Epidural Pain Relief
Epidural Injection For Easing The Pain Of Childbirth

Epidural Pain Relief

Contents

• What Is An Epidural?
• When Is It Administered?
• How Is It Done?
• Does It Hurt?
• How Much Does It Cost?
• What Are The Side Effects?
• When Should It NOT Be Given?

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Guide To Childbirth

What Is An Epidural?

An epidural is a type of local anesthesia which is most commonly used for pain relief (analgesia) during delivery. The goal is local numbness, and not complete anesthesia. Statistics show that nearly 75 percent of women choose to have an epidural during birth in America, the remaining choosing a natural birth. The decision to have an epidural is best taken before severe pain begins. This allows preparation time so that drug can take effect in time for when contractions are at their strongest. Read about the pros/cons and possible side effects and consider your choices before labor. There are many videos and online forum discussions on the subject. An epidural is administered by an anesthesiologist directly into the lower spine. The process takes about 15-25 minutes. Epidurals provide some pain relief within 10 minutes but full effect can take up to 45 minutes. Pain relief however should last for the remainder of the stages of labor. The rise in popularity in recent years in epidural procedures is linked to its relative safety record and successful results. By relieving severe pain epidurals can help mothers have a more positive experience from childbirth and if labor is prolonged, the absence or reduction of pain makes it easier to rest for the duration. For those planning home births or waterbirths, an epidural is not usually an option.

When Is It Administered?

As soon as you indicate you are ready for an epidural the nurse calls an anesthesiologist. Depending on how busy the anesthesiologist is, it could take 15 minutes before they arrive. Also, the preparation steps can take an additional 25 minutes. This time lag is one of the reasons why some doctors suggest requesting the epidural before contractions become too severe. You can request an epidural at any point in labor, but most women request it by the time their cervix has dilated by 5cm or 6cm. On the other hand, many of the problems associated with epidurals are also associated with early labor. One study showed that Cesarean section rates were 11 percent in cases where an epidural was given at 5cm or more dilation. The rates were 16 percent at 4cm dilation and 28 percent at 3cm. Consequently, the longer a woman can labor naturally without medical intervention, the better off she usually is. You may even surprise yourself and complete labor without the planned epidural.

How Is It Done?

Step 1
Before the epidural is administered, the IV with fluids are started. This helps to keep blood pressure stable, as a possible side effect of epidurals is a drop in blood pressure. Additionally the IV will make administration of the drug pitocin easier. As one of the side effects of an epidural is longer labor, pitocin is sometimes administered to speed up contractions.

Step 2
A thin tube called a catheter is inserted into the bladder either before or after the epidural (hospitals have different policies). This helps to keep the bladder drained of urine as the epidural drug can suppress the need to urinate.

Step 3
The lower and middle back is wiped with a topical antiseptic such as betadine.

Step 4
An anesthetic is injected into the lower back to numb the area. Then, a large hollow needle is inserted between the bones of the spine into an area called the epidural space. The expectant woman must remain perfectly still, even through severe contractions. A thin tube called a catheter is passed through the needle. Once the tube is in place, the needle is removed. The tube is then taped up the back and over the shoulder so the woman can move again. The drugs are administered through the catheter. It may take 15 to 45 minutes before medication reaches full effect, but some relief can usually be experienced within 10 minutes.

Step 5
Blood pressure is continually monitored as well as fetal heartbeat.

Step 6
The epidural remains in place until after delivery of both baby and placenta. It can also provide pain relief if stitches are required after birth.

Does It Hurt?

It may be slightly uncomfortable. The nurse will reduce discomfort by numbing the site first with a local anesthetic before inserting the needle. During the insertion of the needle some women report a feeling of pressure or slight stinging, but others are so focused on their contractions they do not feel it at all. Once the catheter is in place, it should take about 20 minutes before the numbing takes full effect.

How Much Does It Cost?

Prenatal Care Costs: The average cost of an epidural is about $1200. If you are planning a hospital or birthing center birth, you will need to make this payment separately. If you change your mind during labor and decide not to have the epidural, the money is then refunded. Interestingly, studies show that private hospitals have a higher epidural rate than public hospitals. A study showed that when one hospital in New South Wales switched from public to private, their epidural rate doubled. In fact American epidural rates have increased in line with the move of more hospitals to the private sector.

What Are The Side Effects?

Prolonged labor is very common as a result of the medication used in an epidural. This can result in interventions becoming necessary such as the use of the drug pitocin to speed up contractions, the use of a forceps for delivery and the necessity of a cesarean section delivery being performed. Common complications or side effects include:

• Pushing: You cannot feel the urge to push, so your midwife will need to tell you when a contraction comes so that you can push.
• Risk of a Blood Pressure Drop: This can usually be prevented with IV fluids, but may also require other drugs and oxygen.
• Headaches for Weeks After Birth: In 1 percent of cases, severe headaches are reported as a result of leakage of spinal fluid. Where symptoms persist, a special procedure called a 'blood patch' can be carried out. This involves an injection of your own blood into the epidural space.
• Backaches: Common to 10 percent of all new moms, the rate jumps to 18 percent in moms who give birth with the aid of an epidural.
• Nerve Damage: In rare instances, there have been reported issues of permanent nerve damage in the area where the catheter was inserted.
• Feeling of Loneliness: Research shows that the labor coach, doula or birth partner is likely to be less attentive (standing further away) where the expectant mother is in less obvious pain.
• Other Side Effects: Which can appear during or after labor include shivering, nausea, difficulties in urinating, ringing in the ears and soreness or itchiness where the needle was inserted.
• Research: This has not been backed up with enough studies, but some initial findings indicate that babies born to unmedicated mothers are more sociable and easier to care for.

See also: Is An Epidural Safe?

When Should An Epidural NOT Be Given?

• If your cervix is less than 4cm dilated.
• If the epidural space cannot be located by the ob/gyn, midwife or physician.
• If you are hemorrhaging.
• If you use blood thinners to medicate an ongoing condition.
• If you have a low blood platelet count or a blood infection.
• If labor is moving so fast that there is not enough time to prepare for and administer the drug.

Related Articles on EPIDURAL PAIN RELIEF

For more on childbirth, see the following:

• C-Section Recovery: Recovery tips and advice for new moms.
• Early Signs of Labor: How to recognized the signs of true labor.
• Labor Induction: When a nature needs a little medical help.
• Natural Labor Induction Methods

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