How does an epidural work?
An epidural delivers continuous pain relief to the lower part of your body while allowing you to remain fully conscious. It decreases sensation but doesn’t result in a total lack of feeling.
Medication is delivered through a catheter – a very thin, flexible, hollow tube – that’s inserted into the epidural space just outside the membrane that surrounds your spinal cord and spinal fluid. An epidural is the most commonly used method of pain relief for labor in the United States.
What is the procedure like?
To allow the catheter to be inserted, you lie curled on your side or sit on the edge of the bed while an anesthesiologist or nurse anesthetist cleans your back, injects the area with numbing medicine, and carefully guides a needle into your lower back. (This may sound painful, but for most women, it’s not.)
The anesthesiologist or nurse anesthetist then passes a catheter through the needle, withdraws the needle, and tapes the catheter in place so medication can be administered through it as needed. You can lie down at this point without disturbing the catheter.
First you’re given a small “test dose” of medicine to be sure the epidural was placed correctly, followed by a full dose if there are no problems. Your baby’s heart rate is monitored continuously, and your blood pressure is taken every five minutes or so for a while after the epidural is in to make sure it isn’t having any negative effects.
The medication delivered by the epidural is usually a combination of a local anesthetic and a narcotic. Local anesthetics block sensations of pain, touch, movement, and temperature, and narcotics blunt pain without affecting your ability to move your legs. Used together, they provide good pain relief with less loss of sensation in your legs and at a lower total dose than you’d need with just one or the other.
You’ll start to notice the numbing effect about ten to 20 minutes after the first dose of medication, though the nerves in your uterus will begin numbing within a few minutes. You’ll receive continuous doses of medication through the catheter for the rest of your labor.
You may also have the option of patient-controlled analgesia, which means that you can control when you get more medication via a pump that’s connected to the catheter. (The amount of medication you can give yourself is limited, so there’s little chance of overdose.)
After you deliver your baby, the catheter will be removed. (If you’ve had a c-section, sometimes the catheter is left in to administer postoperative pain medication.) Having the catheter removed doesn’t hurt at all beyond the sting of having the tape pulled off.
When is the best time to get an epidural?
In the past, many practitioners wanted a woman to be in active labor before starting an epidural due to a concern that it might slow down her contractions. These days, most caregivers will allow you to start an epidural whenever you ask for it.
Studies have shown that starting an epidural in early labor (compared with later in labor) is not more likely to prolong labor or lead to a c-section or other interventions such as a forceps delivery. (However, as we note later, having an epidural at all does increase your risk of a vacuum extraction or forceps delivery.)
If you arrive at the hospital before you’re in active labor and you know you’re going to want an epidural, you can ask the anesthesiologist to place the catheter as soon as you’re settled in your bed. Then you can wait to start the medication when your labor becomes active.
Or you can wait and see how you feel. It’s never too late to get an epidural unless the baby’s head is crowning. The only risk to waiting is that the anesthesiologist may be busy and you may have to wait a bit longer for her to arrive once you decide you want the pain medication.
What are the advantages to having an epidural for pain relief during labor?
- An epidural provides a route for very effective pain relief that can be used throughout your labor.
- The anesthesiologist or nurse anesthetist can control the effects by adjusting the type, amount, and strength of the medication. This is important because as your labor progresses and your baby moves farther down into your birth canal, the dose you’ve been getting might no longer cover the pain, or you might suddenly have pain in a different area.
- Since the effect of the medication is localized, you’ll be awake and alert during labor and birth. And, because you’re pain-free, you can rest if you want (or even sleep!) as your cervix dilates. As a result, you may have more energy when it comes time to push.
- Unlike with systemic narcotics, only a tiny amount of medication reaches your baby.
- Once the epidural’s in place, it can be used to provide anesthesia if you need a c-section or if you’re having your tubes tied after delivery.
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