What is an Epidural?
A thin plastic tube (catheter) threaded into the space surrounding the nerves in your back. This delivers medication to help relieve labor pain.
How will you place my Epidural?
We will ask you to sit up in the bed, legs over the side, in a “slouched” position. We will then clean your back with a cold, soap solution. Next, we will inject a small amount of numbing medicine into your back before we place the epidural. This may be the most uncomfortable part of the process but it only takes a few seconds. We then use a special needle to guide the catheter into the correct space and then remove the needle. The catheter is left in place and carefully secured with tape to your back.
What kind of pain relief does an epidural provide?
The medications we give you will block pain sensation, and may also make your legs feel numb making it difficult to move. You may or may not continue to feel contractions. Our goal is to make you comfortable during labor but allow you to feel enough pressure to push when the time comes.
Does the medication wear off?
No, the medicine is continuously delivered through a pump attached to the epidural catheter. You will receive a button to press to give yourself extra medication as needed. Pump limits prevent “overdosing.” Occasionally, your pain will change as labor progresses so we may adjust the rates.
When should I ask for an epidural?
It‘s up to you. It may take about 45 minutes or more from when you ask for the epidural until it is in place and taking effect. We are good at working around and through your contractions, but keep in mind that you will need to be able to sit very still while we are putting the epidural in.
When is it too late to get an epidural?
If your labor has progressed to the stage where you are actively pushing, it may be too difficult to place the epidural. In addition, the pain relief may not take effect before your baby is born.
Can I eat or drink during my labor?
Small amounts of water are usually permitted but solid food is not allowed. Having an empty stomach is much safer in case an emergency C-section is needed. Please ask permission from your nurse before drinking, as some high-risk patients may not be permitted.
Can I get out of bed after I get my epidural?
No, your legs may be too numb for you to safely move around.
What if I need to use the restroom?
After the epidural has taken effect, your nurse will place a tube called a foley catheter into your bladder to drain the urine. The catheter will stay in place until it is time to push.
Can a family member or friend stay with me while I get my epidural placed?
It usually takes about fifteen to twenty minutes to place the catheter and during that time we ask all visitors to step out of the room.
When does the epidural get removed?
Usually, your nurse will remove the epidural after your baby is born or the next day if you have a c-section. Removal is not painful.
If I don’t want an epidural, what other options do I have?
Your OB doctors can write for pain medicines that can be given through an IV. Other moms choose to use non-medication types of pain relief such as special breathing techniques, massage, etc. We will usually still come by to see you and introduce ourselves whether or not you are planning on having an epidural. We like to meet everybody in the rare case that an emergency c-section is needed.
What if I end up needing a c-section?
If you already have an epidural catheter in place, we can dose it with a concentrated solution to give you enough anesthesia for the surgery. During a routine c-section, we will have your partner or a family member come in and sit with you. You may feel some stretching or pulling sensations during the procedure, but it should not be painful. It is not uncommon for patients to experience nausea or shivering during c-sections. After your baby is born and has been examined by the NICU team (they routinely come to c-section deliveries), your partner may hold your baby and take some photos!
What if I don't have an epidural in and I needed an emergency c-section?
Your obstetrician will let us know of the urgency, and if we have time, we can place an epidural. Alternatively, we can place a spinal anesthetic. It is very similar to an epidural except we do not leave a catheter in place. If we do not have time to place an epidural or a spinal anesthetic, we will do general anesthesia and put you to sleep.
How is my pain managed after a c-section?
We will usually either give a dose of a long-lasting pain medicine through the epidural or spinal, or we may run a solution of anesthesia by epidural pump for 15-18hrs.
What are the risks of epidurals?
Some moms may have soreness in their lower back, similar to the soreness in your arm after receiving a flu shot. The blood pressure may decrease, leading to nausea. Occasionally, the epidural stops working or only partially relieves the pain; in this case, the Anesthesiologist will trouble-shoot the problem and consider replacing the epidural. The most common serious problem is a 1-3% risk of getting a headache. This usually appears within 24-48 hrs following delivery, and we have effective ways of treating it. Very serious risks of epidurals include bleeding or infection at the epidural site, or a nerve injury. These complications are very rare.
Are the medications you give me safe for my baby?
Some types of medications we use for epidural anesthesia will reach your baby. However, they have been shown to be safe, and usually do not cause any problems for your baby. Likewise, breastfeeding is safe and greatly encouraged after birth.
For more information, check out the following websites:
American Society of Anesthesiologists:
http://www.asahq.org/patientEducation/labordelivery.pdf
American College of Obstetricians and Gynecologists:
11http://www.acog.org/publications/patient_education/bp086.cfm
Good examples of anatomy and epidural placement:
http://www.enjoyyourlabor.com/animations.html
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