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Childbirth: Epidurals

Topic Overview

Epidural anesthesia has become a popular and effective form of childbirth pain relief. Epidural anesthesia is the injection of a numbing medicine into the space around the spinal nerves in the lower back. It numbs the area above and below the point of injection and allows you to remain awake during the delivery. It can be used for either a vaginal birth or a cesarean delivery (C-section). An anesthesia specialist administers epidural anesthesia.

How an epidural is given

Epidural anesthesia involves the insertion of a sterile guide needle and a small tube (epidural catheter) into the space between the spinal cord and outer membrane of the spinal cord (epidural space). The epidural catheter is placed at or below the waist. The doctor first uses a local anesthetic to numb the area where the needle will be inserted. Then the guide needle is inserted and removed, while the catheter remains in place. The catheter is taped in place up the center of your back with the end taped in place on top of your shoulder.

See pictures of epidural placement and area of numbness for childbirth.

An anesthetic medicine is injected into the catheter to numb your body above and below the point of injection, as needed. The amount of discomfort or pain that you have depends on the amount of anesthetic used. Less anesthetic (often called a light epidural) will allow you to be more active in your labor and feel enough to push effectively. With higher levels of anesthetic, you will feel little or no pain from your contractions. You may be required to remain in bed when an epidural is used. You will also have a tube placed in a vein (intravenous, or IV tube) and a fetal monitor.

Before delivery, the epidural medicine dose can be decreased so that you can push more effectively while remaining alert and relatively comfortable. The epidural catheter can also be used to numb the area between the vagina and anus (perineum) just before delivery.

Because the amount of medicine given at one time is small, epidural anesthesia wears off during labor unless additional medicine is given. So the use of epidural infusion pumps has become more common. With an infusion pump, the epidural medicine is given continuously in small amounts so that you don't have to worry that the pain relief will wear off during your delivery.

In addition to more constant pain relief, another benefit of having an infusion pump is that it allows you to have more control of your belly and leg muscles. It also reduces the chance of side effects related to a standard epidural.

Side effects

The most common side effect from epidural anesthesia is lowering of the mother's blood pressure. Less common side effects may include severe headache after delivery, difficulty urinating or walking after delivery, fever, and prolonged labor. A rare side effect is seizure.

Because a standard epidural can decrease your ability to push, a forceps delivery or cesarean delivery (C-section) may sometimes be needed. Using less anesthesia (called a light epidural) may reduce the likelihood of needing a cesarean delivery.

After delivery

The epidural catheter may be removed right after delivery, or it may be left in place for several hours to a day and used to give you pain-relieving medicine. This is usually done after a cesarean delivery. If you are planning to have a tubal ligation before you leave the hospital (to prevent future pregnancy), the catheter will be left in place.

The effects of the epidural usually wear off within 2 hours after the epidural medicine is stopped. After the epidural wears off, you may have some hip or back pain from childbirth. You may have a small bruise and the skin may be sore where the epidural was put in your back. This will probably get better in 1 or 2 days.

Credits

By Healthwise Staff
Kathleen Romito, MD - Family Medicine
Kirtly Jones, MD - Obstetrics and Gynecology
Last Revised November 13, 2013

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