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| |    Epidural Placement by Elisa Ross, MD reviewed by Marjorie Greenfield, M.D. If you have decided to get an epidural during the course of your labor, and if there are no medical reasons that would preclude epidural, your practitioner will tell you when the timing is optimal. Epidural placement usually occurs when labor is well established, which means strong regular contractions and cervical dilation of at least 4 centimeters. Benefits of an epidural In addition to providing excellent pain relief for labor with minimal risk to the mother or baby, a practitioner may sometimes actually recommend an epidural be placed for medical reasons. This is common in the case of twins, or if the possibility of cesarean delivery is strong. Sometimes the relaxation that a woman can get with pain relief can help labor to progress, and if she is holding back from pushing because of pain, she may actually push better with an epidural in place. Your practitioner may suggest this as a strategy if labor is not progressing well. How an epidural is placed You may be seated at the edge of your bed or lying on your side to receive an epidural. The area of your back is washed with a disinfecting solution. A surgical drape may cover most of your back. After the practitioner feels your back to find the best spot, an injection of numbing medicine is given. As a second, firmer needle goes in, many women feel pressure or a twinge. A small plastic sleeve (catheter) is slipped through the needle, and the needle is withdrawn. The catheter resembles the intravenous catheter which is used for IVs. The epidural catheter remains near, but not in, your spinal cord. Pain medicine is dripped through the epidural catheter onto the nerves as they emerge from the spinal cord. As labor continues, the amount of the medicine can be adjusted to obtain the right level of pain relief. Side effects of epidurals Commonly, after the epidural is placed, contractions seem to slow down. This may be due to the extra intravenous fluid given just before epidural placement. The contractions may come back on their own, or pitocin may be needed to restore their regularity. Another common, but undesired effect after epidural placement, is the temporary slowing of some babies' heart rates. This may be related to a temporary drop in the mother's blood pressure, and both usually resolve in a few moments with more IV fluid. The vast majority of epidurals are placed and function without problem. Commonly encountered variations include very dense pain relief, which also causes muscle weakness, or patchy or one-sided pain relief. In very rare instances, the pain medication can go where it is not intended. Medication can go into the spinal fluid rather than staying just outside of it, toward the top part of the body rather than to the lower part, or into the blood stream. The anesthesiologist watches for these complications and treats any problems that develop. The next day a small percentage of women experience a specific kind of epidural-related headache (called spinal headache). This can be treated with rest, or occasionally with a procedure similar to epidural placement, called an "epidural blood patch." Common questions about epidurals
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