Obstetric Anesthesia
Most women experience significant pain during labor contractions, especially with their first delivery. Some are able to cope with it by deep breathing and relaxation techniques, but in our practice, the majority of patients request epidural anesthesia for relief of pain during labor. Some of the most frequently asked questions about labor epidurals are discussed below.
Q: When can I have an epidural?
A: When you are in labor you and your baby will be closely monitored by your nurse. Usually you need to be in active labor with regular contractions, and the cervix 4-5 cm dilated. Your current health, past medical and labor history and the present progress of your labor will be considered.
Q: How is an epidural performed?
A: Once you are ready for the epidural, your anesthesiologist will be notified. After a brief interview by your anesthesiologist, you will be positioned for the epidural placement either sitting or lying on your side. The lower part of your back is washed with an antiseptic solution to prevent infection. A small amount of local anesthetic is injected into the skin on the back of the spine to numb the area. Then an epidural needle is inserted through the numbed area into the epidural space and a small catheter is placed through the needle into the epidural space. The needle is removed. It is not unusual to feel a sensation of tingling down one of your legs during the placement of the catheter. The catheter is secured to your back with tape and a test dose of medication is given via the catheter to ensure it is in the correct position. Then a continuous infusion of local anesthetic and pain medication is given through the epidural catheter to provide pain relief during the rest of your labor. Your epidural will be removed after the baby is born.
Q: How soon does the epidural work?
A: Once the epidural catheter has been successfully placed and the anesthetic medication has been given, you will notice pain relief in about 7-10 minutes. Maximum pain relief may take up to 20 minutes.
Q: What are the risks of epidural anesthesia?
A: Epidural anesthesia has been successfully used for pain relief during labor for many years without major complications. Common side effects include decease in blood pressure (which can be easily treated with additional IV fluids and/or medications), shivering due to decrease in body temperature. Sometimes during the placement of the epidural spinal fluid leak may occur which can cause a headache later. The headache may resolve with hydration and pain medications, but sometimes it may need to be treated with an epidural blood patch.
Q: Will the epidural affect the baby?
A: The medication given through the epidural does not enter the fetus in any significant amount. Epidural does not have any direct harmful affect on the baby.
Q: What is the difference between a spinal and an epidural?
A: In spinal anesthetic, the local anesthetic is injected into the spinal fluid. It is a one-time injection and the effect lasts for a variable amount of time ranging from 1 to 4 hours. Spinal anesthetic can cause a spinal headache in some patients. In epidural anesthesia, the local anesthetic is injected into the epidural space which does not have spinal fluid. Also a continuous infusion of local anesthetic can be used which prolongs the anesthetic effect.
Q: What if I have to have a cesarean section?
A: Spinal or epidural anesthesias are the preferred anesthetics for a cesarean section. If you already have an epidural in place the same epidural can be used by giving additional numbing medication. If you do not have an epidural, you will get a spinal anesthetic. In the case of an emergency cesarean section you may get a general anesthetic.