Frequently Asked Questions
What is epidural analgesia?
Analgesia means pain relief. Epidural analgesia is one of the pain relief choices for women giving birth. An epidural is similar to another pain relief option called intrathecal analgesia but the type of medicine, and the amount of numbness is different.
To give the epidural, the anesthetist inserts a small needle between the vertebrae of the spinal column, into the space just outside the dural membrane. The dural membrane surrounds the spinal cord, spinal nerve roots and the spinal fluid. The medication travels to the nerve roots where it numbs them and gives you pain relief.
If you will need more than just one dose of medicine for the epidural, the anesthetist can insert a tiny plastic tube called a catheter into the epidural needle. The needle is then pulled out and the catheter is held in place with tape. Then additional medication can be given when you need it. This is called a continuous epidural.
Is it dangerous to have an epidural? Could I be paralyzed?
The risk of nerve damage or paralysis is extremely rare, but possible. The injection is made into an area of nerves; therefore, it is possible to damage the nerves with the epidural needle. But, put in perspective, the rick of such a complication is far less than the risk of death in a car accident on the way to the hospital.
Can everyone have epidural analgesia?
No. Pain relief with an epidural is not for all patients. You may not be a candidate for epidural analgesia if you:
- are allergic to certain narcotics or local anesthetics
- have nervous system (neurological) disease
- have a bleeding tendency or coagulation disorder
- take aspirin routinely
- have an infection in the lower back
- have had previous back surgery
- have a psychological disorder or a fear of needles
- are very overweight
- have a spinal deformity
- cannot cooperate or get into a position to allow the anesthetic administration
- are too early in your labor
- are progressing too rapidly
- have an abnormal labor or fetal monitoring pattern.
It's important that you be honest and open with your doctor and the anesthetist if you have any of these conditions.
What can I expect if I have an epidural?
The medication used in an epidural is a combination of local anesthetic and narcotics to give significant pain relief. You may feel numbness from the top of your abdomen down to your feet. Usually you can still move your legs, but they may feel weak and difficult to control. Your contractions will feel like a pressure sensation, an important part of being able to have contractions and give birth.
Once in a while women who have epidurals are unable to push well at the time of delivery, so the baby might need additional help during birth. Loss of the urge to push, slowing down of labor, increased use of equipment such as forceps and fetal monitors, and C-sections are all possible with epidurals.
Are there side effects? What are some common problems?
Common side effects of narcotic medications are nausea, vomiting, itching, or slowed breathing. Most of the side effects are normal and go away as the medications wear off.
You might not be able to go to the bathroom due to the numbness, so you may need to have a catheter to empty your bladder. You will not be able to get out of bed to walk while the local anesthetic is working. Some women get pain relief from epidurals in some areas of their body but not in others or on only one side of the body.
Your blood pressure may drop, which may slow the baby's heart rate. Although you might not notice this change in blood pressure, you may experience mild nausea. We can give you additional IV fluids or medications and change your position to help correct the change in blood pressure.
If the needle punctures the membranes around the spinal cord, you may develop a headache. More rarely, epidurals can cause nerve injury or infection.
How is the epidural given? Will it hurt?
The nurse will start an IV so you can be given fluids and medications. The anesthetist and labor nurse will position you correctly for the placement of the epidural, either sitting up or lying on your side. Then the anesthetist will apply an antiseptic solution to your lower back to reduce the chance of infection and give you a shot to numb the ligaments under the skin. You might feel a slight sting and a slight ache until the anesthetic begins to work. When the area is numb, then the anesthetist will actually insert the epidural needle. Because your back ligaments will be numb, you will probably just feel some pressure. If you do feel pain, let the anesthetist know, but try not to move during the placement of your epidural. Some women experience a strong tingling in the hip or running down a leg. This is not unusual, but you should tell the anesthetist if it happens.
How long does it take to work? What will I feel?
Once the epidural catheter tube is placed, the anesthetist will perform several tests to make sure it is in the right position before injecting the pain medication. The epidural space is very small, and the veins located in the space become swollen during pregnancy. The anesthetist wants to make sure the epidural medication does not go into one of the swollen veins. He or she will give you a test dose of medication and ask if you notice any dizziness, a funny taste, rapid heartbeat or numbness.
It usually takes about 25 minutes to place the catheter and perform the tests. Then you will probably have pain relief within five to 10 minutes, although it may take 15-30 minutes for the full effect since the medication needs to be absorbed into several nerves. Although significant pain relief will occur, you may still experience some discomfort and you will be aware of pressure with contractions.
How long will the epidural last?
A continuous epidural can usually be made to last as long as your labor lasts. Usually, the medication is stopped when you are completely dilated so that you are able to push when you need to. Other medication can be given near the time of delivery, but it might make it harder for you to push. If you can't push, then the doctor might have to use instruments such as forceps to help deliver the baby.
When can I have an epidural?
