Epidural Anesthesia for Labor and Birth
Medications for Labor
Making the Decision to Have an Epidural
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. 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
Preparing for the Epidural
IV in Labor
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 with an epidural in place
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
The Epidural Procedure
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 or other family and friends
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
What You Will Feel with an Epidural
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 some where 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 ******** 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
When it comes to pushing, 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