Epidural Anesthesia in Childbirth
(Peridural Anesthesia; Regional Anesthesia; Epidural)
Epidural anesthesia, or “an epidural”, refers to a medicine to numb the abdomen and legs.
Parts of the Body Involved
An epidural directly affects the nerves that come from your spinal cord. It numbs (or deadens) the pain in the lower half of your body, where your baby is being born. It will also help to relieve the pain in your lower back that is often associated with childbirth.
After an epidural, you should no longer be able to feel:
Reasons for Procedure
The reason for epidural anesthesia is to lessen the pain associated with childbirth. An epidural is meant to make it easier to have a baby.
An epidural may also be recommended if you have any conditions that increase the likelihood of a C-section (eg, twins).
Risk Factors for Complications During the Procedure
An epidural can lower the mother’s blood pressure, which can cause a decrease in the baby’s heart rate. Before an epidural is administered, you will be given fluids in your vein (called intravenous, or IV). The baby’s heart rate will be watched with a fetal heart rate monitor attached to your body. You will be positioned on your left side, so that the enlarged uterus will not compress the large blood vessels returning blood to your heart.
An epidural can make it difficult to push the baby out, since you can’t feel the muscles contracting around the baby. Sometimes the epidural medication will be decreased when delivery is near to allow you to push effectively. If you cannot push the baby out, the doctor will sometimes have to use forceps to help pull the baby out.
You cannot use epidural anesthesia if the following occurs:
- Low platelet counts
- Bleeding (hemorrhaging) or in shock
- Serious infection in either your back or blood
- Labor is moving too fast and there is no time to administer the drug
- Blood is too thin because of blood thinners
What to Expect
Prior to Procedure
The area where the epidural is inserted will be numbed with a local anesthesia before the needle is inserted.
Description of the Procedure
Three different kinds of healthcare providers can administer an epidural. They are:
- Anesthesiologist (a doctor who specializes in anesthesia)
- You will need to arch your back and remain very still. You will either be lying on your side or sitting up.
- The area around your waistline on your middle back will be wiped with an antiseptic solution to lessen the chance of infection. The solution may feel cold on your back.
- A small area on your back will be injected with a local anesthetic to make it numb.
- A needle will be inserted into the numbed area in your lower back. A catheter (small tube) will be threaded through the needle into the space that surrounds your spinal cord in your lower back.
- The needle will be removed and the catheter taped to your back. The doctor will use the catheter to put more medicine in, if necessary.
After the epidural is placed in your back, you will need to move from side to side.
Doctors will attach a belt that monitors the heart rate of your baby.
You may experience the following side effects:
- Ringing in your ears
- Soreness where the needle is inserted
- Difficulty urinating
If labor continues for more than a few hours after the epidural, you may need a urinary catheter. This is a tube that your urine will pass through when you need to go to the bathroom. It will be removed after the baby is born.
Rarely, the effect of the epidural may progress up your spinal cord causing difficulty in breathing. Tell your doctor you experience this.
A few hours after the baby is born, you may feel a tingling in the lower half of you body. This means that the anesthesia is wearing off. You may need help to walk until the anesthesia wears off completely.
How Long Will It Take?
The initial numbing of the walls of the uterus or womb will take only a few minutes. You should feel the full effect of the pain reliever within 20 minutes after the catheter is placed. Additional doses of medicine can be given through the catheter so the numbness lasts until the baby is born.
Will It Hurt?
Placing the needle into your back may hurt a little bit, but most people only feel a little pressure as the catheter is placed in the lower back.
An epidural may make the second and third stages of labor (the “active” stages) last longer. It also may increase the chance that you are not able to feel your contractions or a sensation to push. If this happens, the medication can be decreased until some sensation returns.
Average Hospital Stay
The average hospital stay for a normal vaginal delivery is two days. If you have a C-section, you will need to stay in the hospital for four days to recover from the surgery.
Epidural anesthesia does not require postoperative care.
American Academy of Family Physicians
Women's Health Matters
Bennett MJ, Leader LR, Wong F. Handbook of Obstetrics and Gynaecology. 4th ed. London, UK: Chapman and Hall; 1996:242-245.
Comfort measures (pharmacologic) during labor. DynaMed website. Available at: http://www.dynamicmedical.com/dynamed.nsf?opendatabase . Accessed August 24, 2005.
Whitley N. A Manual of Clinical Obstetrics . Philadelphia, PA: JB Lippincott Company; 1985:343:619-621.
Last reviewed February 2009 by ]]>Ganson Purcell Jr., MD, FACOG, FACPE]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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