Anesthesia for Childbirth

 
 

Once you are settled in your birthing room, someone from the Anesthesia Care Team will interview you and discuss anesthesia options as well as answer any related questions you may have. Throughout the labor process, we will always be working in conjunction with your obstetrician and nurses.

FAQ’s

What is a labor epidural?

A labor epidural allows medication to be administered via a thin tube in an area of your spine (the epidural space) to relieve the pain associated with labor and delivery. Pain is relieved by partially numbing the areas where you hurt. It can also be utilized to provide complete anesthesia in the event of a cesarean section.

Do I need an epidural to have a baby?

Not necessarily. Women can have vaginal deliveries without labor epidurals. However, childbirth can be a painful process. Factors such as labor augmentation, baby size, and baby position may worsen labor pain. Medications given via an epidural is the best way to relieve pain associated with labor.

Is there a possibility I might not qualify for a labor epidural?

Yes. Certain medical and/or anatomical conditions may preclude you from being able to have a labor epidural. Your anesthesiologist or nurse anesthetist can provide you with more detailed answers.

What is a walking epidural?

Epidurals vary in strength from a true walking epidural that produces some pain relief without any numbness to that used for caesarian section that renders you unable to move your legs or feel pain. Ideally, walking epidurals take the edge off of early labor pain and will allow you maintain lower body strength so that you are able to walk about. Depending on individual response, a walking epidural may not provide adequate pain relief and require conversion to a regular labor epidural. Note that with regular labor epidurals, you are still able to move your legs as the numbness is only partial.

Epidural Catheter being placed during Labor or before Cesarian Section. The epidural catheter is inserted in a sterile manner through a portion of the lower back that is thoroughly numbed in advance with local anesthetic.

When can I have my labor epidural?

The epidural placement is done at your request with your obstetrician’s approval. We try to place the epidural within 30 minutes of request. On occasion, your medical condition may warrant lab tests that can delay the process.

How does a labor epidural get placed?

You will be asked to sit up or lie on your side and bend your back to optimize needle placement for the procedure. At the lower part of your back, the skin will be prepped with an antiseptic solution. A tiny needle will then be used to numb the skin in the middle of your back with a local anesthetic. Once numb, a larger hollow needle is carefully placed in the epidural space. Thereafter, a thin flexible plastic tube (catheter) is threaded through the needle and into the epidural space. The needle is pulled out and the tube is taped in place. The procedure usually takes less than 10 minutes, although variations in anatomy such as obesity and scoliosis may prolong placement time.

What happens after the epidural catheter is placed?

A test dose of local anesthetic is administered to make sure the catheter is correctly in the epidural space. When all is fine, usually a mixture of local anesthetic and narcotic is infused continuously via the epidural catheter for the duration of your labor.

How soon will I get pain relief?

Pain relief gradually ensues in approximately 15 minutes.

What if I still hurt?

Normally, the epidural medication is very effective in relieving the majority of labor pain. Besides a continuous infusion, the epidural pump will allow you to give programmed extra doses via a bedside button. If you are unable to rest because you are still experiencing too much pain, someone from the anesthesia team will assess you. On occasion, your epidural catheter may need to be replaced.

Besides pain relief, are there any other advantages to a labor epidural?

Yes. Your baby may get better blood flow via the placenta during and between contractions. In certain cases, epidural medications can help control high blood pressure.

What are the risks associated with labor epidurals?

Like any medical procedure, there are risks associated with the procedure. Risks can include but are not limited to:

  • Failure to relieve your pain adequately.
  • Low blood pressure causing fetal distress.
  • Spinal headache if the epidural needle penetrates the covering of the spinal cord during the epidural procedure.
  • Prolonged weakness and/or numbness of your lower extremities.
  • Temporary back pain.
  • Adverse reaction or allergy to any of the administered medications. This can result in respiratory and/or cardiac arrest.
    Infection
  • Bleeding in the spine causing nerve injury and possibly requiring surgery to remove blood from your spine.
  • Nerve injury from the needle or catheter related to the procedure.

Please understand that these risks are real but infrequent. In general, the overall benefits outweigh the risks. From our experience, most women who had a labor epidural felt it was a great benefit and would do it again.

For information on awareness/recall under anesthesia, please click here.