Epidural anesthesia is the most popular means for pain relief during labor. In fact, more women
ask for an epidural by name than any other method of pain relief. Over 50% of women giving birth at hospitals use
As you prepare yourself for “labor day”, learn as much as possible about pain relief options so
you will be equipped and ready to make decisions throughout your birth experience. Understanding the different
types of epidurals, how an epidural is administered, and the benefits and potential risks of an epidural will
prepare you to make an informed decision for you and your baby as your birth unfolds.
What is epidural anesthesia?
Epidural anesthesia is regional anesthesia that blocks pain in a particular region of
the body. The goal of an epidural is to provide analgesia, or pain relief, rather than complete
anesthesia, which is total lack of feeling. Epidurals block the nerve impulses from the lower spinal
segments resulting in decreased sensation in the lower half of the body. Epidural medications fall into a class of
drugs called local anesthetic, such as bupivacaine, chloroprocaine, or lidocaine. They
are often delivered in combination with opioids or narcotics, such as fentanyl and sufentanil, to
decrease the required dose of local anesthetic. This way pain relief is achieved with minimal effects. These
medications may be used in combination with epinephrine, fentanyl, morphine, or clonidine to
prolong the epidural’s effect or stabilize the mother’s blood pressure.
How is an epidural given?
Intravenous (IV) fluids will be started before active labor begins and prior to the procedure of
placing the epidural. You can expect to receive 1-2 liters of IV fluids throughout labor and delivery. An
anesthesiologist, a physician who specializes in anesthesia, an obstetrician, or nurse-anesthetist will administer
your epidural. You will be asked to arch your back and remain still while lying on your left side or sitting up.
This position is vital for preventing problems and increasing the epidural effectiveness. An antiseptic solution
will be used to wipe the waistline area of your mid back to minimize the chance of infection. A small area on your
back will be injected with a local anesthetic to numb it. Then a needle will be inserted into the numbed area that
surrounds the spinal cord in the lower back. A small tube or catheter is threaded through the needle into the
epidural space. The needle is carefully removed leaving the catheter in place so medication can be given through
periodic injections or by continuous infusion.The catheter will be taped to your back to prevent it from slipping
What are the types of epidurals?
There are 2 basic epidurals used today. However, hospitals and anesthesiologists vary on the
dosages and the combinations of medication they use. You will want to ask your care providers at the hospital about
• Regular Epidural: After the catheter is in place, a combination of narcotic and anesthesia is
administered through either a pump or periodic injections into the epidural space. The narcotic, such as
fentanyl or morphine, is given to replace some of the higher doses of anesthetic, such as
bupivacaine, chloroprocaine, or lidocaine, which helps reduce some of the adverse effects of
anesthesia. You will want to find out your hospitals policies about staying in bed and eating.
• Combined Spinal-Epidural (CSE) or “Walking Epidural”: An initial dose of narcotic, anesthetic or
a combination of the two, is injected beneath the outermost membrane covering the spinal cord, and inward of the
epidural space. This is the intrathecal area. The anesthesiologist will pull the needle back into the
epidural space, threading a catheter through the needle, withdrawing the needle and leaving the catheter in place.
This allows you to move more freely in the bed and change positions with assistance. With the catheter in place you
may decide later to request an epidural if the initial intrathecal injection is not enough. You will want to find
out your hospital’s policy on moving around and eating/drinking after the epidural has been placed. With the use of
these drugs, muscle strength, balance and reaction is reduced. CSE should provide pain relief for 4-8 hours.
What are the benefits of epidural anesthesia?
Allows you to rest if your labor is prolonged
Relieving the discomfort of childbirth can help some woman have a more positive birth experience
Most of the time an epidural will allow you to remain alert and be an active participant in your birth
If you deliver by cesarean, an epidural anesthesia will allow you to stay awake and also provide
effective pain relief during recovery
When other types of coping mechanisms are not helping any longer, an epidural may be what you need to
move through exhaustion, irritability, and fatigue. An epidural may allow you to rest, relax, get
focused and give you the strength to move forward as an active participant in your birth experience.
The use of epidural anesthesia during childbirth is continually being perfected and much of its success
depends on the care in which it is administered.
What are the Disadvantages of epidural anesthesia?
Epidurals may cause your blood pressure to suddenly drop. For this reason your blood pressure will be
routinely checked to make sure there is adequate blood flow to your baby. If this happens you may need
to be treated with IV fluids, medications, and oxygen
You may experience a severe headache caused by leakage of spinal fluid. Less than 1% of women
experience this side effect from epidural use. If symptoms persist, a special procedure called a “blood
patch”, an injection of your blood into the epidural space, can be done to relieve the headache
After your epidural is placed, you will need to alternate from lying on one side to the other in bed
and have continuous monitoring for changes in fetal heart rate. Lying in one position can sometimes
cause labor to slow down or stop
You may experience the following side effects: shivering, ringing of the ears, backache, soreness where
the needle is inserted, nausea, or difficulty urinating
You may find that your epidural makes pushing more difficult and additional interventions such as
Pitocin, forceps, vacuum extraction or cesarean may become necessary
For a few hours after birth the lower half of your body may feel numb which will require you to walk
In rare instances, permanent nerve damage may result in the area where the catheter was inserted.
Though research is somewhat ambiguous, most studies suggest some babies will have trouble "latching on"
which can lead to breastfeeding difficulties. Other studies suggest that the baby may experience
respiratory depression, fetal malpositioning; and an increase in fetal heart rate variability, which
may increase the need for forceps, vacuum, cesarean deliveries and episiotomies.