A labor epidural is a means of providing pain management for the duration of the mother's labor and delivery while maintaining the safety of the birthing process. It can also be used to provide surgical anesthesia if a cesarean section and/or postpartum tubal ligation is necessary. You should not eat or drink after your labor contractions begin, regardless of your plans for pain control or delivery.
How labor epidurals are administered
Once the mother is having an established pattern of labor, a member of the anesthesia staff can be called to place a labor epidural. After a brief period of inquiry, examination and discussion, the mother positions herself in a sideways, or more often, a sitting position. Her back is then cleaned and draped and a small amount of local anesthetic (numbing medicine) is injected into the skin of the lower back. Through this now-numb area of skin a needle is inserted until the epidural space is found. A narrow plastic catheter is then placed through the needle and into the epidural space, where it remains for the remainder of the labor and delivery. The needle is removed and local anesthetic is administered through the catheter. Additional local anesthetic and sometimes narcotic pain medication are then continuously infused through the catheter until the baby is delivered.
Serious adverse effects of labor epidurals are uncommon, but include seizures and heart problems if the medicine is inadvertently injected directly into the bloodstream, and total body numbing if injected directly into the spinal fluid. Careful attention to detail is used to help avoid these rare complications. The drugs used cross the placenta in small quantities, but most often only an insignificant amount reaches the fetus and usually is of no clinical consequence. A decrease in the mother's blood pressure can occur, but this, too, is usually of no clinical consequence and can be easily reversed or prevented most of the time. Post-delivery headache or backache occurs occasionally. There is also a small risk of bleeding, infection and nerve injury.
Effects on the progress of labor
Some anesthesiologists and obstetricians believe that labor epidurals can prolong labor, result in more frequent cesarean sections, and increase the possibility of requiring the use of forceps or suction devices for delivery of the baby. On the other hand, sometimes the pain relief provided by the labor epidural seems to hasten the onset of delivery by allowing for a more productive pattern of labor.
Most practitioners have concluded that the labor epidural usually has little clinical impact on the progress of labor and delivery, but does provide the mother with excellent relief of pain in a safe, controlled and effective manner.
For more information, please call the obstetrics department at 513.524.5477.
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