Epidural And Spinal Anesthesia and Pregnancy

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An epidural anesthesia is the injection in the lower back of a lower body numbing local anesthesia medicine (anesthetic) into the space around the spinal nerves (epi=around and dura=space around the spine). After the injection of the anesthetic it numbs the area usually below the point of injection as well as the legs and allows you to remain awake during the delivery.

How the epidural anesthesia 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 doctor injects medicine just outside of the sac of fluid around your spinal cord. This is called the epidural space. The doctor who gives you epidural or spinal anesthesia is called an anesthesiologist.

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. It works well for longer procedures. Women often have an epidural during childbirth.

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 the spinal anesthesia is done

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.

The epidural anesthesia can be used for either a vaginal birth or a cesarean delivery (C-section). An anesthesiologist, a doctor specializing in anesthesia, usually administers epidural anesthesia. Epidural anesthesia is administered through a needle in the back, and a catheter is often placed to adjust the pain medication over time. Epidural catheters can stay in place until the baby is born, and at times after birth to control post pregnancy pain. An epidural can be used for labor and delivery ;as well as for a cesarean section and other surgeries or indications.

Epidural anesthesia pain medication is the most popular choice among women in labor and delivery. 

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 onetime pain medication dose, the amount of medication with an epidural can be increased or decreased as needed. With an epidural, the woman is 100% awake during labor and delivery and mental awareness remains intact. Mom 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 the woman is 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 or Baby

Epidurals if done by experts are safe and present little health risk to some women. A sudden drop in blood pressure is not uncommon. The sudden drop can lead the fetal heart beat to change. That is why the mother's blood pressure and fetal heart beat are monitored closely after the placement of the epidural and IV fluids are given the entire time she is 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 baby are linked to the birthing process and not directly to the baby’s health. In some cases, women who choose an epidural may take longer to push, especially if this is the first delivery, and are more likely to need an assisted birth via vacuum or forceps. There is also the increased risk of having a C-section versus vaginal birth.