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FAQs - Epidural Analgesia

Q: Am I required to have an epidural?
A: No. An epidural is one option for pain relief during labor, but is usually done at your request and with your consent.

Q: What other methods of pain relief are available?
A: For some women, massage and breathing techniques may be adequate, and narcotic drugs are also available, although they might not provide as effective pain relief as an epidural. Your doctor may also inject a local anesthetic to the birth canal at the time of delivery.

Q: Are there patients who cannot have an epidural?
A: Certain medical conditions such as bleeding disorders, infections at the site of epidural, spine surgery or disease of the nervous system might make an epidural unadvisable. You should discuss any concerns with your anesthesiologist.

Q: Is an epidural painful?
A: A local anesthetic, which stings for a few seconds, is injected under the skin before insertion of the epidural to make you more comfortable. You may experience a feeling of pressure in the back during insertion.

Q: Will the epidural slow my labor?
A: The dose and timing of an epidural are carefully tailored to your needs during labor. In fact, an epidural can improve the descent of your baby by relieving pain and relaxing the pelvic muscles.

There is controversy about whether epidurals and spinals will slow labor. This is not normally an issue during the first stage of labor (from the onset of regular contractions to full dilation of the cervix). However, it is possible that these techniques may prolong the duration of the second stage of labor (from full cervical dilation until delivery of the baby) by a few minutes.

The challenge of obstetric anesthesia is to make you as comfortable as possible without compromising your ability to push out your baby. To prevent this, we may slow or stop the infusion of epidural medication to enable you to regain some sensation of pushing and/or muscle strength. Because the epidural catheter remains in place, we can always administer additional doses if needed. Every woman is unique, and we will customize your pain relief to make you as comfortable as possible during the entire labor and delivery process.

Q: When should I have my epidural?
A: Most patients are able to receive an epidural once they are in adequate or active labor. Your provider will help you determine the best time for you, depending on your specific circumstance. An anesthesiologist is available for laboring patients around the clock to provide this service.

Q: How long does it take the epidural to work?
A: Normally, it takes 10 to 15 minutes for the epidural to take full effect. For women who receive the epidural in the active stage of labor, analgesia can take up to 20 minutes. 

Q: Will I be numb?
A: The goal of epidural anesthesia is pain relief rather than total numbness, which can lead to decreased ability to push the baby out. Most patients experience numbness or tingling after the initial dose of medication, then gradually less numbness but continued pain relief. Patients are often aware of their contractions, but they should not be painful. As labor progresses, especially close to delivery, you may experience more pressure; this is difficult to alleviate and attempts to do so can lead to ineffective pushing, which can delay delivery.

Q: Will the epidural/spinal last long enough?
A:  Yes. Epidural catheters are connected to a continuous infusion of medication that is stopped only after the baby is delivered. Except in rare circumstances, spinal anesthetics greatly exceed the time required for a Cesarean section.

Q: What if the epidural does not work?
A: The anesthesia team will assess the patient's response to the initial dose of medication. If the relief is not satisfactory, the epidural is reassessed. Options include administering additional medication, adjusting the catheter, or replacing the catheter.

Q: What if I need a C-Section?
A: Various factors influence the choice of anesthesia for a Caesarean section, but they are usually done under epidural or spinal anesthesia. You are numb from the level of the nipple line down, but will remain awake during the birth of your baby and your partner may be present.
If your baby needs to be delivered quickly due to an emergency situation or if epidural or spinal anesthesia is not adequate, general anesthesia may be necessary. (read more)

Q: Will any of these the medication affect my baby?
A:  Medications used for labor and delivery are safe and normally do not affect the baby. Spinal and epidurals can cause the mother's blood pressure to decrease in the first few minutes, but your vital signs will be followed more frequently during this period and your anesthesiologist and nurse will closely monitor you and your baby throughout your labor and delivery.

Q: What are the risks and side effects of an epidural (or spinal)?
A: Some women experience a persistent headache. Other complications include incomplete anesthesia, low blood pressure, shivering and nausea. Recent studies have ruled out long-term back pain as a side effect of epidural anesthesia.

Q: What is a bolus?
A:  A bolus is the administration of additional medication(s) through an epidural to alleviate pain.

Q: What is a PCEA?
A:  PCEA stands for Patient Controlled Epidural Anesthesia and is a method that allows you to administer your own "extra" dose of medication if the pain intensifies.

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