Have you ever wondered where does an epidural go when you get one during labor?
As your due date approaches, it’s normal to have some questions and maybe a bit of anxiety about this commonly used intervention method. But what exactly is an epidural and how does the anesthesiologist get the catheter in there?
In this series on epidurals, we’ll walk through everything you need to know about epidurals so you can feel informed and confident in your birth choices. Understanding the details of how this technique works can help put you at ease about what to expect if you do opt for an epidural.
What Is an Epidural?
An epidural is an injection in your lower back that blocks pain signals from your lower body. It’s commonly used during childbirth, but also for other procedures. The epidural is the most popular method of pain relief used in many countries.
It is a regional anaesthesia which blocks pain in particular parts of the body. Epidurals block the nerve impulses from the lower spine, resulting in numbness in the lower half of the body. In most high-income countries, epidurals are requested by around 50% of women giving birth in hospital settings.
How Is an Epidural Administered?
If you decide to have an epidural, it will be administered to you by a specialist called an anaesthetist. An anaesthetist is a physician specifically trained to provide pain relief during childbirth and surgical procedures. If your hospital has an anaesthetist on call 24 hours a day, you will probably not have a long wait before your epidural can be placed. Here’s how an epidural is placed:
- You will be asked either to lie on your left side or sit up and curl over a pillow. Either position will encourage you to arch your back so the anaesthetist can find the correct place to insert the epidural.
- You will need to stay as still as possible during the procedure, to assist the anaesthetist in placing the epidural correctly, and to avoid any problems. If you have any contractions during this time (and it’s likely to happen), let the anaesthetist know.
- An antiseptic cleaning solution is used to wipe your back; this helps sterilise the area and prevent infection.
- A local anaesthetic is injected into your skin to numb the area. This may cause a quick stinging sensation.
- An anaesthetist will insert a hollow needle into the space outside your spinal cord in the lower back, called the epidural space.
- You will feel some pressure as the epidural needle is then inserted into this numb area. It can take a few minutes for the anaesthetist to find the epidural space.
- A small tube, called an epidural catheter, is then threaded through the needle into that space.
- The needle is removed, leaving the catheter in place. The catheter is taped to your back to prevent it from becoming dislodged.
- Pain relief medication, usually a combination of local anesthetic and sometimes an opioid or narcotic, is administered through the catheter. This allows you to remain awake but without pain.
- The medication starts working within 10 to 20 minutes, numbing the nerves that transmit pain signals from the lower part of your body to your brain.
- You’ll remain awake and alert and should be able to move your legs, but you may feel heaviness. You should not feel any pain below the point of administration from this point on.
- The epidural catheter can remain in place for the entire procedure if needed and additional medication is given to provide continuous pain relief. It is removed once it’s no longer needed.
- The level of numbness depends on the concentration and amount of medication used. An epidural can provide relief for hours and additional doses or adjustments are often possible.
Epidurals do come with risks, like headaches, but serious side effects are rare when administered by an anesthesiologist. For many, the benefits of pain relief and a better overall birth experience outweigh the potential downsides. If you have questions or concerns, don’t hesitate to discuss them with your doctor.
So, Where Does An Epidural Go?
A small tube (catheter) is threaded through the epidural needle into the epidural space around the spinal cord. You should feel no pain, or perhaps a split second jolt down one leg, similar to how it feels when you hit your elbow.
If you have a regular epidural, the needle is carefully removed once the catheter is in place. The catheter is then taped to your back to prevent it from slipping out, and medication is inserted into the epidural space. Depending on the type of anaesthesia you are having, the medication is inserted either continuously or intermittently. Regular epidural anaesthetic takes about 20 minutes to work.
If you opt for a combined spinal epidural (CSE), otherwise known as a ‘walking epidural’ the anaesthetist will inject an initial dose of anaesthetic beneath the outermost membrane which covers the spinal cord (intrathecal area). The needle is then pulled back into the epidural space and the catheter inserted. The spinal injection provides pain relief within five minutes and the epidural anaesthetic will provide pain relief long-term.
If you wish to avoid having an epidural during labour, the best way is to choose care providers and a birth setting that encourage and support natural birth. Be informed about how labour works. Hire a doula to help you achieve an active labour, and find out what natural pain relief methods are available to you.
Why we use Epidurals?
Epidurals provide much needed relief during labor by numbing the lower part of your body. Why We Use Epidurals
An epidural is administered for two main reasons: to relieve pain and allow you to rest during early labor, and to prepare for delivery of the baby. The epidural medication, usually a mix of anesthetics and narcotics, is delivered through a catheter placed into the epidural space located in your spinal canal.
Once in place, the epidural quickly eases pain from contractions in the uterus, vagina and perineum. This reprieve from discomfort allows you to relax, sleep, and gather your strength for pushing when it’s time to deliver. The epidural also makes the delivery process more pleasant since you won’t feel the full intensity of contractions or the baby descending.
Some women worry an epidural may slow down labor or make pushing less effective. However, studies show epidurals do not usually impact the overall length of labor or your ability to push. The pressure and sensations of the baby moving down the birth canal are still felt, even with an epidural. You will feel the urge to push when fully dilated, though without the agonizing pain.
An epidural provides the best of both worlds: relief from the worst of labor pains while still allowing you to remain awake and alert to experience the joy of your baby’s birth. By managing discomfort during this challenging yet rewarding experience, the epidural helps ensure your labor story is a positive one.
Recommended Reading: Epidural During Labour – Everything You Need To Know.