Epidural Procedure for Labor

1
Making the Decision to Have an Epidural

Epidural anesthesia
BSIP/Universal Images Group/Getty Images

The decision to have an epidural in your labor is best made once labor is well established. Before labor it is best to keep an open mind about all of your options, including an epidural procedure (sometimes called an epidural drip). This means that a good childbirth class will help you learn about what an epidural is and what it isn't, so that there are few surprises once labor starts.

If you are at the hospital and you would like to have an epidural, you will probably have a consultation with the anesthesiologist or nurse anesthetist before getting an epidural. This is a chance for them to get a complete medical history from you, including drug allergies, previous reactions to anesthesia and your family history. This is also the time for them to explain the procedure and what to expect.

You will also have an opportunity to ask questions about the procedure, what you will feel, what you won't feel and potential risks for you, your baby and labor. This is called informed consent and should happen with every medical decision that is made. Remember to use your BRAIN. (Get the benefits, risks, alternatives, intuition, not now, later?)

Once all of this is done, you will usually be given some time to make the decision alone with your support people.

2
Preparing for the Epidural

Man Comforting Woman in Labor
Photo © Christopher Bissell/Getty Images

Once the decision has been made to have an epidural and the anesthesia team has cleared you medically, there are a few things that have to happen before it would be safe to get an epidural.

You will have your blood drawn, if it has not been drawn previously at this hospital visit. You will also be given an IV in your arm. This is to give the medical team access to your veins in case emergency medications are required. It is also used to help keep you hydrated since you will not be allowed to eat or drink in many hospitals with an epidural in place. (Some hospitals allow clear fluids.)

One of the procedures before an epidural is also to ensure that you are well hydrated. You will be given fluids, usually at least 1 liter, prior to the placement of the epidural. This is to expand your blood volume to prevent your blood pressure from dropping dangerously low and harming you or causing fetal distress when the epidural medications are started. You will get continuous IV fluids for the duration of your labor and birth.

You will be attached to electronic fetal monitoring (EFM) prior to the epidural to check your baby's baseline heart rate. You will most likely have continuous electronic fetal monitoring to ensure that your baby is responding well to the medications of the epidural.

3
The Epidural Procedure

Getting an Epidural
Photo © Universal Images Group/Getty Images

Once you have been prepared for the epidural procedure the anesthesia team will come in. This may be just your labor and delivery nurse and the anesthesiologist or nurse anesthetist. Typically everyone else will be asked to leave while your epidural is placed. In some hospitals, doulas are allowed to stay for the procedure, but not your husband. Be sure to ask about hospital policy.

You will be asked to assume a position that will help the anesthetist find the landmarks on your body needed to place the needle correctly. This maybe sitting up on the edge of the bed leaning over and pushing your back outward or it may be laying on your side curled up in a ball, also pushing your back out. The position is uncomfortable because of the belly in the way. Most moms worry a lot about having to stay still during contractions. Be sure to talk to those with you about this fear. They will tell you what you need to do to ensure that they know when you're having a contraction, so it is well timed.

Your back will be washed and a shot of a numbing agent will be given before the epidural. Then the epidural needle is placed into the epidural space around the spinal cord. A test dose is given to ensure that the epidural is in the correct place. Once this test is done the medications are set to a continuous drip. A small catheter is left in place to deliver the medications continuously throughout labor. This catheter is taped up your back so that it is difficult to remove without trying.

You may be asked to lay in certain positions for awhile as the medication works with gravity. You will also have your blood pressure monitoring every few minutes, continuous fetal monitoring and other monitoring to ensure you react well with the anesthesia.

Once you are numb, a urinary catheter will be placed because you can't go to the bathroom.

4
What You Will Feel with an Epidural

Epidural Kit
Photo © Beano5/Getty Images

The medications used in the epidural vary widely. The amounts and mixtures, often called epidural cocktails, will largely determine what you feel. Some epidurals, like those used for surgeries, like a cesarean section, leave you feeling very little or completely numb. Some epidurals are designed so that they just barely take the edge off the pain, even allowing some women to be able to have enough control that they could walk, hence the name walking epidural. Most epidurals are somewhere in between.

