Epidurals

Epidural anesthesia is the most popular method of pain relief during labor. More women request an epidural by name than any other method of pain relief. More than 50% of women giving birth at hospitals use epidural anesthesia. As you are preparing yourself for the big day, do not hesitate to ask questions about other types of pain medication options available to you.

• What is Epidural Anesthesia?

Epidural anesthesia is regional anesthesia that blocks pain in a particular region of the body. The goal of an epidural is to provide analgesia, or pain relief, rather than anesthesia which leads to total lack of feeling. Epidurals block the nerve impulses from the lower spinal segments. This results in decreased sensation in the lower half of the body.

Epidural medications fall into a class of drugs called local anesthetics, such as bupivacaine, chloroprocaine, orlidocaine. They are often delivered in combination with opioids or narcotics such as fentanyl and sufentanil in order to decrease the required dose of local anesthetic. This produces pain relief with minimal effects. These medications may be used in combination with epinephrine, fentanyl, morphine, or clonidine to prolong the epidural’s effect or to stabilize the mother’s blood pressure.

• How is an Epidural Administered?

IV fluids will be given prior to the procedure of placing the epidural. An anesthesiologist will administer your epidural. You will be asked to arch your back and remain still while lying on your left side or sitting up (used most often). This position is vital for preventing problems and increasing the epidural effectiveness. It is important to inform the anesthesiologist of any curves or other issues with your spine.

An antiseptic solution will be used to wipe the 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. A needle is then inserted into the numbed area surrounding the spinal cord in the lower back. After that, a small tube or catheter is threaded through the needle into the epidural space. The needle is then carefully removed, leaving the catheter in place to provide medication either through periodic injections or by continuous infusion.The catheter is taped to the back to prevent it from slipping out.

• When is an Epidural placed?

Every hospital and physician is different, but typically an epidural is not placed until you are 4-5 cm dilated. You also must be in true, active labor to have an epidural placed.

• Types of Epidurals:

1. Regular Epidural:
After the catheter is in place, a combination of narcotic and anesthesia is administered either by a pump or by periodic injections into the epidural space. A narcotic such as fentanyl or morphine is given to replace some of the higher doses of anesthetic such as bupivacaine, chloroprocaine, or lidocaine. This helps reduce some of the adverse effects of the anesthesia. You will want to ask about your hospital’s policies about staying in bed and eating. Usually once the epidural is in place, you receive a catheter and are not allowed out of bed. 

2. Combined-Spinal Epidural or "Walking Epidural":

An initial dose of narcotic, anesthetic or a combination of the two, is injected beneath the outermost membrane covering the spinal cord,and inward of the epidural space. This is the intrathecal area. The anesthesiologist will pull the needle back into the epidural space, threading a catheter through the needle, then withdrawing the needle and leaving the catheter in place.

This allows more freedom to move while in the bed and greater ability to change positions with assistance. With the catheter in place you can request an epidural at any time if the initial intrathecal injection is inadequate. You should ask about your hospital’s policy on moving around and eating/drinking after the epidural has been placed. With the use of these drugs, muscle strength, balance and reaction are reduced. CSE should provide pain relief for 4-8 hours.

• Benefits of Epidural Anesthesia 

1. Allows you to rest if your labor is prolonged.
2. By reducing the discomfort of childbirth, some woman have a more positive birth experience.
3. Normally, an epidural will allow you to remain alert and be an active participant in your birth.
4. If you deliver by cesarean, an epidural anesthesia will allow you to stay awake and also provide effective pain relief during recovery.
5. When other types of coping mechanisms are no longer helping, an epidural can help you deal with exhaustion, irritability, and fatigue. An epidural can allow you to rest, relax, get focused and give you the strength to move forward as an active participant in your birth experience.
6. The use of epidural anesthesia during childbirth is continually being refined and much of its success depends on the skill with which it is administered.

• Risks of Epidural Anesthesia

1. Epidurals may cause your blood pressure to suddenly drop. For this reason your blood pressure will be routinely checked to help ensure an adequate blood flow to your baby. If there is a sudden drop in blood pressure, you may need to be treated with IV fluids, medications, and oxygen.
2. You may experience a severe headache caused by leakage of spinal fluid. Less than 1% of women experience this side effect. 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.
3. After your epidural is placed, you will need to alternate sides while lying 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.
4. You might experience the following side effects: shivering, ringing of the ears, backache, soreness where the needle is inserted,nausea, or difficulty urinating.
5. You might find that your epidural makes pushing more difficult and additional medications or interventions may be needed such forceps or cesarean. Talk to your doctor when creating your birth plan about what interventions he or she generally uses in such cases.
6. For a few hours after the birth the lower half of your body may feel numb. Numbness will require you to walk with assistance.
7. In rare instances, permanent nerve damage may result in the area where the catheter was inserted.
8. Though research is somewhat ambiguous, most studies suggest that some babies will have trouble “latching on” causing breastfeeding difficulties. Other studies suggest that a baby might experience respiratory depression, fetal malpositioning, and an increase in fetal heart rate variability, thus increasing the need for forceps, vacuum, cesarean deliveries and episiotomies.

• 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

Sources: American Pregnancy Association

C-sections
11 Things NOT To Say To A Woman In Labour
Nipple Stimulation – 7 Steps To Encourage Or Speed Up Labour