Epidural anesthesia is one way of taking away the pain of labor and birth. Like most medical treatments it has risks and benefits. It is important that you learn about those risks and benefits before deciding if an epidural is right for you.
What is epidural anesthesia?
Epidural anesthesia uses repeated doses of a local anesthetic in the epidural space of the spinal area. It numbs the nerves from the uterus and birth passage without stopping labor. A successful epidural once administered gives you an almost pain-free awake state throughout the entire labor and birth of your baby.
An epidural is administered by an anesthesiologist, a physician who is a specialist in anesthesia. Your labor is watched carefully before the medication is given. A specially trained nurse or the physician will be near you until the baby is born.
You and your support person should discuss risks and benefits and sign a written consent before the epidural anesthetic is given.
How is it done?
An epidural is not administered until you are in active labor. Before the procedure begins, intravenous (IV) fluids are started and 1-2 liters of fluids are given. The IVs will continue throughout labor and birth. Then you will be asked to position yourself on your left side or in a sitting position with your chin on your chest and you knees close to your abdomen. This position is uncomfortable for most women. The waistline area of your mid back is wiped with an antiseptic solution to reduce the skin bacteria and thus lessen the chance of an infection.
A coin-sized area of skin on your back is numbed with an injectable local anesthetic. Then a larger needle is placed through the numbed area and into the epidural space of your spine. A small tube (catheter is threaded into that needle until the tip reaches the epidural space around the spinal cord. At that time the needle is removed carefully leaving the catheter in place.
A “test dose” of medication is injected into the catheter to confirm the proper placement. If the placement is correct an initial dose is administered. The catheter is then taped to your back so more medication can easily be injected later. Once in place the catheter does not restrict moving side to side in bed and it is not felt in the back. The pain involved during the administration procedure may be a slight pinch or it may be painful for several minutes.
Three to five minutes following the initial dose, the nerves of the uterus begin to numb. After ten minutes you will feel the full effect. As the initial anesthesia begins to wear off, another dose can be given through the catheter before contractions become uncomfortable. This will be done every one to two hours depending on the specific anesthetic drug(s) and the amount and strength of the medication given.
As soon as the baby is born, the catheter is removed. The effect of the anesthesia usually wears off completely in one or two hours. At that time you may experience an uncomfortable burning sensation around the birth canal.
Are epidurals safe?
At this time, epidurals are thought to be safe for both mother and baby. However, there are risks, and limited studies have been done. Epidurals may require other medical procedures (such as forceps) which add to the risk. The most common side effect is a sudden drop in the woman’s blood pressure. This problem occurs 1 to 2 percent of the time and can be dangerous to a woman and baby. When it does occur, the medical staff is there to take quick action. Usually they can correct the problem. Frequent blood pressure monitoring with either a machine or by a staff member is required after each dose of medication. Some women find this comforting while others find the monitoring irritating because it disturbs the interaction with their support people.
When can I have it and Will it affect my labor?
An epidural anesthetic is administered once you are in true labor. Once started, however, it can slow your labor and make the contractions weaker. If this happens you may be given oxytocin, a drug which makes contractions stronger. If oxytocin is used you will be watched closely since oxytocin can over stimulate the uterus, causing contractions that are too severe.
Does it always work?
If the physician cannot easily locate the epidural space, it may not be possible to use epidural pain relief. This seldom happens. Sometimes labor begins so fast that there is not enough time to use an epidural. Some epidurals give “patchy” anesthesia, causing the feeling that some parts of the abdomen are anesthetized and other parts are not.
Can anyone have it?
Most women can have an epidural, although women who have had back surgery, heart or blood disorders and those who have an allergy to “-caine” medications should discuss those problems with their physicians and anesthesiologists.
Must I remain in bed after I receive the epidural?
Yes, you will be allowed to lie on your side with your head elevated 30 degrees. The epidural also anesthetizes your legs somewhat so you cannot bear your weight and stand. This means, of course, that you cannot go to the bathroom or walk about. You must also have continuous intravenous fluids and electronic fetal monitoring. Electronic fetal monitoring involves having two belts around your abdomen or a wire into your vagina which attaches to your baby’s head.
What else will be done?
Because your abdomen is anesthetized you cannot urinate as you wish. If your labor lasts more than a few hours you will probably need a urinary catheterization which requires that a tube be put into your bladder to release your urine. Catheterization increases the risk of urinary infection 1 to 2 percent each time it is done.
Will I be able to push?
Under epidural anesthesia you may not be aware that you are having a contraction. If you are aware, you can cooperate by pushing. If you cannot feel the contractions, you will probably not be able to push. The baby will then be forced down the birth canal by someone pushing down on your abdomen at the top of your uterus and/or forceps will be placed around the baby’s presenting part and pulled. Both methods produce some risks to the baby. Many experts feel that the timing of the re-injections determines whether the woman can feel her contractions.
Will it slow labor?
Some labors are slowed by the use of an epidural. For other labors, an epidural may actually speed labor because the mother is more relaxed.
Will I need forceps?
There is an increased possibility that forceps will be necessary. Forceps usually require an episiotomy which is a cut enlarging the birth opening. The use of forceps makes most episiotomies extend (get larger), requiring even more stitches and potential pain.
Advantages of an epidural
- Freedom from pain during labor and birth.
- Unlike some other drugs it does not make the mother drowsy before or after the birth.
- Little medication reaches the baby.
- Close monitoring by the hospital staff may give the laboring woman a sense of confidence
Disadvantages of an epidural
- Labor may be slowed by the woman’s inability to move about and make use of gravity.
- The woman must remain in bed on her side with her head at the same level throughout labor.The woman must have constant intravenous fluids and electronic fetal monitoring.The woman must have her blood pressure taken frequently.
- The woman will probably require catheterization which has risks.
- The baby will probably be delivered by forceps which has risks.
- The woman will have little control over her body and may not feel the birth process. This can interfere with maternal-infant bonding.
- The woman must depend totally on nurses and doctors for basic physical needs.
- Extremely rare but serious medical risks exist about which the woman and her partner must be aware.
What else can be used instead of an epidural for pain relief?
There are other ways of reducing the pain of labor. Many women are helped by techniques learned in childbirth classes – relaxation, massage, positioning, visualization, distraction, focusing and breathing that are done with the support of another person. These non-drug coping skills use your own strengths and place you in control of your own 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. It does involve risks. The final decision is yours. Understanding this procedure can help you decide what is right for you.