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Epidural Anesthesia in Childbirth

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Epidural Anesthesia in Childbirth

(Peridural Anesthesia; Regional Anesthesia; Epidural)

Definition

Epidural anesthesia refers to the placement of a catheter to administer medication to numb the abdomen and legs.
Epidural Injection
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Reasons for Procedure

An epidural is used to decrease pain during labor. An epidural directly affects the nerves that come from your spinal cord. It numbs the pain in the lower half of your body. It will also help to relieve the pain in your lower back that is often associated with childbirth.
After an epidural, you should no longer be able to feel:
  • Intense pain with your labor contractions
  • Lower back pain
  • Episiotomy (if needed) or vaginal tears from labor
  • Incision in your abdomen, if cesarean section (C-section) is needed

Possible Complications

An epidural may make labor take longer. It may also increase the chance that you are not able to feel your contractions or feelings to push. If this happens, the medicine can be decreased until some feeling returns.
An epidural can lower the mother’s blood pressure. This can affect the amount of oxygen that reaches your baby. Before an epidural is administered, you will be given IV fluids. The baby’s heart rate will be watched with a fetal heart rate monitor attached to your body. You will be positioned on your left side, so that your enlarged uterus will not compress the large blood vessels returning blood to your heart.
You may have a headache after having an epidural. This can be treated.
You cannot have epidural anesthesia if the following occurs:
  • Low platelet counts
  • Blood is too thin because of blood thinners
  • Bleeding (hemorrhaging) or you are in shock
  • Serious infection in your back or blood
  • Labor is moving too fast and there is no time to place the catheter to administer the drug

What to Expect

Prior to Procedure

    Description of the Procedure

    • You will need to arch your back and remain very still. You will either be lying on your side or sitting up.
    • The area around your waistline on your middle back will be wiped with an antiseptic solution to reduce the chance of infection. The solution may feel cold on your skin.
    • A small area on your back will be injected with a local anesthetic to make it numb.
    • A needle will be inserted into the numbed area in your lower back. A catheter (small tube) will be threaded through the needle into the space that surrounds your spinal cord in your lower back.
    • The needle will be removed and the catheter taped to your back. The doctor will use the catheter to put more medicine in, if necessary.

    Immediately After Procedure

    After the epidural is placed in your back, you will need to move from side to side. Doctors will attach a belt that monitors the heart rate of your baby. You may experience the following side effects:
    • Shivering
    • Ringing in your ears
    • Backache
    • Soreness where the needle is inserted
    • Nausea
    • Difficulty urinating

    How Long Will It Take?

    The initial numbing of the walls of the uterus or womb will take only a few minutes. You should feel the full effect of the pain reliever within 20 minutes after the catheter is placed. Additional doses of medicine can be given through the catheter so that the numbness lasts until the baby is born.

    How Much Will It Hurt?

    Placing the needle into your back may hurt a little bit. Most people feel only a little pressure as the catheter is placed in the lower back.

    Post-procedure Care

    At the Care Center
    • If labor continues for more than a few hours after the epidural, you may need a urinary catheter. This is a tube that your urine will pass through when you need to go to the bathroom. It will be removed after the baby is born.
    • Rarely, the effect of the epidural may progress up your spinal cord causing difficulty in breathing. Tell your doctor if you experience this.
    • A few hours after the baby is born, you may feel a tingling in the lower half of you body. This means that the anesthesia is wearing off. You may need help to walk until the anesthesia wears off completely.
    • If you have a headache, let your nurse or doctor know.

    Call Your Doctor

    The epidural will have worn off before you go home. Call your doctor if you have:
    • Lingering or worsening back pain
    • Severe headache
    • Signs of infection such as redness or swelling

    RESOURCES

    American Academy of Family Physicians http://familydoctor.org/

    The American Congress of Obstetricians and Gynecologists http://www.acog.org/For%5FPatients

    CANADIAN RESOURCES

    Health Canada http://www.hc-sc.gc.ca

    Women's Health Matters http://www.womenshealthmatters.ca/

    References

    Bennett MJ, Leader LR, Wong F. Handbook of Obstetrics and Gynaecology . 4th ed. London, UK: Chapman and Hall; 1996.

    Comfort measures (pharmacologic) during labor. DynaMed website. Available at: http://www.ebscohost.com/dynamed.what.php . Updated November 12, 2012. Accessed December 20, 2012.

    Whitley N. A Manual of Clinical Obstetrics . Philadelphia, PA: JB Lippincott Company; 1985:343:619-621.

    Revision Information

    This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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