For most women, the most effective way to control labor pain is with epidural anesthesia. Opioids or medications may be given through the IV, but these are typically not as effective.
Epidural anesthesia interrupts the transmission of pain signals to the spinal cord and brain, but it causes minimal effects on memory and thinking. Many women feel more relaxed after placement of the epidural catheter, and some can rest before they give birth. Many women are glad that they received their epidural catheter as it allows them to enjoy the birth process more.
You may do this, but it is important to be aware of two issues. The intensity of pain increases as labor progresses towards delivery. While initially it may be tolerable, rupture of membranes and dilation of the cervix increase the intensity of labor pain. Secondly, increased labor discomfort may make your positioning – and in turn, placement of the epidural catheter – more difficult. Occasionally, labor is considered too far advanced for epidural catheter placement.
Positioning is very important for epidural placement. Excellent patient positioning makes it more likely that your epidural will be placed quickly and correctly. Generally, the sitting position is used. This makes it easier to identify the middle of your back. Your anesthesia provider will ask you to stick out your lower back toward him/her and away from your belly button. Hugging a pillow and allowing your shoulders to drop towards the bed will help you arch your back (like the letter “c”).
Epidural anesthesia provides significant pain relief for most laboring women. Before placing the epidural catheter, the insertion site will be numbed up with local anesthetic. This is mildly uncomfortable (like with placement of an IV), but many laboring women find that it is much less painful than their contractions. Most labor patients are glad that they decided to have an epidural anesthetic.
Sometimes placement of the epidural is challenging because of patient anatomy. Abnormal side-to-side curvature of the spine (called scoliosis) and obesity may make the procedure more difficult.
Your epidural procedure will require placement of monitors, positioning, identification of the correct site, safety tests, and securing the catheter with a special dressing. Most of the time, this takes between 15 to 30 minutes.
Epidural anesthesia does not guarantee relief of labor pain. Sometimes the numbness covers only one side of the body, and occasionally, the procedure is unsuccessful. However, most women have labor pain that is significantly improved with epidural anesthesia.
The risks of epidural anesthesia are very low for most women in labor. There are rare circumstances or conditions that may make it unsafe to place an epidural anesthetic. Dangerous complications including bleeding, nerve damage, or severely exaggerated effects are very rare.
This is common. Most women tolerate continuation of the procedure throughout the contractions. It is important to try to remain still during the process.
Nausea, itching, or low blood pressure can sometimes occur, but these are usually short-lived and easily managed by your provider.
The chance of a headache caused by placement of an epidural anesthetic is less than 1%. This may resolve on its own after a few days, but sometimes a special procedure called an epidural blood patch is necessary.
We prefer family members not being present during epidural placement for safety reasons. These have to do with keeping the procedure as clean (or sterile) as possible as well as distraction-free. We will try to make you as comfortable as possible, and you will have an OB nurse with you throughout the process.