What is Epidural Anesthesia?
Epidural anesthesia is regional anesthesia that blocks pain in a particular region of the body. The goal of an epidural is to provide analgesia, or pain relief, rather than complete anesthesia, which is total lack of feeling. Epidurals block the nerve impulses from the lower spinal segments resulting in decreased sensation in the lower half of the body.
Epidural medications fall into a class of drugs called local anesthetics, such as bupivacaine, chloroprocaine, or lidocaine. They are often delivered in combination with opioids or narcotics, such as fentanyl and sufentanil, to decrease the required dose of local anesthetic. This way pain relief is achieved with minimal effects.
These medications may be used in combination with epinephrine, fentanyl, morphine, or clonidine to prolong the epidural’s effect or stabilize the mother’s blood pressure.
Epidurals can be an effective intervention for an abnormal labor that preserves vaginal delivery. The benefit outweighs the risk in those situations because the alternative is cesarean delivery. Sometimes, clients plan epidurals and we support them. Midwifery is not just about natural birth; it is about meeting clients where they are and supporting the client in her choices.
Intravenous (IV) fluids will be started before active labor begins and prior to the procedure of placing the epidural. You can expect to receive 1-2 liters of IV fluids throughout labor and delivery.
An anesthesiologist, a physician or nurse anesthetist who specializes in anesthesia, will administer your epidural. You will be asked to round your back out and remain still while lying on your left side or sitting up. This position is vital for preventing problems and increasing the epidural effectiveness. An antiseptic solution will be used to wipe the waistline area of your mid back to minimize the chance of infection.
A small area on your back will be injected with a local anesthetic to numb it. Then a needle will be inserted into the numbed area that surrounds the spinal cord in the lower back.
A small tube or catheter is threaded through the needle into the epidural space. The needle is carefully removed leaving the catheter in place so medication can be given through periodic injections or by continuous infusion. The catheter will be taped to your back to prevent it from slipping out.
• Allows you to rest if your labor is prolonged
• Allows relaxation of the pelvic floor which can assist with decent of the baby’s head in long or abnormal labors
• Relieving the discomfort of childbirth can help some woman have a more positive birth experience
• Most of the time an epidural will allow you to remain alert and be an active participant in your birth
• If you deliver by cesarean, an epidural anesthesia will allow you to stay awake and also provide effective pain relief during recovery
• When other types of coping mechanisms are not helping any longer, an epidural may be what you need to move through exhaustion, irritability, and fatigue.
• An epidural may allow you to rest, relax, get focused and give you the strength to move forward as an active participant in your birth experience.
• The use of epidural anesthesia during childbirth is continually being perfected and much of its success depends on the care in which it is administered.
• Epidurals may cause your blood pressure to suddenly drop. For this reason your blood pressure will be routinely checked to make sure there is adequate blood flow to your baby. If this happens you may need to be treated with IV fluids, medications, and oxygen.
• You may experience a severe headache caused by leakage of spinal fluid. Less than 1% of women experience this side effect from epidural use. If symptoms persist, a special procedure called a “blood patch”, an injection of your blood into the epidural space, can be done to relieve the headache
• After your epidural is placed, you will need to alternate from lying on one side to the other in bed and have continuous monitoring for changes in fetal heart rate.
• You may experience the following side effects: shivering, ringing of the ears, backache, soreness where the needle is inserted, nausea, or difficulty urinating
• You may find that your epidural makes pushing more difficult, and the epidural may need to be decreased or shut off. If this is not tolerated, additional interventions such as Pitocin, forceps, vacuum extraction or cesarean may become necessary
• For a few hours after birth the lower half of your body may feel numb which will require you to walk with assistance
• In rare instances, permanent nerve damage may result in the area where the catheter was inserted.