Epidural Analgesia for Pain Relief in Labor:

 

Frequently Asked Questions


The University of North Carolina School of Medicine
Department of Anesthesiology

Faculty:
Dr. David Mayer
Dr. Kathleen Smith
Dr. Fred J. Spielman


What is an epidural?


An epidural is an anesthetic technique using a small tube placed in the lower back to deliver local anesthetic or other pain medicines near the nerves that cause pain in labor. You will not get sleepy from this type of anesthesia.

Will it hurt my baby?


If you have an epidural anesthetic, your baby will be safe. The epidural will not depress your breathing or put your baby to sleep.

How long does it take to do?


Placing the epidural takes about 10 minutes, with good pain relief starting in another 10-15 minutes. In patients who are obese or have scoliosis, more time might be required to place the epidural.  Once the epidural is in place, medicine will go through the tubing continually to maintain pain relief through the rest of your labor and the delivery of your baby.

Will it hurt?


Compared with the pain of contractions, placement of an epidural results in minimal discomfort. As the epidural is placed, you will feel a brief sting on the skin. After this, you should feel only pressure in your back during the procedure. The needle is then removed entirely. Once placement of the epidural is completed, you will feel only the tape on your back that keeps the tubing in place.

How is it done?


The anesthesiologist will ask you to sit up or lie on your side, keeping the lower part of your back curved towards him/her. You will be asked not to move at all during some parts of the procedure. Your nurse will help you get in the correct position. After the anesthesiologist numbs your skin with a local anesthetic, he or she will insert a needle between the bones of your spine into the epidural space and then leave a tiny tube (catheter) in place while the needle is removed. The tube is secured in place with an adhesive and bandage, and the tube stays in place for the duration of labor and delivery. You should be comfortable, and it is okay to move around in bed, but do not drag or slide on your lower back, because this could accidentally pull the catheter out.

Does all the pain go away?


Epidurals make the contractions feel less strong and easier to manage. Some pressure might be felt in the rectum and in the vagina later in labor. Being totally numb during labor is undesirable because you need to know when and where to push at the end of your labor. At UNC, we adjust the medication type and amount to meet each patient's needs. Most of our epidurals allow the patient to give herself a couple of extra doses of medication each hour, which is called patient-controlled epidural analgesia or PCEA. For the majority of patients, these safe extra doses will provide satisfactory pain control. If you start to develop a lot of pain after the epidural is in place, we will add more medicine to your catheter. If you are too numb, we will decrease the amount of medication you are receiving. Ask your nurse to call the anesthesiologist with any questions you have about your pain relief. An anesthesia doctor is available for labor and delivery 24 hours a day. Within the limits of safety for you and your baby, we will work with you to obtain the comfort level that you desire.

Does epidural anesthesia always work?

The majority of patients experience significant pain relief from an epidural.  Occasionally (5% of the time), pain relief is one-sided or patchy, but the anesthesiologist can usually do something about this, most often without needing to repeat the procedure.  Very rarely there are technical problems that prevent the anesthesiologist from getting the needle into the epidural space. These patients may not get adequate pain relief.

Are there any side effects?


Common side effects:

a. Your legs might tingle or feel numb and heavy. This is normal and will disappear soon after delivery.

b. Your blood pressure might fall slightly but this is easily and rapidly treated.

c. Some back tenderness might occur at the site of the insertion, and it might last for a few days. However, no evidence exists that epidurals cause chronic back pain.

d. Headache can occur after delivery in 2-3% of patients, due to unplanned puncture of the lining containing spinal fluid. This headache can be moderate to severe, but is not permanent or life-threatening. Specific treatment is available for severe headaches.

e. Itching, very mild sedation, and difficulty urinating are also occasionally noted.

f. You might have temporary temperature elevations that are not significant. No evidence exists that the increased temperature is due to an infectious source.

Rare side effects:

a. After delivery, some women might develop minor neurologic problems (e.g., a small patch of numbness on one leg). Such problems are rare, and most patients have complete resolution of their symptoms. The exact cause might be impossible to determine and these problems might occur both with and without epidural anesthesia. The delivery of the baby can itself cause pressure on nerves, as can some of the pushing positions used.

b. Permanent neurologic problems, such as paralysis, can occur with ANY type of anesthetic procedure, but they are exceedingly rare. About 60% of patients who deliver at this hospital use epidurals, and we have an excellent safety record. The drugs and equipment used for these procedures are thoroughly checked, and our placement technique is very cautious.

Can I walk with my epidural?


The anesthetic solution used for control of labor pain can sometimes make it difficult to walk without assistance. For this reason, most women do not ambulate following epidural placement.  Please be sure to check with your labor nurse before attempting to get out of bed.

What is a CSE?

CSE, which stands for combined spinal-epidural, is similar to an epidural. Sometimes we use this technique when a faster onset of pain control is needed.  CSE uses the same types of drugs and has similar side-effects to those of epidural pain control.

Does an epidural affect the progress of labor?


a. The first stage of labor (until the cervix is fully dilated): The effect of an epidural on this stage is impossible to predict in an individual. Labor might not be affected at all; or labor might slow down and a drug (oxytocin) will be needed to speed it up; or labor might go faster, especially in some patients who develop poor labor patterns and are progressing slowly.
b. The second stage (the pushing stage, after full dilatation and until delivery): This stage may be slightly  longer with an epidural, but there is no evidence that this harms mother or baby; if the patient is very numb, she might not push effectively. For this reason, we try to balance pain relief so that the patient is comfortable but still feels some pressure in the rectum and vagina during contractions.

Does using an epidural for pain relief in labor increase my chances for a cesarean section?


There is no evidence that epidurals increase the risk of cesarean section.  This is also supported by the American College of Obstetrics and Gynecology (ACOG), who state that "fear of unnecessary cesarean delivery should not influence the method of pain relief women choose during labor". At UNC, we use dilute solutions of local anesthetic; studies show that these dilute solutions do not affect labor. You should speak with your obstetrician about his or her beliefs and feelings about pain relief during childbirth.

Are there any patients who cannot have an epidural catheter?


Yes. For example, patients with the following conditions:
a. blood clotting problems, or the use of blood thinning medications
b. heavy bleeding
c. neurologic disorders
d. patients who have had certain types of lower back surgery

Do I have to have an epidural?


Certainly not! If you are coping well with labor pain you might choose not to use any kind of pharmacologic pain relief. If you find the pain too unpleasant, the anesthesiologist is available every day and night to help you. Many women try having no pain medications at all in the beginning; they might then request a shot in their intravenous (IV) line; some will be quite happy with this, while others might desire the stronger pain relief that comes from an epidural. Remember, the choice is yours.

 

What if I have more questions or need more information about epidural anesthesia?


If you have specific questions or concerns that are not covered here, we would be glad to speak with you. Two web sites that have more information are www.soap.org (select Patient Education) and www.asahq.org (select Public Education; then Planning Your Childbirth). We also encourage women who have unusual and/or complex medical problems to come talk with us during the latter part of their pregnancy. Above all, our strongest desire is that you have a safe and rewarding experience during childbirth.