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Getting an Epidural During Labor

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- Having a baby is an exciting and special time,

but labor can be painful.

And it's important that you be well-informed

about your options for pain control.

You have many choices for pain relief during labor,

which include unmedicated methods

such as breathing techniques or massage,

and medicated options such as IV pain medication,

breathing in nitrous oxide, or getting an epidural.

The decision is personal,

and you may choose a combination of methods.

An epidural involves putting a local anesthetic

or numbing medication like what you get

when you go to the dentist

into the epidural space in your back.

The epidural will deliver a continuous infusion

of medicine that works directly on the nerves

in your back and numbs the lower half of your body

in contrast to systemic medications,

which act on your brain and sedate you.

An epidural acts locally at the nerves that transmit pain

from the uterus and the vagina.

And since the epidural medicine works directly

on the nerves in your back, very little medicine gets

to your baby; and you can safely breastfeed

after having an epidural.

You can get an epidural at any time

once you've gone into labor.

Typically it'll take about 30 minutes

to get the epidural catheter started,

and then an additional 15 minutes or so

for the medicine to work.

If you have obesity or scoliosis,

it may take slightly longer.

We're not actually gonna place the catheter today

because the patient here is not quite at that stage,

but so what we would do at this point

is put a little numbing medication here in the skin.

One thing that's really helpful is the positioning

of the spine here, and what we're trying

to get is a curve right down at the base.

So, Christina, if you can just, yeah,

curve over the baby like an angry cat,

and then curve, push once against me here.

That's beautiful.

So the curve, this is the area that we're trying

to get the curve into to help separate the bones

of the spine to make the gap bigger

for the catheter to go in.

Okay.

And then we use another needle

to help

get

this

thin, floppy

catheter into place

to drip medication right next

to the nerves coming out of the spine.

During this part you should only feel pressure,

sometimes a needle or a catheter may brush against the nerve

and cause a brief electric feeling similar

to when you bang your funny bone,

but nothing more serious than that.

Once the catheter's in place, we then secure it

with some tape,

up the back,

and over the shoulder

where we can connect it to the medication.

The soft catheter will then stay in your back

until you deliver your baby

with a constant infusion of medication.

The epidural can also stay in place

and be used in the event that you need a Cesarean section.

You can expect to slowly feel your contractions

becoming less intense and shorter,

and your legs may feel weak and heavy

like they've fallen asleep.

You'll also have your nurse place a catheter

into your bladder after you've had your epidural.

And many studies have shown

that an epidural does not significantly slow down labor,

and if it does, it only increases the second stage

of labor by a few minutes.

And there's no evidence

that epidurals increase the likelihood

of needing a Cesarean section.

Sometimes the epidural needs some fine tuning,

and one in every 10 women will need the epidural replaced.

Even with the epidural, you should expect

to feel pelvic pressure, especially

when the baby's head is low, and you're about to deliver.

And the ability to feel pressure is good

'cause it lets you know when it's time to push.

An epidural might decrease your blood pressure,

which might cause you to have nausea and vomiting,

so you'll be given IV fluids to try and prevent this.

And your anesthesiologist will watch your blood pressure

closely after you receive the epidural,

provide treatments if necessary.

You could develop a fever, or itchiness, shivering,

or experience temporary soreness at the epidural site,

which may last for several days.

But general back pain is not caused by epidurals

though it's common after any delivery.

Rarely, around one in a hundred or 1% of women

will develop a severe headache

called a post-dural puncture headache,

which can last for several days if not treated.

Serious complications after an epidural,

such as the misplacement of the catheter

into a vein, potentially causing seizures, is very rare.

A block at a higher level than intended,

requiring intubation and breathing assistance,

again, very rare.

Serious nerve injury: one in 20,000 to one in 200,000.

Bleeding: one in 40,000 to one in a million.

Infection: one in 20,000 to one in 200,000.

Or other life-threatening complications

are exceedingly rare.

Staying comfortable is an important part

of a positive birthing experience.

Your anesthesiologist is a pain-management specialist

who works with your obstetrician to help you safely

through the birthing process.

Feel free to discuss all your options for pain control

during delivery with your obstetrician and anesthesiologist

so that you can make an informed decision.

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