It is important that you talk about your pain management wishes during your prenatal visits to the doctor. Once you are in labor, it can be difficult for you to talk about your pain relief options and hard for you to cooperate in receiving medication.
SSM Health St. Clare Hospital - Baraboo physicians and staff prefer to begin the epidural only after you have clearly demonstrated progress in labor. For most patients, this is usually when cervical dilation reaches four centimeters. When you can actually receive the epidural depends on what's happening in your labor and your doctor's professional judgment. When the time is right, the doctor will notify the anesthetist who will talk with you and suggest options in accordance with your wishes and those of your physician. It's important that you ask questions and talk about concerns you may have. Please not that, although it is unlikely, the anesthetist may not be immediately available to administer the epidural because of emergencies.
Is it ever too late for an epidural?
Sometimes the cervical dilation in labor progresses so quickly, especially if you have given birth before, that there will not be enough time before delivery to achieve pain control with the epidural. In many of these situations, a more rapid-acting pain relief option called an intrathecal can provide the best option for pain management during delivery.
Will an epidural lengthen my labor? Will it cause me to have a C-section?
The pain relief medication will make you feel more comfortable. It will also slow many of the conditions of your labor including your blood pressure, heart rate, and breathing rate. It may also change the rate of your uterine contractions, resulting in a longer labor. An epidural may cause changes in the baby's position, which can also slow down labor progress. But it can also sometimes actually result in a more rapid labor and delivery. On average, there will be a longer labor with an epidural. You may also need to have medication called Pitocin to make your contractions stronger.
There is no clear evidence to show that the appropriate use of epidurals will result in a higher number of C-section deliveries. If a C-section is needed, then the epidural catheter can be used to provide anesthesia for the surgery. Sometimes, other anesthetics like a spinal block or general anesthesia may be needed.
Does the medication affect my baby? Will I be able to breast feed after having an epidural?
The amount of medication in your blood stream is influenced by the dose given. The baby is exposed to any medication given to the mother. However, the amount of epidural drug that crosses into the baby is minimal and is safe for both mother and baby. Your body will eliminate the medications before your breasts begin producing milk for breastfeeding.
Do epidurals always work?
Epidurals usually give good pain relief, but it is possibly that they might not relieve some or all of your pain. The catheter or needle must be in the proper position for the medication to work. Sometimes it is hard to get the epidural needle in place because of your labor or your back. Also, women vary in their response to medications. Sometimes people experience what is called a "patchy block", where you get pain relief in some areas but not others. Sometimes adequate pain relief is not possible.
What are the risks of an epidural?
While not common, complications can occur, even though you are monitored carefully and your anesthetist takes special precautions to avoid them. Fluids will be given through an IV before the epidural is given and while the medication is in effect. Shivering is a common reaction. Mild soreness or aching for several days at the site of the injection is also normal.
Although uncommon, a headache may develop following the procedure. You can help decrease the likelihood of a headache by holding as still as possible when the injection is given. The headache, sometimes lasting a few days, often can be reduced or eliminated by lying flat, drinking fluids and taking pain tablets. Sometimes when you get a headache it will not go away with the usual treatments. When this happens, the anesthetist will draw some blood from your arm and inject it into your back. This seals the area where the epidural was given and stops your headache. This is call an epidural blood patch.
Other complications that can occur include, but are not limited to, infection, nerve damage (including paralysis, loss of bladder and bowel function, and loss of sexual function), allergic reactions, seizures, cardiac arrest, and death. Although the consequences of these complications are very severe, they are also extremely rare.
How much do they cost? Will my insurance pay for an epidural?
Epidural analgesia can be expensive and is not a free service of the hospital. This is because of the risk involved, the high level of training needed for the anesthetist to place the epidural catheter, and the length of time needed to manage the analgesia during labor and delivery. The actual cost will vary depending on the technical difficulties and the length of time pain management is required. Very few insurance companies pay the total charge. If you are unsure of your coverage, please speak with your insurance company. If you are concerned about cost, then talk with your doctor about the many other options you have for pain management during labor and delivery.
What is the different between an epidural and an intrathecal?
An epidural is an injection or infusion of local anesthetic/narcotic into the epidural space, where the nerves come out of the spinal canal to the various parts of the body. An intrathecal is an injection of narcotics (occasionally with small amount of local anesthetics) into the spinal fluid, which is in direct contact with the spinal cord. Both techniques produce excellent pain relief by temporarily reducing the function of the sensory nerves. Each technique has its pros and cons. Please see Intrathecals: Frequently Asked Questions to make a full comparison of the two techniques. Ask your doctor for further explanation.
The material above was gathered from a number of websites available to the general public including the public information site of the American Association of Nurse Anesthetists, the Yale-Newhaven Hospital maternity site, and many others. Additional material was obtained while in clinical practice at the May Clinic and while in private practice. All information is intended for your general knowledge and is not a substitute for medical advice or treatment.