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 prepare yourself for labor day, try to learn as much as possible about pain
relief options so that you will be better prepared to make decisions during the labor and
birth process. Understanding the different types of epidurals, how they are administered
and their benefits and risks, will help you in your decision-making during the course of
labor and delivery.
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, or lidocaine. 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 epidurals effect or to stabilize the mothers blood pressure.
How is an epidural given?
Intravenous (IV) fluids will be started before active labor begins and prior to the
procedure of placing the epidural. You can expect to receive 1-2 liters of IV fluids
throughout labor and delivery. An anesthesiologist (specialist in administering anesthesia),
an obstetrician, or nurse-anesthetist will administer your epidural. You will be asked to
arch your back and remain still while lying on your left side or sitting up. This position is
vital for preventing problems and increasing the epidural effectiveness. 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.
What are the types of epidurals?
There are 2 basic epidurals in use today. Hospitals and anesthesiologists will differ on
the dosages and combinations of medication. You should ask your care providers at the

hospital
about
their
practices
in
this
regard.
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.
Combined Spinal-Epidural (CSE) 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 hospitals
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.
What are the benefits of epidural anesthesia?

Allows you to rest if your labor is prolonged

By reducing the discomfort of childbirth, some woman have a more positive birth
experience
Normally, an epidural will allow you to remain alert and be an active participant in
your birth
If you deliver by cesarean, an epidural anesthesia will allow you to stay awake and
also provide effective pain relief during recovery
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.
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.

What are the Disadvantages of epidural anesthesia?

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.
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.
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.
You might experience the following side effects: shivering, ringing of the ears,
backache, soreness where the needle is inserted, nausea, or difficulty urinating.
You might find that your epidural makes pushing more difficult and additional
interventions such as Pitocin, forceps, vacuum extraction or cesarean might become
necessary
For a few hours after the birth the lower half of your body may feel numb.
Numbness will require you to walk with assistance.
In rare instances, permanent nerve damage may result in the area where the
catheter was inserted.
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.

Common Questions about Epidurals:

Does the placement of epidural anesthesia hurt? The answer depends on who you ask.
Some women describe an epidural placement as creating a bit of discomfort in the area
where the back was numbed and a feeling of 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
make your contractions weaker. If this happens you may be given the medicine Pitocin to
help speed up labor.
How can an epidural affect my baby? As previously stated, research on the effects of
epidurals on newborns is somewhat ambiguous, and many factors can affect the health of
a newborn. How much of an effect these medications will have is difficult to predetermine
and can vary based on dosage, the length of labor, and the characteristics of each
individual baby. Since dosages and medications can vary, concrete information from
research is currently unavailable. One possible side effect of an epidural with some
babies is a struggle with "latching on" in breastfeeding. Another is that while in-utero, a
baby might also become lethargic and have trouble getting into position for delivery.
These medications have also been known to cause respiratory depression and decreased

fetal heart rate in newborns. Though the medication might not harm these babies, they
might experience some subtle effects like those mentioned above.
How will I feel after the placement of epidural? The nerves of the uterus should begin to
numb within a few minutes after the initial dose. You will probably feel the entire numbing
effect after 10-20 minutes. As the anesthetic dose begins to wear off, more doses will be
given--usually every one to two hours. Depending on the type of epidural and dosage
administered, you can be confined to your bed and not allowed to get up and move
around. 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
disappear within one or two hours. Some women report experiencing an uncomfortable
burning sensation around the birth canal as the medication wears off.
Will I be able to push? You might not be able to tell that you are having a contraction
because of your epidural anesthesia. If you can not feel your contractions, then pushing
may be difficult to control. For this reason your baby might need additional help coming
down the birth canal including the application of pressure on your abdomen at the top of
your uterus and/or the use of forceps.
Does an epidural always work? For the most part, epidurals are effective in relieving pain
during labor. Some women complain of being able to feel pain and/or feeling that the
drug worked better on one side of the body than the other.
Spinal and epidural anesthesia are generally safe. Ask your doctor about these possible
complications:

Allergic reaction to the anesthesia used

Bleeding around the spinal column (hematoma)
Difficulty urinating
Drop in blood pressure
Infection in your spine (meningitis or abscess)
Nerve damage
Seizures (this is rare)
Severe headache

