Monday, November 9, 2009

Share With Women - Epidurals

SHARE WITH WOMEN - American College of Nurse-Midwives


There are many options for managing pain during labor. You might decide before you begin labor that you want pain medication, or you may not want any medications. This handout discusses epidural analgesia.

What is Epidural Analgesia?
Epidural analgesia is a local anesthetic placed in a part of your back where it numbs the nerves that go from your pelvis and legs to your brain. The anesthetic is like the kind you get when you go to the dentist. With an epidural, you get an injection into the space around the nerves in your spine that makes your body numb below the site of the injection.

How Does an Epidural Work?
All of the nerves of the body send their messages to the brain through the spine. Anesthetics are
medicines that block the messages from traveling up nerves to the brain. When the pain messages are blocked before getting to your brain, you do not “feel” the pain.

How is an Epidural Done?
There is a very small space around the nerves in your spine. This is called the epidural space. A specially trained doctor or nurse places a thin tube, called a catheter, into this space. You will have to sit on the side of the bed or curl up on your side on the bed. The nurse or doctor will give you a shot of Novocain in your back. Then the nurse or doctor will put a long needle through the area that is numbed into the epidural space. When he or she has found the space, the thin tube will be threaded through the needle, and the needle is removed. A pump is then set up to deliver the anesthesia through the tube into the epidural space during your labor. After birth, the tube will be taken out. The numbness will begin to go away. You will be able to move your legs and walk in a few hours.

How Well Does an Epidural Work?
For some women, an epidural works very well. Within 15 to 20 minutes of starting the anesthesia, they lose feeling below the waist. Many women are so comfortable they can talk, watch television, or even sleep. Occasionally, the epidural does not work as well, and you may continue to feel pain or pressure even though your legs are numb. There is no way to guess who will get a “pain free” epidural and who will have an epidural that does not work completely.

Are There Risks Associated With Having an Epidural During Labor?
Your labor progress depends on lots of things: the size of your pelvis, the size of your baby, the
position of your baby, and the strength of your contractions. Most of this is out of your control.
Sometimes an epidural can help and sometimes it makes labor longer and more complicated.

Risks of Insertion and Placement of Anesthesia in the Epidural Space
● The epidural is inserted sterilely, but there is a small chance of infection at the site where the needle is inserted. A serious infection could cause paralysis or, very rarely, death.
● The needle could hit a nerve and cause nerve damage or paralysis. In most people, the spinal cord is above the area where the needle is placed, which is why this problem is rare.
● If the epidural is incorrectly placed too high in your back or into spinal fluid, you may lose the
sensation of your breathing and need help to breathe regularly.

Risks During Labor
● If your bladder is full, you will not be able to feel it, so you will need a catheter to drain the urine.
● Women who have an epidural have a higher chance of getting a fever during labor, and then the baby may need additional blood work and observation to rule out infection.
● Women who have an epidural are more likely to need medication to make contractions stronger.
● Your legs will be numb. If your baby gets stuck in a “crooked” position, you will not be able to move around to “jiggle” the baby into a good position. This may increase your chance of needing a cesarean section.
● It may be hard to feel your contractions when you need to push. Pushing takes longer.
● Women who have an epidural have a higher chance of needing a vacuum or forceps to help give birth.

Risks Afterward
● The most common risk of an epidural after the baby is born is a “spinal headache.” This only happens one or two times for every 100 epidurals that are used. This is a terrible headache that comes 1 to 2 days after the epidural is removed. If you get a spinal headache, you will need to return to the hospital to have a special procedure called a “blood patch.” The patch usually helps right away.
● Your baby may have a harder time getting started breastfeeding.
● Many women report ongoing back pain after an epidural, but we do not know if this is because of the epidural or because of other things that may have happened during their labor.
● There is a very, very small risk of permanent paralysis—loss of the ability to move your legs.

What Are the Benefits of an Epidural?
● If the epidural works well, you will not feel the intense pain.
● Sometimes—especially with a first baby—early labor may be long. An epidural can give you a
chance to rest so that you can gather your strength for active labor and birth.
● If you are very anxious, an epidural may help you relax. In some women it appears that the epidural may actually make your labor go more quickly.
● If you need a cesarean section, your epidural can be used to make you numb for the surgery.
● Women with twins or babies in a breech position who plan a vaginal birth may use an epidural so they are prepared for a cesarean section if their baby (or babies) have problems during labor or birth.

Childbirth Connection:
Options: Labor Pain (Epidural and Spinal)

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