Epidural Anesthesia for Labor and Delivery

Once your Obstetrician has confirmed that you are in active labor and the labor has progressed a bit, an epidural can be placed for you with your Obstetrician’s approval. Most labor patients at Virtua Memorial choose to have one. In the absence of serious medical problems, epidural are a very safe and effective way to provide comfort.

As soon as the decision to have an epidural is made, the Anesthesiologist will come to your bedside.  Your health issues will be reviewed and an explanation of the procedure will be given to you. The risks and benefits of the epidural will be explained to you.  You will be asked to review and sign a formal anesthesia consent form. After you have given permission, the epidural will be done right away.

Typically, the patient is asked to sit up in bed and dangle her legs over the side.   Occasionally the patient may be given the epidural while lying on her side.  While sitting, the patient will be asked to push their lower back out “like an angry cat” or to try to make you back seem C-shaped.  A good image of this is to imagine curling down to “give the baby a kiss”.   It will be important to hold this position to allow the spaces in the back to open to allow passage of the epidural needle.

After sitting, the back will be washed with an antiseptic solution and covered with a plastic drape all to keep things as clean and sterile as possible.   The anesthesiologist will feel the bones in your back to determine the best place to insert the epidural.  Once that spot is determined, it will be made numb will a small injection of local anesthetic or numbing drug.   Generally this feels like a little pinch or insect bite.  Patients generally tolerate this quite well.

Through the numb spot, the epidural needle will be advanced in to the epidural space in the back.  This is the space just outside the sac of fluid which bathes the spinal cord and spinal nerves.   Most patients report that the placement process feels like pressure and is otherwise fairly comfortable. Once the needle is in the right placement a small amount of anesthetic is injected to confirm that it is in the right place. You will be observed for a minute or two to help confirm this.   After this is tiny plastic tube about the thickness of a dental floss will be passed thought the needle. This tiny tube (epidural catheter) will be left in place and the needle removed. More anesthetic will be given to get you very comfortable at this time.  The tiny tube will be connected on the outside to a special pump which will flow the same type of medicine already given in a continuous manner. There will be a slow and steady flow of new medicine thought the little tube throughout labor.  This is how the epidural can be made to last as long as the labor does. The pump is turned off after delivery and then the epidural catheter can be easily removed.

Most patients are so comfortable with their epidurals that they can even take a nap and rest until the time comes to deliver the baby. The epidural does not remove all sensation and generally patients notice a pressure feeling with each contraction. Some patients will notice that their legs feel warm, tingly, and a bit heavy. These are all normal things. If your Obstetrician determines that you need a C-section, in most cases, the epidural can be used for this purpose also.   In this case, a stronger type of anesthetic is given through the epidural catheter to make your lower body very numb for this type of delivery.

Risks of Epidural or Spinal Anesthesia

Backache - Back soreness after epidural anesthesia can occur.  Back pain can also occur in labor patients who did not have an epidural as well.  Generally this is mild and improves over a number of days after delivery.  This can be treated with warm compresses and mild pain relievers such a Motrin or Tylenol.  Before taking any medicines at home, make sure your doctor approves.   If the pain is more severe and does not improve, you should call your doctor to make certain that there is not a serious problem.

Headache - Headache is another possible problem with epidurals and spinals   A headache related to a spinal or epidural typically is located on the front of the head.  It feels better when lying down and worse when sitting or standing.  Headache can also be from other causes than the epidural.  Epidural headaches are initially treated with mild pain medicines, an abdominal binder, drinking lots of fluids, caffeine, and bed rest.  These headaches can resolve in a few days to a few weeks in most patients.   If the simple conservative measures don’t work or if the headache is severe, an epidural blood patch may be done to eliminate the headache.  The headache is caused by a tiny leak of spinal fluid from the sac of fluid that bathes the spinal cord.   The blood patch involves placing another epidural needle in the same spot as the original one.  However, this time through the needle, some of your own blood in injected.  This blood tends to clot around the tiny hole in the spinal fluid sac and seals the little hole that was leaking.  This treatment is very successful in most patients. 

Nerve Injury - This is a rare complication of spinals and epidurals.  It may occur in somewhere between 0.03- 0.1% of all cases of spinals and epidurals.  In this situation the patient may experience continuing numbness and/or weakness.   Severe cases are even more unusual.  Most of these complications are temporary and get better on their own over the course of a number of weeks.