An epidural is an injection in the lower back of a body numbing local anesthetic into the space around the spinal nerves. The anesthetic numbs the area below the point of injection as well as the legs, and allows you to remain awake during the delivery.
How an epidural is done
First, the skin area of your back where the needle is inserted is cleaned with a special solution. The area may also be numbed with a local anesthetic. The anesthesiologist injects medicine just outside of the sac of fluid around your spinal cord. This is called the epidural space.
The medicine numbs or blocks feeling in a certain part of your body so that you cannot feel pain. The medicine begins to take effect in about 10 to 20 minutes and works well for longer procedures. A small tube (catheter) is often left in place. You can receive more medicine through the catheter to help control your pain during or after your procedure.
How spinal anesthesia is administered
The doctor injects medicine into the fluid in your spinal cord. This is usually done only once, so you will not need to have a catheter placed. The medicine begins to take effect right away. It works well for shorter and simpler procedures. Your pulse, blood pressure and oxygen level in your blood are checked during the procedure. After the procedure, you will have a bandage where the needle was inserted.
Benefits of an epidural
The benefit of choosing an epidural for labor and delivery is the constant stream of pain medication that can be delivered. Unlike the spinal block, which is a one-time pain medication dose, the amount of medication with an epidural can be increased or decreased as needed. With an epidural, you are 100% awake during labor and delivery and your mental awareness remains intact. You can listen to the doctor, understand all commands and push as needed.
One advantage of the epidural is that it allows most women to fully participate in the birth experience (continue to feel touch and pressure) while relieving most, if not all, of the pains of labor. The epidural can be placed before or anytime during labor.
When choosing an epidural during labor and delivery it may take some time for the pain medication to fully work. Typically it takes 10-15 minutes for an epidural to reach peak performance. If you are in the advanced stages of labor, there may not be enough time to administer the epidural with any effectiveness. In those cases, a combined spinal-epidural may be placed to hasten the pain relief.
Effects on the mother and baby
Epidurals, if done by experts, are safe and present little health risk. A sudden drop in blood pressure is not uncommon. The sudden drop can lead the fetal heartbeat to change. That is why your blood pressure and fetal heartbeat will be monitored closely after the placement of the epidural. IV fluids are given the entire time you are taking the epidural to prevent this drop in blood pressure. Medications to raise blood pressure can also be administered through the IV.
The effects of an epidural on the baby are linked to the birthing process and not directly to the baby’s health. In some cases, with an epidural, it may take longer to push, especially if this is the first delivery. You may also be more likely to need an assisted birth via vacuum or forceps, and there is an increased risk of having a C-section versus vaginal birth.