Outlook (Prognosis)
Most patients feel no pain during spinal and epidural anesthesia and recover fully.
Alternative Names
Intraspinal anesthesia; Subarachnoid anesthesia; Epidural; Peridural anesthesia

Epidural Anesthesia During Labor and Delivery

Epidural anesthesia is an excellent way of taking away the pain of labor and delivery. Like
most invasive medical treatments it has risks and benefits, but it is generally safe, has
significant advantages over general anesthesia, and less anesthetic is needed than with
general anesthesia. An epidural causes less stress to the cardiovascular system because
there is fewer ups and down with pain relief. There are times that an epidural would not
be recommended such as:

patients on coagulation or platelet therapy

long-term use of aspirin or nonsteroidal anti-inflammatory drugs
problems with blood clotting
hypovolemic shock
abruptio placentae
an infection near the insertion site for the catheter
history of headaches
history of backaches (not related to pregnancy)
chronic neurologic disorders
an allergy to the pain medicines to be used
a history of certain heart conditions (talk with your anesthesiologist if you know
you have heart disease)
not being able to understand the risks and benefits or how the procedure is done
well enough to give informed consent
not being able to cooperate during the procedure for positioning and insertion of
the needle
being unable to give feedback about pain levels or problems
previous spinal surgery has scarred the epidural space
spinal curvature such as scoliosis is present

It is important that you learn about those risks and benefits before deciding if an
epidural is right for you. Although rare, infection and neurologic injury can happen. You
and your support person should discuss risks and benefits and sign a written consent
form before the epidural anesthetic is given. If you do not understand the risks and
benefits or how the procedure is done, an epidural is not 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.

Most obstetricians will consider an epidural if the mother asks for it. Epidural is often the
method of choice in cases of hypertension and premature labor.
An epidural is administered by an anesthesiologist a physician who is a specialist in
anesthesia. Your labor is watched carefully before the medicine is given. A specially
trained certified nurse midwife or the physician will be near by until your baby is born.
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 womans blood pressure. This problem occurs 1 to 2 percent of the
time and can be dangerous to a woman and baby. When it happens, 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
medicine. Some women find this comforting, while others find the monitoring irritating,
because it disturbs the interaction with their support people.
Other complications:

Infection
Needle is inserted into the wrong space and the epidural doesnt relieve pain
Loss of tone in the bladder which can require a catheterization (about 40% of the
time)
Total spinal block can happen if the anesthetic is injected into the cerebrospinal
space. Breathing is paralyzed and a drop in blood pressure. This is an emergency.

Do epidurals 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 numb and other parts are not.
Can anyone have an epidural?
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 medicine should discuss those
problems with their physicians and anesthesiologists.
Advantages of Epidural Anesthesia

Freedom from more pain during labor, birth and an episiotomy if you need it.

Unlike some other drugs, it does not make the mother drowsy before or after
delivery.
Limited amount of medicine reaches the baby.
Close monitoring by the hospital staff may give the laboring mother a sense of
confidence.

Disadvantages of Epidural Anesthesia

The second stage of labor may be slowed down by the mothers inability to move
about and make use of gravity.
The mother must stay in bed on her side with her head at the same level
throughout labor.
The mother must have constant intravenous fluids and electronic fetal monitoring.
The mother must have her blood pressure taken often.
The mother will probably need a urinary catheter, which has its own risks.
The baby may be delivered by forceps, which has risks.
The mother has little control over her body and may not feel the birth process.
This can interfere with maternal-infant bonding.
The mother must depend totally on nurses, certified nurse midwives and doctors
for basic physical needs.
Extremely rare, but serious medical risks exist, about which the mother and her
partner must be aware.

Side effects
The most common side effect from epidural anesthesia is lowering of the mother's blood
pressure. Less common side effects may include severe headache after delivery, difficulty
urinating or walking after delivery, fever, and prolonged labor. A rare side effect is
seizure.
Because a standard epidural can decrease your ability to push, a forceps delivery or
cesarean delivery (C-section) may sometimes be needed. Using less anesthesia (called a
light epidural) may reduce the likelihood of needing a cesarean delivery.