What Is an Epidural Block?
An epidural block provides excellent
relief by blocking painful sensations between the uterus and cervix,
and your brain. Medication in the epidural prevents pain messages from
traveling up your spinal cord to your brain.
Focusing on your breathing can help you stay relaxed during labor.
An epidural is one of the most popular
anesthetics today and provides relief from the pain of uterine
contractions and delivery. It should be administered only by someone
trained and experienced in this type of anesthesia. Some obstetricians have this experience, but in most areas an anesthesiologist or nurse anesthetist administers it.
In 1986, only 10% of women in labor in
the United States received an epidural. Today, over 70% of women in
labor have an epidural.
While you are sitting up or lying on your
side, an area of skin over your lower back in the middle of your spinal
cord is numbed. A needle is placed through the numbed skin; anesthetic
flows through the needle and around the spinal cord but not into the
spinal canal. A catheter is left in place to deliver anesthesia. It can
take up to 25 minutes before you experience pain relief.
Epidural pain medication may be delivered
by a pump. The pump injects a small amount of medicine at regular
intervals or as needed. Many hospitals use patient-controlled epidurals
(PCEA)—you press a button for more medication when you need it.
You may have heard various things about
when an epidural can be given. Most healthcare providers believe an
epidural block should be given based on your level of pain. Most agree
a woman can have an epidural anytime after she begins active labor. You
may not be required to be dilated to a specific point before getting an
epidural.
Some medical conditions may keep you from
having an epidural, such as a serious infection when you begin labor,
scoliosis, previous back surgery or some blood-clotting problems. If
you have one of these problems, discuss it at a prenatal visit.
You may have problems pushing if you have
an epidural. But you should be able to feel enough pressure to push. An
epidural may increase the chances forceps or a vacuum extractor may be
needed during delivery.
An epidural block can make your blood
pressure drop. Low blood pressure may affect blood flow to the baby.
Fortunately, I.V. fluids given with the epidural help reduce the risk.
Studies have not shown epidural
anesthesia increases the risk of Cesarean delivery. And no link between
use of epidurals during labor and back pain after delivery has been
established.
On the average, epidurals slow labor by 45 minutes.
An epidural can
cause shaking, as well as itching and headache. There are remedies for
these problems. If you have trembling (nearly 50% of all laboring women
do), ask for blankets, a heating pad or a hot-water bottle.
If you itch, wait a bit. Itching is
usually mild and goes away on its own. Put pressure on the area with a
towel, or apply lots of lotion. If itching doesn’t go away, your
healthcare provider may recommend medication, such as naloxone (Narcan).
Very occasionally, you’ll get a headache.
Drink a caffeinated beverage, such as coffee, tea or a caffeinated
soda. Try resting on your back. If the headache persists for more than
24 hours, talk to your healthcare provider. If you become nauseous,
breathing deeply can help. Inhale through your nose, and exhale through
your mouth.
Combined Spinal-Epidural Analgesia (CSE). A combined spinalepidural analgesia (CSE)
uses epidural and spinal techniques to relieve pain. It is one of the
most popular epidural options. The combination provides the quick
relief of a spinal block, with the option of an epidural if your labor
is longer. It is sometimes called a walking epidural.
A walking epidural doesn’t have much to
do with walking. It refers to regional labor-pain relief in which a
woman maintains some strength in her legs. Few women actually walk
after receiving pain relief, although some may walk to the toilet,
while others use their legs to position themselves for delivery.
With CSE, there is a lower incidence of
spinal headache. There may be less numbness with a CSE. CSE can also be
delivered as PCEA.
