Anesthesia During Labor

An epidural catheter is a thin tubing, about the size of a fish line that is inserted into your lower back. The tip of the catheter is positioned in a unique spot called the epidural space. The epidural catheter allows anesthesiologists to deliver very potent numbing medication close to the nerves that are responsible for the discomfort associated with childbirth. Importantly, unlike pain medications, the medication you receive from an epidural catheter does not reach the baby and does not produce the sedative effects that would otherwise make it more difficult for the newborns to transition to breathing on their own following delivery.

Having an epidural catheter is not a requirement for childbirth. Many women will choose to give birth without an epidural catheter; however, having one will significantly decrease the pain associated with labor and delivery. In addition, many women feel that the comfort received by the epidural catheter allows them to have a better overall experience, helping them be more present and in the moment during labor and delivery.

Another important benefit of an epidural catheter is the decreased chance of the need for general anesthetic, which means using full anesthesia, including a breathing tube, in case an emergency cesarean section is required. On rare occasions, if the mother or the baby is not doing well around the time of the delivery, the doctors may need to urgently deliver the baby via cesarean section. If the mother already has an epidural catheter, in many cases, that catheter can be used for anesthesia during the cesarean section instead of the general anesthetic. Multiple studies have demonstrated that regional anesthesia, such as spinal block or epidural catheter is much safer for the mother and the baby than general anesthesia.

Everyone’s anatomy is different. In general, placement of an epidural catheter takes a few minutes. On occasion, the anatomy is challenging, and it may take a little longer. The most uncomfortable part of an epidural catheter placement is the skin-numbing medication, which can result in a burning sensation similar to the placement of an IV that lasts for a few seconds. Most women describe the discomfort of an epidural catheter placement as “weird pressure” and they may experience a few “nerve zings” in their back or legs.

As we consider medical interventions, we always want to make sure that the benefits of the procedure outweigh the risks; however, potential risks are still possible. When breaching skin, there is always a chance of bleeding and infections but we take special precautions to minimize these risks. The risk of a serious complication that could lead to lasting effects is extremely low. There is a very small chance of a headache that may need to be treated with a separate procedure. The main risk is that the epidural catheter may not have the desired pain relief and may need to be adjusted or replaced.

The decision of when to get an epidural catheter is made in coordination with you, the OB doctor, the L&D nurse, and the anesthesiologist. In general, you would not want to get the epidural catheter before you are making progress with your contractions and cervical dilation. At the same time, the safety and comfort of epidural catheter placement is to a large degree dependent on your ability to position yourself. If you choose to request the epidural catheter when the contractions are so intense that you are unable to remain still, the process of placement will be less safe, less comfortable, and may take longer.

It is important to have realistic expectations. The epidural catheter significantly decreases the pain associated with the labor and delivery but you will still feel intense pressure. This pressure is important because without it, it is very challenging to push the baby.

Depending on the approach indicated in a given clinical situation, the epidural catheter may take anywhere from one minute to 20 minutes to take full effect.

The epidural catheter is connected to the pump that delivers the medication to the nerves. The pump can supply the epidural pain medication for as long as needed during the labor and delivery process.

Once the epidural catheter is in place and working, your legs will begin to feel very numb, heavy, and tingly. You will not be able to get up from the bed but you should still be able to feel the movement of your legs. If you are approaching the point where you cannot move your legs at all, let your nurse know right away and they will slow down the medicine.

On rare occasions, the epidural catheter does not produce the desired pain relief in which case the catheter may need to be adjusted or replaced.