Epidural Anesthesia

Epidural anesthesia is the most popular means for pain relief during labor. In fact, more women ask for an epidural by name than any other method of pain relief. Over 50% of women giving birth at hospitals use epidural anesthesia. It is important to understand the benefits and potential risks that an epidural may have when you are deciding if this option is right for you.

What is epidural anesthesia?

Epidural anesthesia uses repeated doses of a local anesthetic in the epidural space that surrounds the spinal cord in the lower back. The nerves from the uterus to the birth passage are numbed without stopping labor. The goal of an epidural is to provide an almost pain free labor experience while still allowing you too feel the pressure of a contraction and feel the need to push.

How is an epidural given?

Before active labor begins and prior to the procedure of placing the epidural, intravenous (IV) fluids will be started. You can expect to receive 1-2 liters of IV fluids throughout labor and delivery. An anesthesiologist, a physician who specializes in anesthesia, will administer your epidural. The position you must be in for the epidural to be given may be uncomfortable but you will not have to stay in the position long. You may be asked to lie on your left side or sit up with your chin on your chest and your knees close to your stomach. An antiseptic solution will be used to wipe your waistline area of your mid back to minimize the chance of infection. A small area on your back will be injected with a local anesthetic to numb it. Then a needle will be inserted into the numbed area that surrounds the spinal cord in the lower back. A small tube or catheter is threaded through the needle into the epidural space. The needle is carefully removed leaving the catheter in place so medication can be injected as needed. The catheter will be taped to your back to prevent it from slipping out.

What are the benefits of epidural anesthesia?

  • Allows you to rest if your labor is prolonged
  • Empowers you to cope with the discomfort of childbirth so you can have a more positive birth experience
  • Unlike some drugs, an epidural will not make you drowsy before or after birth, and little medication reaches your baby.
  • If you deliver by cesarean-section, an epidural anesthesia will allow you to stay awake and also provide effective pain relief during recovery
  • If your baby must be turned using forceps, epidural anesthesia can relieve pain
  • The use of epidural anesthesia during childbirth has been well researched and proven safe in most cases

What are the disadvantages of epidural anesthesia?

  • Epidurals may cause your blood pressure to suddenly drop. (This happens in about 1-2% of all mothers who receive an epidural) For this reason your blood pressure will be routinely checked to make sure there is adequate blood flow to your baby. If this happens you may need to be treated with IV fluids, medications, and oxygen.
  • You may experience a severe headache caused by leakage of spinal fluid. Less than 1% of women experience this side effect from epidural use. If symptoms persist a special procedure can be done to relieve the headache.
  • After your epidural is placed, you will need to lie on your side in bed and have continuous monitoring for changes in fetal heart rate. Lying in one position can sometimes cause labor to slow down or stop.
  • You may experience the following side effects: shivering, ringing of the ears, backache, soreness where the needle is inserted, nausea, or difficulty urinating
  • You may find that your epidural makes pushing more difficult and forceps may be needed to help pull your baby through the birth canal.
  • For a few hours after delivery your lower half of your body may feel numb which may not allow you to walk without assistance.
  • In rare instances, permanent nerve damage may result in the area where the catheter was inserted.

Common Questions About Epidurals

Does the placement of epidural anesthesia hurt?
This depends on who you ask. Some women describe an epidural placement as feeling a bit of discomfort in the area where the back was numbed and then feeling pressure as the small tube or catheter was placed.

When will my epidural be placed?
Typically epidurals are placed when the cervix is dilated to 4-5 centimeters and you are in true active labor.

How can my epidural affect labor?
Your epidural can cause your labor to slow down and also make your contractions weaker. If this happens you may be given the medicine Pitocin to help speed labor up.

How will I feel after the placement of epidural?
The nerves of the uterus will begin to numb just a few minutes after the initial dose. Then you will probably feel the whole numbing effect after 10 minutes. As the anesthetic dose begins to wear off, more doses will be given usually every one to two hours. The epidural also anesthetizes your legs so that you can not stand and bear weight. For this reason, you must stay in bed. If labor continues for more than a few hours you will probably need urinary catheterization because your abdomen will be numb, making urinating difficult. After your baby is born, the catheter is removed and the effects of the anesthesia will usually wear off completely in one or two hours. Some women experience an uncomfortable burning feeling around the birth canal as the medication wears off.

Will I be able to push?
You may not feel that you are having a contraction because of your epidural anesthesia. If you can not feel contractions then pushing may be difficult to control. For this reason your baby may need additional help coming down the birth canal. It may be necessary to apply pressure on your abdomen at the top of your uterus and/or use forceps to pull the baby out.

Does an epidural always work?
For the most part, epidurals are effective in relieving pain during labor. Less than 8% of women who receive epidurals complained of being able to feel pain and/or feeling that the drug worked better on one side of the body than the other.

When can an epidural NOT be used?
An epidural may not be an option to relieve pain during labor if any of the following apply:

  • You use blood thinners
  • Have low platelet counts
  • Are hemorrhaging or in shock
  • Have an infection in the back
  • Have a blood infection
  • If you are not at least 4 cm dilated
  • Epidural space can not be located by the physician
  • If labor is moving too fast and there is not enough time to administer the drug

Reprinted with permission from American Pregnancy Association