An epidural is a type of regional anesthesia. It is used to provide analgesia in a specified area. For women in labor it is the most popular type of pain relief. There are 2 types of epidurals used in labor, regular and combined spinal-epidural. The type chosen is dependent on your provider.
Labor and childbirth is a stressful time and pain is one of the main culprits. Planning your pain relief before you go into labor will be to your advantage.
HOW IS AN EPIDURAL ADMINISTERED.
An epidural is a complex anesthetic procedure that requires an understanding of anatomy, physiology and pharmacology. The process has two general parts. The placement of a catheter in the epidural space and the decision of what drug to use for pain relief. For labor the epidural is placed in the lower back and you can use your waist as a guide to the likely location. The best position for placement is for you to be sitting. Once you are in active labor and in pain its an appropriate time to ask for an epidural.
Once you have made the decision an Anesthesiologist will be called. Likely it will be the first time you are meeting this Physician. She will introduce herself, identify you by your hospital ID bracelet and proceed to get a history and explain what is to follow. Positioning and identifying a starting point for the catheter placement is 90 % of the epidural process. Once positioned appropriately the Anesthesiologist will glove, mask and prep the designated spot with a sterile solution. Your back is draped to help keep the area sterile. The only part of the process that will be painful is administration of local anesthetic at the insertion site. Once numbed the epidural needle is inserted and the epidural space is identified and the catheter is placed and tested. While the catheter is being place you may feel a sensation like hitting your funny bone. This is very transient. Your Anesthesiologist will ask if you have numbness around your lips or tongue, ringing in your ears or cannot move your feet. Once the catheter is secured it will be loaded. After the load is complete you should be pain-free within twenty minutes. Your contraction should start to feel shorter and shorter until you don’t notice them. Your legs should feel like they are “falling asleep” but you should still be able to move them. That is the goal of the epidural. Depending on the dosage and type of medication used in your epidural and hospital policy you maybe able to walk while your epidural is in place. You may lose urinary sensation and need a bladder catheter to keep your bladder empty. Once the epidural is loaded your position in bed should not significantly affect your pain relief.
BENEFITS OF AN EPIDURAL.
The goal of the epidural is pain relief and along comes stress relief and allows you to rest and even sleep through most of your labor. The medications chosen also tries to decrease effects on the baby and has compared with other means of pain control in labor is much safer for the baby. Along with increased safety for the baby the epidural allows for you to be fully alert to welcome your baby into the world. Furthermore, if you labor proceeds to a cesarean section the epidural can be used as the sole anesthesia and allows you to be awake and unimpaired for the delivery.
RISKS AND COMPLICATIONS.
A labor epidural is a very safe modality for labor pain relief. However, there are risks. These risks are of low probability, but potentially of high impact. This is where your providers medical knowledge and training comes into play. Expect some soreness at the site for several days, but extreme pain should be reported immediately. Around the time of delivery your epidural will be stopped and full sensation should return to your legs. If hours later you are still having numbness or difficulty moving your legs please report it. Headaches after labor and delivery are not uncommon. However, if you have a headache on standing and non while sitting or lying this maybe related to your epidural. Another common occurrence in the labor process is nausea this could be related to the epidural.
Enjoy your newborn. Questions?