A labor epidural is the most commonly requested form of pain relief for childbirth. That is because it provides excellent comfort during labor, allows mother to be wide-awake and comfortable during the delivery, and is friendly to the baby.

Other methods to improve comfort during labor include breathing exercises and intravenous medication. Both of these can be helpful, but neither provides pain relief as good as an epidural. Intravenous medication may cause sedation and disorientation.

A labor epidural uses a solution of local anesthetic and narcotic slowly and continuously infused through a small, soft, long plastic tube, an epidural catheter, which is inserted in the low middle part of mother’s back. The infusion can continue as long as the catheter is in place, so comfort can continue as long as labor. If a laboring mother should need a Caesarian section, the epidural can be used to provide anesthesia. Anesthesia for emergency section is very rapidly available by simply injecting a different local anesthetic through the epidural catheter.epidural_copy.JPG (10134 bytes)

Before you can have a labor epidural, the anesthesiologist needs your permission, your obstetrician’s permission, and the results of some blood tests. Often your obstetrician will want you to have well established labor with 3 to 5 centimeters cervical dilation before allowing the epidural. But sometimes it can be started earlier. If you are soon to deliver your baby, it may be too late to have an epidural.                    epidural catheter        

Your anesthesiologist needs your help as he puts in your epidural catheter. If you feel a contraction coming on tell him. He may wait for it to pass before continuing. Please try very hard to be still while he is working. He is doing a delicate job! You will find that you can help him, even though your labor may be very uncomfortable. The anesthesiologist may agree to your having your support person present while he inserts the epidural. This person should use good judgement in deciding whether to stay and how close to stand. Our attention will be on Mom and help may not be available for him if he begins to feel bad.

The doctor will ask you either to sit or lie on your side to start the epidural. The position you get into is very important, as a good position will make it easier to install the catheter. The nurses are positioning experts and will guide and support you in a good position. The doctor will tell you each thing that he is going to do before he does it, so there will be no surprises. He will wash your back with some cool solution on a sponge, then inject local anesthetic under the skin to numb the area through which the epidural needle will pass. The local anesthetic under the skin will sting. Then you will feel pressure as he positions the epidural needle. Next he will put some local anesthetic through the epidural needle. Some patients say they feel something "strange" but not painful when this is done. Next the epidural catheter is inserted. Usually this is not noticed but sometimes patients again will say they feel something "strange" but not painful. The needle is then removed leaving the catheter in place. The small tube is brought up over your shoulder and carefully taped in place. Finally you lie down again or roll onto your back.

It takes 15 to 20 minutes for the epidural to have its full effect. It doesn’t start instantly. Over this time, you may feel your contractions weaken in intensity. It is also common for feet to feel warm, and for one’s bottom to perhaps feel a bit numb. Sometimes patients are aware that one side of them is more effected than the other. This is ok. Some patients have only pain relief. Some patients have pain relief plus some numbness, especially in the thighs and bottom. Some patients also get some weakness in their legs. All of these are ok and normal. The longer your epidural runs, the more likely are numbness and weakness.

Many patients will have complete pain relief. Some patients will have mild, but tolerable discomfort. Rarely the epidural will fail and need to be redone. Sometimes obstetricians will ask that the epidural be turned down when it is time to push, as pushing may be more effective when contractions are felt. If this is the case for you, you may have some pain when the epidural is turned down for pushing. Please try hard to avoid dislodging the epidural catheter as you move about the bed during labor. It is well secured, and will stay that way with a little care.

After the epidural has been inserted, a small pump will be attached to it. This pump will slowly and continuously push the solution of local anesthetic and narcotic through the catheter. The pump infuses new medicine at a rate that matches he rate at which the medicine wears off keeping the effect about constant. Your doctor or nurse may assess the effect of the medicine at intervals by touching you with an alcohol sponge and asking you to report what you feel.

Labor epidurals do have some risks, and it is important that you understand and accept them before you have one. The risks include spinal headache, backache, possible labor slowing, and a very tiny chance of temporary or permanent nerve damage. Backache is usually mild. Many pregnant patients have low backache, and there is disagreement as to whether an epidural influences this. Some doctors believe epidurals can slow labor. If that is true, then maybe they also increase the chance of needing a section. This issue is also controversial. Permanent nerve damage is exceedingly rare. Labor epidurals are used all the time everywhere. They have an excellent safety record for both mother and baby.