The hard part, the art part of an epidural, is getting exactly what you want with the epidural. You might order completely numb and still feel contractions. Or vice verse. About 80% of women say that their epidurals worked adequately. Some women find that they had very little pain relief, either completely or partially, known as a window. A window is where you have one small area that you are not numb at all. This can be simply an anatomy issue with your body. The anesthetist may be able to help you, or you may need to rely on other comfort measures or IV medications to assist you.

Many women are able to sleep or at least rest with an epidural. Some women feel when they are having contractions, but don't feel pain with the epidural. Supporting a woman with an epidural may be different than you thought.

When it comes to pushing with an epidural, you should be able to have some feeling to feel to push. Many practitioners recommend the process of laboring down, or letting the baby come down on its own without a lot of pushing on your part. In this case you wouldn't start pushing until the baby had descended well into your pelvis.

5
Labor with an Epidural

Mom and Dad in Labor
Photo © Lillian Elaine Wilson/Getty Images

With an epidural you will continue to have contractions. Though many women will experience a slowing of their labor once the epidural is placed. Many doctors will use a medication known as Pitocin to help augment labor or speed it up. This medication is given in your IV. You may also have your water broken.

If you have been in labor awhile, you may have an opportunity to sleep or rest before it is time to push your baby out.

You will be able to move around in your hospital bed, with the help of others. In fact, continuing to move your body around can help prevent some of the risks of your baby getting in a bad position and staying there. Have your support team or doula remind you to move, even if it's simply from side to side, about every half an hour. Some anesthesiologists also recommend this for better medication coverage. If you are worried about moving with tubes and monitors, ask your labor nurse to help you.

You can choose to use side lying positions, semi-sitting, etc. If you have more movement or feeling in your legs, you may be able to use even more positions. Feel free to use pillows to help hold your body at appropriate angles and to give you support so that you feel and look stable.

6
What to do if the epidural doesn't work.

Woman in labor
Photo © Photographer's Choice/Getty Images

Occasionally the epidural does not work, for whatever reason. You may have the option of undergoing another epidural procedure. For many women this works well, for others it is eitehr not an option or simply doesn't work. If you fall into this category, you will need a back up plan.

Many women will try to use other medications, like IV pain medications to help them with the pain of labor.

This may be a time where your doula and other support people can also help you with non-medicinal forms of pain relief, including positioning, massage, relaxation and more.

7
Epidural Risks

Woman on the electronic fetal monitor in labor
Photo © Aurora/Getty Images

The complications that are most common with an epidural are things like a drop in mom's blood pressure (maternal hypotension) which can lead to fetal distress if not treated, this is usually quickly treated by medications and position changes. Other complications can include:

These are relatively common with epidurals, but corrections require various procedures. Paralysis, numbness, nerve injury, accidental spinal and infection for mom are really rare.

8
Epidural Recovery

Family visit postpartum
Photo © Design Pics / John Kroetch/Getty Images

Once you have your baby, the epidural catheter is usually pulled out after the repair of any tearing or your episiotomy. If you had a cesarean surgery, you may have it in a bit longer. Once the catheter is pulled out, the medication is discontinued. You will usually be able to begin feeling tingling in your legs, and then feel the sensation slowly return. Most moms are able to walk within a few hours after the epidural. Though sometimes your legs will still feel a bit weak. This is not uncommon and does not necessarily indicate a complication. If you have questions, ask to speak to the anesthesia team.

You may keep both your IV and urinary catheter for a few hours, depending on how your recovery is going.

Sources:

Anim-Somuah M, Smyth RMD, Jones L. Epidural versus non-epidural or no analgesia in labour. Cochrane Database of Systematic Reviews 2011, Issue 12. Art. No.: CD000331. DOI: 10.1002/14651858.CD000331.pub3

Simmons SW, Taghizadeh N, Dennis AT, Hughes D, Cyna AM. Combined spinal-epidural versus epidural analgesia in labour. Cochrane Database of Systematic Reviews 2012, Issue 10. Art. No.: CD003401. DOI: 10.1002/14651858.CD003401.pub3

Sng B, Leong W, Zeng Y, Siddiqui F, Assam PN, Lim Y, Chan ESY, Sia AT. Early versus late initiation of epidural analgesia for labour. Cochrane Database of Systematic Reviews 2014, Issue 10. Art. No.: CD007238. DOI: 10.1002/14651858.CD007238.pub2

Continue Reading