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What is an epidural?
An epidural is an option for pain control during labor. A thin plastic catheter is placed in your back through which medications to reduce contraction pain are given. Stronger medications can be given so you will not feel pain during an operation like a C/S.
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What is a spinal?
A spinal is a single injection of medication given through a needle in the lower back. Once the medication is given, the lower part of your body will become numb. Spinals can be used for C/S.
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How is an epidural or spinal performed?
You will be asked to either sit on the edge of the bed or lie on your side and curl your lower back. We will then clean your skin to prevent infection and numb the site. The more you are able to sit still, the easier and safer it is to perform the procedure. We will then put a needle into the epidural or spinal space. During this part, you should only feel pressure no sharp pain. We will then thread a catheter into the epidural space and remove the needle. After the catheter is in place, we will secure it to your back with tape to prevent it from becoming dislodged. We will explain each step as it is being performed. One support person may remain in the room with you during the procedure, but we ask that they remain seated in front of you. The whole procedure typically takes 15-30 minutes.
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When can I have an epidural in labor?
Except in rare circumstances, you can get an epidural any time after you go into labor. You do not have to wait until you are dilated a certain amount to receive an epidural.
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Who cannot receive an epidural?
Patients on certain blood thinning medications may have to wait a certain length of time before it is safe to place an epidural. In patients with a history of scoliosis, difficult epidural placement or previous back surgery epidural placement may be difficult.
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How long will the epidural last?
The epidural block can be extended for as long as you need it. Additional medication can be given through the catheter if necessary. In most cases, any numbness from the epidural will wear off within a few hours of the baby’s birth. When the catheter is removed, all you will feel is the tape being removed from your back.
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What can I expect from my epidural?
Expect to feel a little numb, but not all at once. Your legs and belly may feel like they have “fallen asleep” and your legs may feel weak and heavy. It takes about 20 minutes after giving the medication for you to be comfortable. Your contractions will first feel shorter, and then they will drift away.
Expect to feel something. You may feel tightness or pressure, especially close to delivery. The ability to feel pressure allows you to know when it is time to push.
Expect to need some fine-tuning. Many women will need an increase or additional dose of medication as labor continues. Some women may be numb on one side or not at all; we will work to adjust the epidural to try to help. We may need to replace the epidural to make it work.
Expect to stay in bed and have a bladder catheter placed. The epidural medications can make your legs weak during labor, and we ask that you stay in bed while the epidural is running and until the effects have worn off to keep you and your baby safe. You will also have a catheter placed in your bladder after your epidural.
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What if a Cesarean Section (C/S) is necessary?
If you have already received an epidural, we can usually put stronger medication in it that makes you numb. If you did not receive an epidural, we can place a spinal. In either situation, you will be numb from your chest down to your toes for a few hours. In emergencies or if you cannot receive an epidural or spinal, we may need to give you general (asleep) anesthesia for your C/S.
If you require general anesthesia we will be focused on caring for you and your baby and your partner will not be allowed back in the operating room.
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What are the risks of epidural or spinal anesthesia?
Your epidural may not work as well as we want. We may need to adjust the epidural or replace it.
It may lower your blood pressure. We will watch your blood pressure closely, especially right after we give the medications. We have options to treat your blood pressure if needed.
About one in 100 women will develop a headache after they have their baby. This headache usually goes away on its own but if necessary, you may request medications that are safe even if you are breastfeeding. You may need other treatments to make the headache better; your anesthesia provider will discuss this with you if needed.
*adopted from Duke Obstetric Anesthesiology Division and Society for Obstetric Anesthesia and Perinatology.