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Anesthesia Associates of Southern Connecticut

Epidurals for Labor and Delivery

Epidurals for labor are extremely common at Norwalk Hospital. Approximately 90% of first-time labor patients receive epidurals. Our anesthesiologists are extremely experienced in this very important technique. We have a staff anesthesiologist in the hospital at all times. Our response times are extremely fast, never exceeding 30 minutes from the time we are notified.

This is an old and reliable technique. As with spinal anesthesia, it is extraordinarily safe and has survived the test of time.

HOW IS AN EPIDURAL DONE

An epidural can be done in either the sitting position or on the side. Most of our anesthesiologists prefer the sitting position. Once you are positioned, the back is cleaned with an antiseptic such as betadine and a sterile drape is placed over the area.

A note about positioning: it is very important that you make your back as round as possible. Rounding your back will open up the spaces between the spinous processes.

The anesthesiologist will usually put his or her hands on your sides to feel the top of the hip bones - these are at the level of the 4th lumbar vertebrae (L4). Next, a thumb or finger will be pushed into your back to feel the spinous processes. These are the bumps you can see along the spines of thin people. Obesity and/or edema (fluid collection in the skin) makes the spinous processes more difficult to feel, so you may feel fairly hard pushing on your back.

Once the correct site is identified, the skin is numbed with a little injection of local anesthetic. The epidural needle is then inserted through the numbed skin and advanced until the epidural space is hit. This is usually painless or only minimally uncomfortable.

When the needle is correctly placed in the epidural space, a little medication is injected through the needle - this causes a pressure sensation in the back. Then a catheter (medical term for "tube") is inserted through the needle until it is about an inch or two into the epidural space. The needle is then removed, leaving the epidural catheter in place. The catheter is then taped to the back. Note that the catheter is about as thick as a strong kite string, so you do not even feel it when lying on your back.

Once the epidural catheter is secured, medication is injected through the catheter into the epidural space. The anesthetic usually is fully set up in about 15-20 minutes. What you will notice first is that the contractions will seem shorter and shorter, until they are barely noticeable.

While the anesthetic is setting up, a continuous infusion of medication is started with a special pump. This will keep the epidural working throughout the entire labor and delivery period.

After the baby is delivered, the anesthesiologist will come around and remove the catheter. This is entirely painless, except for the removal of the tape.

RISKS OF EPIDURAL ANALGESIA FOR LABOR

As stated before, labor epidurals are extraordinarily safe. In the past 20 years, there have been no major or permanent complications in any of the thousands of labor epidurals placed. However, you should know the risks, and they are listed below.

  • Headache - nationally, a spinal headache occurs in about 1:100 patients receiving a labor epidural. However, at Norwalk Hospital the indidence is far lower than this. The classic spinal headache is much worse when sitting or standing and relieved by lying down. Click here to read more. If the headache is mild, it can be treated conservatively - fluids, rest, and caffeine. If more severe, it can be treated with an epidural blood patch. Click here for description.
  • Low blood pressure - this is not nearly as common with epidural anesthesia as it is with spinal. It is usually not noticed by the patient.  The low blood pressure is quickly and easily corrected.
  • Nerve damage - nerve damage, including paralysis, is extremely rare. The reported cases almost always result from bleeding into the spinal canal as a result of anticoagulants (blood thinners). For this reason, anesthesiologists will not do a spinal if your blood has been thinned from anticoagulants or from disease. Blood thinners will need to be stopped for a period of time if epidural (or spinal) anesthesia is planned.
  • Minor complications - these include itching and nausea.
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