An epidural is a common method of pain management involving an injection into the epidural space, a region around the spinal nerves. The medication, typically a combination of local anesthetics and sometimes opioids, works by blocking nerve impulses from the lower spinal segments, creating a band of numbness from the belly button to the upper legs. This allows individuals to remain awake and alert, feeling pressure but not the sharp pain of contractions.
Ideal Timing During Labor
The timing for receiving an epidural during labor is flexible, without a single universally designated “perfect” moment. Healthcare providers typically recommend administration during active labor, a phase generally characterized by the cervix being dilated to 4 to 6 centimeters or more, accompanied by regular and intense contractions. However, current guidelines from organizations like the American College of Obstetricians and Gynecologists (ACOG) indicate that a patient’s request for pain relief is a sufficient reason for administration, regardless of cervical dilation, provided the individual can remain still during the procedure.
It is generally beneficial to request an epidural before labor becomes too advanced and pain becomes overwhelming. The procedure itself takes approximately 15 minutes for placement of the catheter, with pain relief beginning within 10 to 20 minutes and reaching full effect in about 15 to 30 minutes. Anesthesiologist availability can also influence the exact timing. Despite past concerns, recent studies suggest that receiving an epidural early in labor does not increase the risk of a Cesarean delivery or significantly prolong labor.
Situations Where it May Not Be Possible
While epidurals are considered a safe and effective pain relief option, certain medical conditions or circumstances may prevent their administration. Individuals with bleeding disorders, such as low platelet counts or issues with blood clotting, are typically not candidates due to an increased risk of hematoma, a collection of blood outside blood vessels. Similarly, those taking anticoagulant medications, or blood thinners, may need to discontinue them within an appropriate timeframe before labor to be eligible.
Infections at or near the injection site, or a systemic infection like bacteremia, also contraindicate epidural placement to prevent the spread of infection to the spinal area. Other factors include severe maternal hemorrhage, significantly increased intracranial pressure, or certain neurological conditions. Prior back surgery with implants or significant scar tissue can make proper catheter insertion challenging or reduce the epidural’s effectiveness. Finally, if labor is progressing very rapidly and delivery is imminent, there may not be sufficient time for the anesthesiologist to safely administer the epidural before the baby is born.
What to Expect During Administration
The administration of an epidural involves several distinct steps, typically performed by an anesthesiologist. Before the procedure begins, intravenous (IV) fluids are usually started to help manage blood pressure changes that can occur. The individual will then be positioned, either sitting up and leaning forward with their chin tucked, or lying on their side with knees pulled towards the chest; this posture helps to open the spaces between the spinal bones.
The anesthesiologist will clean the lower back area with an antiseptic solution to minimize the risk of infection. A small injection of local anesthetic is then given to numb the skin where the epidural will be inserted, which may cause a minor pinch or sting. Following this, a specialized needle is carefully inserted into the epidural space, located just outside the membrane surrounding the spinal cord. A thin, flexible tube called a catheter is then threaded through the needle into this space, and the needle is removed, leaving only the catheter in place, which is secured to the back with tape. Medication is then continuously administered or given in periodic doses through this catheter, providing ongoing pain relief throughout labor.