Epidural analgesia is used for pain relief during labor and delivery. It is one of several choices of pain management during labor. The epidural is a safe and effective way of eliminating most of the pain associated with labor and delivery. It can be used in any pregnancy but it is especially helpful with first babies as the labor tends to be longer. There is some evidence that epidural analgesia when used for the first pregnancy can help reduce the risk of having a c-section.
If you desire an epidural during your labor let the labor and delivery nurse know. They will consult your obstetrician and if appropriate, the anesthesiologist will be called. The anesthesiologist will take a history and do a brief physical exam to be sure the epidural will be safe for you. Previous back surgery, for example, may keep you from being a candidate for an epidural. The anesthesiologist will explain the procedure, discuss the risks and benefits with you, and then have you sign a consent form. The consent form states that you understand the information and give the anesthesiologist permission to perform the epidural.
Epidurals can be placed with the patient sitting up curled over the tummy or with the patient lying on her side curled up in a “fetal position”. Curling up and pushing the back out is important. These positions open up the space between the spinous processes, the bones of the back. The needle will be placed between these bones; the position you will be asked to be in makes more room for the needle.
The skin of the back is numbed using a local anesthetic. Because numbing medicine is used, the epidural placement is not a painful procedure. Most patients report the epidural placement hurts less than starting an IV. Once the back is numbed, the epidural needle is placed in through the back into the epidural space, just short of the sac that contains the spinal fluid. A test dose of medication is given to check that the needle is in the correct place, not in a vein or the spinal fluid. A plastic catheter is then placed through the needle and the needle is then removed. The needle is only in the back a short time, the plastic catheter will remain until after you deliver.
Medication is placed through the plastic catheter to keep you comfortable until labor and delivery is accomplished. Medication is initially injected through the catheter by the anesthesiologist. It is then connected to a pump that has a button you can press if you need more pain relief.
It is normal to feel a warm sensation in the bottom from the epidural. Some women have difficulty moving their legs while the epidural is working. A urinary catheter will be placed after you are numb as you will not have the sensation to urinate. You will not feel the catheter being placed because the epidural will have numbed the area. The plastic catheter is removed shortly after you deliver; you will not feel this. The effects of the epidural will be gone about one to two hours after you deliver the baby.
Occasionally there can be an area on the abdomen that does not get pain relief, this is called a “window”. This can be treated by giving additional medication through the catheter and have the patient lay on the area that is not numb. Most women will get relief from this “window” in about 15 minutes. A rare complication of the epidural is a spinal headache. This is easily treatable if it occurs.