Epidural

DO I WANT AN EPIDURAL?

Women have all heard the universal birth story about the worst pain of your life- labor. However, with that knowledge, some women still elect to bravely endure labor without the benefit of pain relief. Guess what? All have survived to tell the tale. Getting an epidural is a deeply personal decision that impacts the outlook of one of the most important days of your life. To help make the decision, we offer some useful information, but at the end of the day, only you know how you handle pain. Then at the moment of labor, you can decide to experience your contractions first hand or hear about it from the nurse. Most importantly, keep your mind open to both options, and you might be surprised at your choice.

WHAT IS AN EPIDURAL?

Epidural anesthesia is regional anesthesia that blocks pain in a particular portion 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. So yes, you will feel the pressure of the baby entering the birth canal. An epidural blocks the nerve impulses from the lower spinal segments. This results in decreased sensation in the lower half of the body.

HOW IS AN EPIDURAL GIVEN?

Your anesthesiologist will give you an injection in your lower back and then guide a hollow needle between the small bones in your spine.

The needle goes into the space between the layers of tissue in your spinal column (the epidural space). A fine tube (catheter) is then passed through the needle and the needle is removed. The tube is taped up your back and over your shoulder. This catheter is then attached to a pump that continuously delivers the pain-relieving drugs into your back.

Try to keep very still while the anesthesiologist sets up the epidural. While on your side or sitting on the edge of the bed, you will be asked to lean forward. This opens up the spaces between the bones of your spine. Concentrate on your breathing to help you be as still as possible. Breathe in deeply through your nose, and sigh out slowly through your mouth. Your labor nurse will be there to hold your hand and help you through this process.

DOES THE PLACEMENT OF AN EPIDURAL HURT?

The answer depends on who you ask. Most women describe an epidural placement as creating a bit of discomfort in the area where the back is numbed and a feeling of pressure as the small tube or catheter is placed.

WHEN WILL MY EPIDURAL BE PLACED?

Typically epidurals are placed when you are determined to be in active labor, but some physicians will allow it upon request.

HOW CAN AN EPIDURAL AFFECT LABOR?

Studies show, on average, women with epidurals are in labor an hour less than those without an epidural.

HOW CAN AN EPIDURAL AFFECT MY BABY?

Research on the effects of epidurals on newborns is somewhat ambiguous. Many factors can affect the health of a newborn. Since the medication is given in the epidural space, there are no drugs circulating in your blood, like IV pain medication. Medications that circulate in the blood are transmitted to the baby.

HOW WILL I FEEL AFTER AN EPIDURAL IS PLACED?

The nerves of the uterus should begin to numb within a few minutes after the initial dose. You will probably feel the entire effect after 10-20 minutes. As the medication begins to wear off, more doses will be given– usually every one to two hours. Depending upon the type of epidural and dosage administered, you may be asked to stay in bed and not walk around. If labor continues for more than a few hours, you will probably need urinary catheterization because the abdomen will be numb, making urination 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 experience 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 the epidural anesthesia. Your labor nurse will assist and coach you through the pushing phase of labor. With current epidurals, this is usually not an issue. If it does hinder delivery, your physician may order your epidural stopped.

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 or that the drug works better on one side of the body than the other. Also, if you wait until the baby is too far down the birth canal the relief will be minimal.