Epidural analgesia is one option available for managing pain during labor. It is a local anesthetic injected in the lower back. The function is to numb the nerves in the pelvis and legs. As with all anesthetics, epidural analgesia prevents the brain from experiencing the trauma and pain occurring in the body.
Epidural analgesia is performed by a trained doctor or nurse. The patient must sit up on the side of her hospital bed or lie on her side to expose the lower back. First, the patient will get a shot of Novocaine to numb the back. Then the nurse or doctor will inject a long needle into a very small area around the nerves in the spine, called the epidural space. A thin tube, called a catheter, is then threaded through the needle, and the needle is removed. The catheter is connected to a pump that is set to deliver the anesthesia throughout labor.
There are different types of epidurals available. The types are separated in two categories. The first category is local anesthetics. Bupivacaine hydrochloride, ropivacaine hydrochloride, and lingocaine hydrochloride are examples of epidural local anesthetics. The second category is opioids, which include morphine and fentanyl.
Advantages of an epidural are mostly centered around pain relief. The pain relief not only helps during the most intense pain of delivery, but it is also given during early labor. It is not uncommon for labor to last a long time, especially for first-time pregnancies. The pain relief in early labor can help the patient rest. Epidural analgesia can also speed up labor by relaxing anxious mothers to be. Lastly, an epidural is helpful if an emergency ceasarian section needs to be performed, as the patient is already numbed.
Any procedure done in or around the spinal chord comes with risk, no matter how routine. In a hospital, all needles are sterile, but this doesn't prevent all incidents of infection. Infection is rare, but it can cause paralysis and even death. There is also risk of the epidural injection damaging a nerve or being injected too high. Again, instances are very rare, but if the epidural is placed in the spinal fluid, it can permanently affect the patient's ability to breathe.
There are a few other disadvantages of an epidural. The epidural analgesia prevents the patient from feeling when her bladder is full, and so a catheter is required to drain the bladder. It also increases the chance of fever occurring during labor, which can cause problems for the baby. The epidural also weakens contractions, so more medicine may be needed to strengthen them.
Another risk to consider is that the baby may get stuck in a crooked position during labor, but because of the numbness, the patient can't move to adjust her baby's position. There is also a higher chance of needing an episiotomy, vacuum, or forceps to help labor. One of the more rare risks of an epidural analgesia is that it can cause a spinal headache one to two days after delivery. If this occurs, the patient will have to go back to the hospital for relief.
Every body responds uniquely to epidural analgesia. Some patients respond very well and lose feeling below the waist within minutes, allowing them to rest comfortably. Other patients continue to feel pain and pressure, despite the fact that they've lost feeling in their legs. There is no way to tell how someone will respond to epidural analgesia.