Childbirth: Epidurals

Childbirth: Epidurals

Topic Overview

Epidural anesthesia is an effective form of
childbirth pain relief. Epidural anesthesia is the injection of a numbing medicine into the space around the spinal nerves in the lower back. It numbs the area above and below the point of injection and allows you to remain awake during the delivery. It can be used for either a vaginal birth or a
cesarean delivery (C-section). An anesthesia specialist administers epidural anesthesia.

How an epidural is given

Epidural anesthesia involves the insertion of a sterile guide needle
and a small tube (epidural catheter) into the space around your spinal cord (epidural space). The epidural catheter is
placed at or below the waist. The doctor first uses a local anesthetic to numb
the area where the needle will be inserted. Then the guide needle is inserted
and removed, while the catheter remains in place. The catheter is taped in
place up the center of your back with the end taped in place on top of your
shoulder.

See pictures of
epidural placement and area of numbness for childbirth.

An anesthetic medicine is injected into the catheter to numb your
body above and below the point of injection, as needed. The amount of discomfort or pain that you have
depends on the amount of anesthetic used. Less anesthetic (often called a
light epidural) will allow you to be more active in your
labor and feel enough to push effectively. With higher levels of anesthetic,
you will feel little or no pain from your contractions. You may be required to
remain in bed when an epidural is used. You will also have a tube placed in a
vein (intravenous, or IV tube) and a fetal monitor.

Before delivery, the epidural medicine dose can be decreased so
that you can push more effectively while remaining relatively
comfortable. The epidural catheter can also be used to numb the area between
the vagina and anus (perineum) just before delivery.

Because the amount of medicine given at one time is small, epidural
anesthesia wears off during labor unless additional medicine is given.
So the use of epidural infusion pumps is common. With an
infusion pump, the epidural medicine is given continuously in small amounts
so that you don't have to worry that the pain relief will wear off during your
delivery.

In addition to more constant pain relief, another benefit of having
an infusion pump is that it allows you to have more control of your belly
and leg muscles.

Side effects

The most common side effect from epidural anesthesia is lowering of
the mother's blood pressure. Less common side effects may include severe
headache after delivery, difficulty urinating or walking after delivery, and fever. A rare side effect is seizure.

Because an epidural can decrease your ability to push, a
forceps or vacuum delivery may
sometimes be needed.

After delivery

The epidural catheter may be removed right after delivery, or it may
be left in place for several hours to a day and used to give you pain-relieving
medicine. This is usually done after a cesarean delivery. If you are planning
to have a
tubal ligation before you leave the hospital (to
prevent future pregnancy), the catheter may be left in place.

The effects of the epidural usually wear off within 2 hours after the epidural medicine is stopped. After the epidural wears off, you may have some hip or back pain from childbirth. You may have a small bruise and the skin may be sore where the epidural was put in your back. This will probably get better in 1 or 2 days.

Credits

ByHealthwise StaffPrimary Medical Reviewer Kathleen Romito, MD - Family Medicine Adam Husney, MD - Family Medicine Specialist Medical Reviewer John M. Freedman, MD - Anesthesiology

Current as ofDecember 8, 2017

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