Labor Analgesia with Epidural Anesthesia
An epidural delivers continuous pain relief to the lower part of your body while allowing you to remain fully conscious. It decreases sensation but doesn’t result in a total lack of feeling. Medication is delivered through a catheter – a very thin, flexible, hollow tube – that’s inserted into the epidural space just outside the membrane that surrounds your spinal cord and spinal fluid. An epidural is the most commonly used method of pain relief for labor in the United States.
To allow the catheter to be inserted, you lie curled on your side or sit on the edge of the bed while an anesthesiologist or nurse anesthetist cleans your back, injects the area with numbing medicine, and carefully guides a needle into your lower back. (This may sound painful, but for most women, it’s not.) The anesthesiologist or nurse anesthetist then passes a catheter through the needle, withdraws the needle, and tapes the catheter in place so medication can be administered through it as needed. You can lie down at this point without disturbing the catheter. First you’re given a small “test dose” of medicine to be sure the epidural was placed correctly, followed by a full dose if there are no problems. Your baby’s heart rate is monitored continuously, and your blood pressure is taken every five minutes or so for a while after epidural catheter placement to ensure that the epidural catheter is functioning properly and not causing any adverse effects.
The medication delivered by the epidural is usually a combination of a local anesthetic and a narcotic. Local anesthetics block sensations of pain, touch, movement, and temperature, and narcotics blunt pain without affecting your ability to move your legs. Used together, they provide good pain relief with less loss of sensation in your legs and at a lower total dose than you’d need with just one or the other.
You will start to notice the numbing effect about 10 to 20 minutes after the first dose of medication, though the nerves in your uterus will begin numbing within a few minutes. You’ll receive continuous doses of medication through the catheter for the rest of your labor in order to ensure adequate pain control.
Not all women are good candidates for this kind of pain relief. You won’t be able to have an epidural if you have abnormally low blood pressure (because of bleeding or other problems), a bleeding disorder, a blood infection, a skin infection on the lower back where the needle would enter, or if you’ve had a previous allergic reaction to local anesthetics. Women taking certain specific blood-thinning medications cannot have an epidural for labor pain management.