Labor Epidural

Facts About Labor Epidurals

Benefits:

• It’s the most effective form of pain relief for labor.
• It’s the least likely to have an effect on your baby.
• Mother is completely awake and aware.
• It can be used in an emergency cesarean; therefore, it avoids the risks of general anesthesia.
• American College of OB/GYN and American Academy of Pediatrics recommends it as the most effective and least depressive form of labor analgesia for the baby.

Risks

• Failed or inadequate block – may need to be replaced (5-10 percent).
• Itching (20 – 75 percent).
• Shivering (can happen without epidural too).
• Nausea or vomiting (<1 percent).
• Decrease in blood pressure (5 – 10 percent).
• Difficulty moving legs (varies greatly depending on dose).
• Spinal headache (1 percent) – can be treated with separate procedure.
• Temporary nerve injury lasting days to weeks (one or two in 10,000).
• Accidental high block, often called a “high spinal” (one in 15,000).
• Some complications are possible but are VERY RARE (one in 100,000), including epidural hematoma, abscess (infection), meningitis, permanent nerve injury, IV toxicity and seizure.
• Cardiac arrest or anaphylaxis (extreme allergic reaction). The incidence is one in 500,000.
• Death. Anesthesia is one of the rarest causes of death in pregnancy (one in a million).
• Temporary tenderness at epidural site. Not associated with long-term back pain.
• Transient changes in the baby’s heart rate (a non-specific indicator of fetal well-being) may occur from positioning, changes in uterine tone, changes in blood pressure or a combination of the above that may be directly or indirectly related to the epidural.

Instructions for Labor Epidural

How to use your epidural:

A pump will deliver a dose of medicine in your epidural once an hour. You’ll have a button allowing you to self- administer additional medication as you need it. How often varies from person to person, ranging from often to rarely. By controlling your own analgesia (pain relief), you should get just the right amount of medicine to make you comfortable but not too numb. When you feel any discomfort, be sure to push the button – don’t wait to press it until you’re hurting.

What to expect from your epidural:

A perfect epidural takes away the pain of your labor with a minimal amount of numbness. It will make you feel tightening in your abdomen with contractions and a little pressure in your bottom or perineum, but you’ll still be able to move your legs.

If you’re still experiencing pain, an anesthesia provider will assess you and probably give you stronger medication. This may make your legs numb, and it can sometimes make pushing harder if it’s given close to your baby’s delivery. Your epidural shouldn’t affect the strength of your pushing, but it may require more mental effort.

If the epidural doesn’t seem to be working well, we may recommend replacing it. When you’re close to delivering your baby, epidurals sometimes seem less effective for the pain and pressure you may have in your bottom. The nerve roots that supply your bottom (the sacral nerve roots near your tailbone), are more resistant to the medications than other nerves. We’ll do our best to minimize your pain, but this can sometimes be difficult.