Epidural anesthesia for childbirth
Epidural anesthesia has become a popular and effective form of childbirth pain relief. It can be used for either a vaginal birth or a cesarean delivery (C-section). A doctor trained in the use of anesthesia (anesthesiologist) administers epidural anesthesia.
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 numbs the area where the needle will be inserted with a local anesthetic. 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 illustrations of epidural placement and area of numbness for childbirth
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An anesthetic medication is injected into the catheter to numb your body below the insertion site. 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 medication 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 medication is given. Therefore, the use of epidural infusion pumps has become more common. With an infusion pump, the epidural medication 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 abdominal 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 necessary. Using less anesthesia (called a light epidural) may reduce the likelihood of needing a cesarean 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 medication. This is usually done after a cesarean delivery. If you are planning an immediate tubal ligation to prevent future pregnancy, the catheter will be left in place.
| Author: | Bets Davis, MFA Kathe Gallagher, MSW | Last Updated: December 5, 2007 |
| Medical Review: | Sarah Marshall, MD - Family Medicine Adam Husney, MD - Family Medicine Kirtly Jones, MD - Obstetrics and Gynecology | |
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