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Choosing an Epidural for Labor and Delivery including Cesarean Section

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Updated February 12, 2014

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

Epidural Anesthesia for labor

Epidural Anesthesia

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Why is an epidural done?:

An epidural can be done for regular labor and childbirth, induced labors (induction), a forceps or vacuum delivery or even a cesarean section. You can learn more about epidural anesthesia from your childbirth class instructor.

How is an epidural done?:

An epidural is usually done with you on your side or sitting up, but in these positions you curl up tightly over your pregnant abdomen to give the anesthesiologist the best view of your spine. The area of the back is then washed with a very cold cleansing solution. You are then numbed with a local anesthetic to minimize the pain you feel from the actual epidural needle going in. A test dose is delivered to be sure that the medication is going into the right space. The needle is removed and a thin, plastic catheter is left in your back and taped down for security.

How will the epidural give me pain relief?:

If the test dose given is good, then you are hooked up to a bag of medications that will flow continuously until remove catheter from your back. This medication can be changed or altered depending on your needs.

How does it feel to have an epidural put in?:

The actual procedure is described anywhere from uncomfortable to very painful. It can be hard to lean over while pregnant and having contractions. The local anesthesia hurts more than the epidural needle, because at the point which the epidural needle goes in, you are numb. Most women describe the epidural needle as feeling more like pushing and shoving. Occasionally the needle will touch a nerve causing your leg to jump or you may feel a shooting pain. This is normal and does not mean you are paralyzed.

What will I feel with an epidural during labor?:

What you feel will depend on the combination of medications, how far along you are in labor and various factors. Some women feel the contractions but do not experience it as pain. Other women report that they feel nothing from their nipples to their knees. Be sure to talk to your anesthesiologist about what you want to feel and see if they can work with you.

What happens after I give birth?:

After you have given birth, the epidural catheter is removed by removing the tape around it and pulling the catheter out. You may still experience numbness in your legs for several hours. Occasionally mothers will feel weak in the legs or even numb for longer periods of time. Back pain may also occur at the site of the epidural.

What are the risks of an epidural?:

The risks of an epidural are numerous. The complications that are most common are things like a drop in mom's blood pressure, which can usually be quickly treated by medications and position changes. Other risks like fetal distress, fetal malpositioning, and an increase in the cesarean rate are also possibilities with epidurals, but there are often safety measures put in place to prevent or, when needed, minimize the affects. Paralysis, numbness, nerve injury and infection for mom are really very extremely rare.

Can everyone have an epidural?:

Not everyone can have an epidural. There may be reasons as to why an epidural may not be for you. This may include your medical history, some conditions you may have, hospital staffing or availability. If you have a concern prior to labor, it is possible to schedule an appointment for a consultation with anesthesia.

When can an epidural be done?:

Some hospitals, doctors or midwives may have a policy to only provide epidural anesthesia after a certain point in your labor. This is meant to help insure that your labor does not slow down or stop because of the epidural. It may also decrease your risks of certain complications. Be sure to ask what your practitioner and hospital's policies are about when you can get an epidural. Prior to getting an epidural you can use other forms of pain relief like comfort measures and IV medications to help you cope with labor.

What if I don't want an epidural?:

If you do not want to have an epidural you do not have to have one. Many mothers choose to use various techniques to get through labor without using any medication. Using a doula is also known to help reduce the likelihood that you will want an epidural.

Sources:

Capogna, G., & Stirparo, S. (2013). Techniques for the maintenance of epidural labor analgesia. Curr Opin Anaesthesiol, 26(3), 261-267. doi: 10.1097/ACO.0b013e328360b069

George, R. B., Allen, T. K., & Habib, A. S. (2013). Intermittent epidural bolus compared with continuous epidural infusions for labor analgesia: a systematic review and meta-analysis. Anesth Analg, 116(1), 133-144. doi: 10.1213/ANE.0b013e3182713b26

Kemp, E., Kingswood, C. J., Kibuka, M., & Thornton, J. G. (2013). Position in the second stage of labour for women with epidural anaesthesia. Cochrane Database Syst Rev, 1, CD008070. doi: 10.1002/14651858.CD008070.pub2

Lawrence, A., Lewis, L., Hofmeyr, G. J., & Styles, C. (2013). Maternal positions and mobility during first stage labour. Cochrane Database Syst Rev, 8, CD003934. doi: 10.1002/14651858.CD003934.pub3

Lippert, T., Nesje, E., Koss, K. S., & Oian, P. (2013). Change in risk status during labor in a large Norwegian obstetric department: a prospective study. Acta Obstet Gynecol Scand, 92(6), 671-678. doi: 10.1111/aogs.12092

Pitkanen, M. T., Aromaa, U., Cozanitis, D. A., & Forster, J. G. (2013). Serious complications associated with spinal and epidural anaesthesia in Finland from 2000 to 2009. Acta Anaesthesiol Scand, 57(5), 553-564. doi: 10.1111/aas.12064

Obstetrics: Normal and Problem Pregnancies. Gabbe, S, Niebyl, J, Simpson, JL. Sixth Edition.

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