Sensation and the ability to move are controlled by nerves that reach through your body. Information about pain, heat, cold, and movement travel along these nerves toward your spine. These stimuli cross the epidural space — the space which lies between the spinal cord and its protective bony spine — to the spinal cord,where they are transmitted to the brain. The brain in turn interprets these stimuli and the appropriate sensation is experienced. When anesthesia is delivered into the epidural space, these transmitted sensations are blocked.
Epidural anesthesia involves the repeated delivery of a local anesthetic into the epidural space. A skilled anesthesia care provider can easily place a needle into the epidural space and bathe the nerves carrying painful stimuli from the uterus in anesthetic, thus numbing the nerves from the uterus and birth passage.
To have your epidural catheter placed, you may be asked to lie on your side with your knees drawn upward, or sit with your chin tucked into your chest. It is important for you to keep your back rounded outward. Once you are positioned, your anesthesia care provider will wash your back with antiseptic, place a sterile drape over your back, and numb your skin with local anesthetic.
A needle will be placed into the epidural space, then a soft thin tube, or catheter, will be threaded through the needle. The needle will then be removed from your back, and the soft catheter will be secured into place so that you may move freely in bed without fear of dislodging the catheter. Your epidural will be connected to a continuous pump, which will deliver steady doses of anesthesia and can be turned up or down as needed.
Remember, the skin on your back will be numbed with local anesthetic before placement of the epidural. The amount of discomfort you may feel is comparable to that of an injection into your muscle, such as a tetanus shot.
The earlier you arrange for your labor epidural, the better. Arrangements should be made by your last trimester of pregnancy. Making your arrangements ahead of time does not mean that you are obligated to have a labor epidural; the decision will be yours.
Tell your physician about your symptoms. After your physician has spoken to you and has done a physical exam, you may need to have some testing done.
The majority of women can have an effective epidural for their labor experience. Here are some exceptions:
Though rare, there is the possibility of complications with epidural anesthesia. Your anesthesia care provider will discuss with you the risks of epidural based on your particular case.
The most common complications include:
Possible, but much rarer complications are: