Epidural anesthesia

Epidural anesthesia is the most popular method of labor pain relief. Women require epidural anesthesia more than any other method of pain relief. More than 50% of women who give birth in a hospital use epidural anesthesia.

As you prepare for Labor Day, try to learn as much as you can about pain management options so you are better prepared to make decisions during childbirth. Understanding the different types of epidurals, how they are used, and their benefits and risks will help you make decisions during childbirth.

What is epidural anesthesia?

An epidural is a local anesthetic that blocks pain in a specific area of the body. The goal of an epidural is pain relief or pain relief, not anesthesia, resulting in a complete lack of sensation. Epidural anesthesia blocks nerve impulses from the lower spine. This leads to decreased sensitivity in the lower half of the body.

Epidurals belong to a class of drugs called local anesthetics, such as bupivacaine, chlorprocaine, or lidocaine. They are often given in combination with opioids or narcotics such as fentanyl and sufentanil to reduce the required dose of local anesthetic.

It gives pain relief with minimal effect. These drugs may be used in combination with epinephrine, fentanyl, morphine, or clonidine to prolong the effect of an epidural or to stabilize the mother's blood pressure.

How is epidural anesthesia done?

Intravenous fluids will be started prior to active labor and prior to the epidural procedure. You can expect to receive 1-2 liters of fluid intravenously during labor. An anesthesiologist (anesthesia specialist), obstetrician, or nurse anesthetist will give you an epidural.

You will be asked to arch your back and remain still, lying on your left side or sitting. This position is necessary to prevent problems and increase the effectiveness of epidural anesthesia.

The waist area in the middle of the back will be treated with an antiseptic solution to minimize the risk of infection. A local anesthetic will be injected into a small area of his back to numb him. The needle is then inserted into the numb area surrounding the spinal cord in the lower back.

A small tube or catheter is then inserted through the needle into the epidural space. The needle is then carefully withdrawn, leaving the catheter in place to administer the drug, either by intermittent injections or by continuous infusion. The catheter is sealed at the back to prevent it from slipping.

What are the types of epidural anesthesia?

There are two main epidurals in use today. Hospitals and anesthesiologists will vary in dosages and drug combinations. You should ask your doctor at the hospital about his practice in this regard.

Regular epidural anesthesia

Once the catheter is in place, a combination of narcotic and anesthesia is administered either by pumping or by intermittent injections into the epidural space. Narcotics such as fentanyl or morphine are prescribed to replace some of the higher doses of anesthetics such as bupivacaine, chlorprocaine, or lidocaine.

This helps reduce some of the side effects of anesthesia. You'll want to know about your hospital's bedding and eating policies.

Combined spinal-epidural anesthesia or "walking epidural"

The initial dose of a drug, anesthetic, or combination thereof is injected under the outer membrane covering the spinal cord and into the epidural space. This is the intrathecal zone. The anesthesiologist inserts the needle back into the epidural space, threads the catheter through the needle, then removes the needle and leaves the catheter in place.

This provides greater freedom of movement in bed and greater ability to change position with assistance. With the catheter in place, you can request an epidural at any time if the initial intrathecal injection is not enough. You should inquire about your hospital's policy regarding travel, food, and drinking after an epidural.

When using these drugs, muscle strength, balance and reaction are reduced. Combined spinal epidural anesthesia should relieve pain for 4-8 hours.

What are the benefits of epidural anesthesia?

Allows you to rest if your labor is prolonged.
By reducing the discomfort of childbirth, some women have a more positive birth experience.
Usually an epidural will keep you energized and actively involved in labor.
If you are giving birth by caesarean section, an epidural will keep you awake and will also provide effective pain relief during recovery.
When other types of coping mechanisms no longer help, an epidural can help you deal with exhaustion, irritability, and fatigue. An epidural can allow you to rest, relax, focus, and give you the strength to move forward as an active participant in labor.
The use of epidural anesthesia during childbirth is constantly being improved, and its success largely depends on the ability to use it.

What are the risks of epidural anesthesia?

Epidural anesthesia can lead to a sharp drop in blood pressure. For this reason, your blood pressure will be checked regularly to ensure adequate blood flow to your baby. If a sudden drop in blood pressure occurs, you may need treatment with intravenous fluids, medications, and oxygen.
You may experience a severe headache caused by leakage of cerebrospinal fluid. Less than 1% of women experience this side effect. If symptoms persist, a procedure called a blood patch, which involves injecting your blood into the epidural space, may be done to relieve the headache.
Once your epidural is in place, you will need to alternate sides while lying in bed and constantly monitor changes in the fetal heart rate. Lying in one position can sometimes slow or stop labor.
You may experience the following side effects: chills, ringing in the ears, back pain, pain where the needle was inserted, nausea, or difficulty urinating.
You may find that your epidural makes it difficult to push, and additional medications or procedures such as forceps or a caesarean section may be needed. When planning your birth, discuss with your doctor what interventions he or she usually uses in such cases.
You may feel numbness in your lower body for a few hours after birth. The numbness will require you to walk with assistance.
In rare cases, irreversible nerve damage at the insertion site of the catheter is possible.
Although the research results are somewhat mixed, most studies show that some babies have trouble latch-on, resulting in difficulty breastfeeding. Other studies show that the baby may have respiratory depression, fetal malposition, and increased fetal heart rate variability, which increases the need for forceps, suction, caesarean section, and episiotomy.

Frequently asked questions about epidural anesthesia

Does epidural anesthesia hurt?

The answer depends on who you ask. Some women describe an epidural as feeling a bit of discomfort in the area where the back is numb and a feeling of pressure when a small tube or catheter is inserted.

When will I get an epidural?

As a rule, epidural anesthesia is placed when the cervix is dilated by 4-5 centimeters and you have a really active labor.

How can my epidural affect labor?

Your epidural can slow down labor and ease contractions. In this case, you may be given the drug pitocin to speed up labor.

How will epidural anesthesia affect my baby?

As stated earlier, research on the effects of epidural anesthesia on newborns is somewhat mixed, and many factors can affect the health of the newborn. The magnitude of the effect of these drugs is difficult to predict and may vary depending on the dosage, duration of labor, and the characteristics of each child.

Because dosages and medications may vary, specific information from studies is not available at this time. One possible side effect of epidurals in some babies is difficulty latching on to the breast while breastfeeding. Another is that during fetal development, the baby may also become lethargic and find it difficult to get into position for childbirth.

These drugs are also known to cause respiratory depression and a decrease in fetal heart rate in neonates. Although the drugs do not harm these babies, they may have little effect on the newborn.

How will I feel after an epidural?

The nerves in the uterus should begin to go numb a few minutes after the first dose. You will probably feel the full effect of the numbness after 10-20 minutes. As the anesthetic dose begins to wear off, additional doses will be given, usually every one to two hours.

Depending on the type of epidural and the dose prescribed, you may be bedridden and unable to get up or move.

If labor lasts more than a few hours, you will likely need a bladder catheter because your abdomen will become numb, making it difficult to urinate. After the baby is born, the catheter is removed and the anesthesia usually wears off within one or two hours.

Some women report an unpleasant burning sensation around the birth canal as the medication wears off.

Can I push?

You may not be able to tell that you are having a contraction due to the epidural. If you do not feel contractions, then it will be difficult for you to control your efforts. For this reason, your baby may need extra help moving through the birth canal. This is usually done with tongs.

Does the epidural always work?

For the most part, epidurals are effective in relieving pain during childbirth. Some women complain that they may feel pain or feel that the medicine works better on one side of the body.