Labor Epidurals
A labor epidural involves the placement of a narrow plastic tube in the lower back. This tube, the “epidural catheter”, allows the delivery of local anesthetic in proximity to nerves to lessen the pain associated with labor and contractions.
The epidural catheter is placed below the spinal cord.
Epidural medication is the most effective mechanism for pain relief during labor.
An epidural catheter can be used for emergency cesarean deliveries if the need arises.
It generally takes 5-20 minutes to get good pain relief after the successful deployment of an epidural catheter. It generally takes 10-15 minutes to set-up equipment and successfully place an epidural.
After the epidural catheter is placed, a special pump administers medication until delivery. A button attached to the epidural pump allows for additional doses of medication if needed.
As with any procedure, the risks of epidural catheter placement are not zero. However, the benefits of getting an epidural are far greater than the risks.
Serious risks include:
- Blood clot or “hematoma” in the spine = 1:170,000 to 1:1,000,000
- Infection = 1:50,000 to 1:100,000
- Nerve damage = 1:250,000
Less serious risks include:
- Headache = 1:100 to 1:500
- Lack of pain relief = 1:10 to 1:50
- Catheter in wrong location = rare
First, a small needle is used to “numb” the skin; this feels like a brief “stinging” sensation. Next, “pressure” will be felt in the area the anesthesiologist is working.
An epidural may increase the “pushing” stage of labor by approximately 30 minutes.
A labor epidural should not increase the risk of a cesarean delivery. However, epidural anesthesia may slightly increase the risk of delivery with a special tool such as a vacuum.
- A drop in blood pressure may occur following epidural placement; fluids and medications may be used to resolve low blood pressures.
- Itching.
- A sensation of “heaviness” in both legs.
- Soreness in the back which may last for a few days. Long-lasting back pain is not caused by epidurals; back pain is common after pregnancy secondary to physiologic changes in maternal ligaments and muscles.
- “Sleepiness” may be experienced following epidural placement secondary to pain relief.
- Epidural anesthesia offers effective pain relief for all stages of labor.
- The small amounts of local anesthetics and opioid analgesics utilized in epidural anesthesia result in very little medication entering the patient’s bloodstream. Unlike IV pain medications, labor epidurals are less likely to cause sedation or drowsiness.
- Pain relief may allow the patient to “rest” for periods during labor.
- Epidural anesthesia lowers “stress” hormones by decreasing pain; lowering “stress” hormones assists in lowering blood pressure and heart rate during labor.
- Epidural catheters can be used for cesarean delivery without patients needing to go to sleep with general anesthesia.
Labor Epidurals and Spinal Anesthesia in Patients with Scoliosis
Yes, having scoliosis does not prevent someone from getting a labor epidural. The presence of scoliosis may make epidural placement more difficult (or even impossible); though, a majority of patients with scoliosis are able to receive successful epidurals.
Risks of epidural placement are similar in patients with or without scoliosis; though, the risk of “partial” pain relief may be higher in patients with scoliosis.
Yes, patients with scoliosis can receive spinal anesthesia for cesarean delivery. If a spinal anesthetic cannot successfully be placed, a general anesthetic can safely be used for surgical anesthesia.
Administering spinal anesthesia in a patient with scoliosis and/or a history of surgery for scoliosis may be technically more challenging; though, absent contraindications (blood-thinning medications, low platelet count, etc.), an attempt at spinal anesthesia can be undertaken.
Pain control via IV pain medications or nerve blocks can be discussed with the anesthesiologist in the event a spinal anesthetic cannot be placed.
Cesarean Delivery
Either spinal anesthesia or epidural anesthesia may be utilized for cesarean delivery.
In the event a cesarean delivery is needed during the course of labor, an effective epidural catheter already in place may be utilized for surgical anesthesia by administering additional doses of medication.
Spinal anesthesia is utilized for cesarean delivery if an epidural catheter is not already in place.
Spinal anesthesia is similar to an epidural, but medication is administered in the spinal fluid, below the end of the spinal cord.
Unlike an epidural, no catheter is left behind following the injection of medication into the spinal fluid.
Long-lasting pain medication is often given in the spinal fluid to assist with pain management following cesarean delivery.
Spinal anesthesia takes effect quickly, with “numbness” starting in the feet, and subsequently rising to approximately the level of the mid-chest. Patients will often not be able to move their legs for 1-2 hours following the administration of a spinal anesthetic.
Patients receiving spinal anesthesia will continue to feel touch, pressure, and other sensations; however, the spinal medication will prevent the patient from feeling “sharp” pain during cesarean delivery. The surgeon will examine the patient prior to beginning surgery to assure that “sharp” pain sensations are appropriately blocked.
Risks of spinal anesthesia are similar to the risks of receiving a labor epidural.