor or during surgery.  Medication used is delivered through a catheter inserted into the epidural space just outside the spine.  The discomfort of placing an epidural is minimal.

The anesthesiologist will have you sit up on the edge of the bed or curled on your side.  She then cleans your back, injects the lower back with a numbing medicine, and carefully guides a long skinny needle into the proper space. The anesthesiologist then passes a catheter through the needle, takes out the needle, and tapes the catheter in place.  Intravenous fluids are given prior to the epidural to hydrate you. Usually you’re given a small dose of medicine to test your response and test placement.  Then a full dose will be administered.  Medication is administered by a continuous pump while you are in labor.  There will be continuous monitoring of the baby’s heart rate and your blood pressure is checked frequently to watch for any side effects.

The epidural provides a good deal of pain relief and also numbs your lower abdomen, pelvis and legs to a certain degree.  After the baby is delivered, the catheter will be removed.

You will want to be in active labor before getting the epidural to reduce the chance that it could slow down your contractions. Active labor is usually at least at 4 cm. dilated with regular contractions.

When or if you get your epidural is a decision you’ll make while you are in labor.  You will probably want to get it before the baby’s head is crowning, or showing at the perineum.

There have been a few cases, up to 3% of patients who experience a severe headache caused by leakage of spinal fluid after an epidural.  This may be treated with liberal amounts of oral fluids and pain medication. If symptoms persist, a procedure called a “blood patch”, which is an injection of your blood into the epidural space, can be performed to relieve the headache.

If labor continues for more than a few hours you will probably need a catheter placed in the bladder because your abdomen will be numb, temporarily making urinating difficult.

If the labor progresses quickly, you may need the attendant to tell you when to push because the lower half of the body is still numb.  Sometimes the mother may rest with the epidural turned off to allow enough sensation to return to allow effective pushing.

In some case the woman in labor may not be able to have an epidural administered because of a low platelet count, an infection of the skin of the back, or infection in the blood, or labor is progressing so fast there is no time for the medication to be administered.

If you are coping well with labor you may choose not to use any medication for relief.  Some women may use just a shot in the IV periodically and find that this gives adequate relief. Some women may use both the IV medication and later the epidural.  It is always completely up to the laboring mother.  We always remind our laboring mothers that there is no medal given for not using medication in labor and certainly no disgrace if analgesia is used.  The focus is on having a safe delivery and healthy mother and infant.