Epidurals

Many women want to hug their doctors for giving them epidurals during labor. The epidural has made most other methods of pain relief obsolete – and has even done away with the belief that you must experience pain to birth a baby. Yet before you grab for this magic medicine, inform yourself about its benefits and risks.

Before you receive an epidural, you will get a liter of intravenous fluids to build up your blood volume and prevent the decrease in blood pressure that sometimes accompanies an epidural.

Your doctor or anesthesiologist will then ask you to sit or lie on your side and curl into the knee-chest position to round your lower back. This widens the space between the vertebrae, making it easier to find the right area for injection. As your doctor or nurse scrubs your lower back with an antiseptic solution, it will feel cold. Next, you will feel a slight stinging sensation as the doctor injects some local anesthetic under your skin to numb the area. When the area is sufficiently numb, he or she will insert a larger needle into the epidural space and inject a test dose to determine if the needle is in the right place and ensure that you are not allergic to the medication. Once the needle is properly inserted, the doctor threads a plastic catheter through the needle into the epidural space and removes the needle, leaving the flexible catheter in place. The pain reliever you and your doctor have decided on is then fed into the catheter. A few minutes later you may feel a shooting sensation, like an electric shock, down one leg. Within five minutes you are likely to begin to feel numb from your navel down, or you may notice that your legs are feeling warm and/or tingly. Within 10-20 minutes the lower half of your body will feel partially or completely numb, depending on the type of medicine used, and the pain of contractions will subside. The exact level of loss of sensation cannot be predicted precisely. Most mothers experience numbness from the navel down, some experience loss of sensation as high as the nipples. A few mothers notice some patchy areas on their skin where they can still feel sensations.

This is the point where most women sing the praises of the epidural, yet this is also the instant at which a woman becomes more of a patient than a participant. Yes, once the pain is relieved you can rest and recoup your energy. But because the lower half of your body can't move, you will need assistance changing positions. Since the sensation to empty your bladder is impaired, a nurse will insert a urinary catheter to take away urine. Because of the possibility of the epidural lowering your blood pressure, the nurse will monitor your blood pressure every two to five minute until it is stable, and then every fifteen minutes. To keep the pain relief even on both sides of your body, the nurse will turn you from side to side. To be sure baby is handling the epidural well, you will be hooked up to an electronic fetal monitor. You will also notice that the doctor or nurse periodically rubs the skin of your abdomen, checking to be sure the drug is giving you sufficient pain relief, but not ascending high enough to interfere with your breathing. Now comes the juggling act of getting you just enough anesthetic to give you pain relief and help you manage your labor, but not so much that it interferes with your labor.