Epidural Analgesia for Labor & Delivery

What is an Epidural ?
Does the Epidural Hurt ?
With an Epidural what will I feel during labor ?
When can I have an Epidural ?
Do Epidural medications adversely affect my baby ?
Am I a good candidate for an Epidural ?
What if I need to have a C-section ?
Is a Spinal the same as an Epidural ?
What are some problems with Epidurals ?

What is an Epidural?
An epidural is a regional anesthesia technique used in labor and delivery for the relief of labor pain.
Position of the patient is very important to the success of an epidural. Epidurals are placed with the
patient on the side or in the sitting position. The patient will be helped to assume the correct position. An
epidural is performed using sterile technique under local anesthesia at the injection site. Local
anesthetics are injected into the epidural space and this "numbs" the nerves that cause labor pain. Most
labor epidurals are made "continuous" by placing a small soft tube or catheter into the epidural space
through the needle. This tube is secured to the patient's back with a sterile dressing. Epidural analgesic
medications are infused through this catheter to keep the patient comfortable during labor and delivery.

Does the Epidural hurt?

Since the Epidural Anaesthesia procedure is done under local anaesthesia most patients experience a
"sting" when the skin is anesthetized and some cramping in the back or hips when the epidural pain
medicine is injected. Some patients experience a paresthesia or "intense tingle" down to the foot during
placement of the epidural catheter. This is very brief and normal. The cause of this tingle is the brushing
of a spinal nerve by the epidural catheter when it is placed. This sensation may (or may not) occur and in
both instances is normal. Most patients find that epidural placement not as uncomfortable as they thought
it would be.

With an Epidural what will I feel during labor?

Epidural analgesia for labor and delivery produces a "numb" sensation over the abdomen and legs. The
feeling is much like that experienced during dental analgesia only in a different region of the body. This
numbness masks the discomfort of labor and allows the patient relief from the pain of labor. While
epidural analgesia has no major effect on awareness or mental functions, many patients are able to rest,
and in some cases sleep, until it is time to push. Many patients experience a pressure sensation with
uterine contraction. This is normal and in some cases preferred.

When can I have an Epidural?

You should discuss epidural analgesia with our health care professional during your prenatal visits.
Generally, you may have epidural analgesia for labor and delivery when you are in a regular labor pattern
and you and your health care professional feel you are ready. You do not have to decide whether or not to
have an epidural on arrival to the hospital.
Do Epidural medications adversely affect the baby?
The medications used for labor epidural analgesia do not cause any significant effect on the baby. The

amount of medicine transmitted from the mother to the baby by the placenta does not cause any
appreciable effect on the baby's Apgar scores or behavioral tests. Epidural labor analgesia has been safely
used to treat labor pain for many decades and has a good record.

Am I a good candidate for an Epidural?

The vast majority of patients are good candidates for epidural analgesia for labor and delivery. However
certain conditions, if present, could possibly make performing an epidural problematic. A partial list of
common conditions are:

True allergy to the medications used in an epidural

A disorder of blood clotting or serious abnormal bleeding
Delivery of the infant is in progress
A serious spinal deformity or extensive surgery to the spine
Infection at the site of injection
Serious neurologic disease: tumors, deformity, etc.
Inability to cooperate with the procedure

If you have concerns about you ability to have an epidural and are planning epidural analgesia to manage
your labor pain control, you may wish to consult with our healthcare provider and if necessary seek
consultation with our Anesthesiology department prior to your due date.

What if I need a C-section?

In most cases with a labor epidural in place, the epidural can be reinforced with additional medicine
injected through the epidural catheter to make the regional block stronger. A C-section can usually be
performed without an additional procedure. C-section with epidural anesthesia is very common and
regional anesthesia for surgical delivery of the baby is preferred.
In rare cases due to urgency of the C-section you may require a general anesthetic. Your obstetric health
care provider and your anesthesiologist will confer on this need and communicate it to you. The
anesthesia department is always prepared to perform a general anesthetic if required.

What are some problems with Epidurals ?

This section is not a substitute for informed consent for a labor epidural and is not exhaustively complete.
The purpose here is to discuss some general issues associated with labor epidurals.

Hypotension sometimes may occur after the epidural but is corrected immediately if at all it
occurs.

Soreness at the site of injection, like any other injection, is possible and normal. Chronic back
pain is not generally associated with labor epidurals. The incidence of back pain in patients after
delivery is similar for patients with and without epidurals. In fact, epidural injections are used to
treat chronic back pain disorders.

Spotty, "Hot Spot" or one sided epidurals do occur but infrequently. The factors involved are
generally individual to the patient's anatomy, epidural catheter location and response to the
medications. Generally, problems with lack of adequate analgesia can be resolved by additional
injections of medications through the epidural catheter or repositioning the catheter. Rarely, an
epidural will have to be replaced to provide proper analgesia.

Post-dural puncture headaches are, again, uncommon complications of epidural analgesia.

Patient movement, difficult anatomy or an abnormally small space could cause the needle to nick
or perforate the covering of the spinal space. The resultant leak of cerebrospinal fluid will usually
cause a headache. Conservative treatments for this headache include; hydration, rest, caffeine
containing fluids, and many others. The definitive treatment is to perform an "epidural blood
patch". The blood clots and this seals the hole. Performing a blood patch does not alter the
patient's ability to have an epidural for subsequent deliveries in the future.

Dr. Mahavir Gemavat