Labor Epidural FAQ

• Low Blood Pressure. Medication given into the epidural space may lower your blood pressure. When you’re in pain, your blood pressure rises. So a slight decrease in blood pressure with an epidural is not a problem because such a small decrease will only bring your blood pressure closer to what it was before you started having labor pain. But if your blood pressure drops too low, it may reduce blood flow to the placenta, which in turn may reduce the amount of oxygen delivered to your baby. If this should happen, you will be given fluids and/or medication through your IV to raise your blood pressure back to normal levels. This is why your blood pressure is closely monitored when you get an epidural.
• Slowing of the Baby’s Heart Rate. If your blood pressure drops too low with an epidural, it may reduce blood flow to the placenta and reduce the amount of oxygen delivered to your baby, which in turn may cause your baby’s heart rate to slow. If this should happen, you will be given fluids and/or medication through your IV to raise your blood pressure and your baby’s heart rate back to normal levels. This is why your blood pressure is closely monitored when you get an epidural. Keep in mind, though, that an epidural is not the only reason as to why your baby’s heart rate may slow down. There are other causes unrelated to an epidural that could slow down your baby’s heart.
• Itching Because of Medication. Medication given into the epidural space may cause you to itch. If this should happen, it is usually short-lived and should subside after 30 minutes. If it doesn’t, or if it is too unbearable for you, then you can ask for medication to help alleviate the itching.
• Inability to Urinate. One way in which an epidural blocks pain messages from traveling up the spinal cord to the brain is by blocking pain nerves that carry pain messages. In doing so, epidurals may also block nerves that tell the bladder to empty and so you may be unable to urinate with an epidural. This should be no cause for alarm because women in labor usually get a urinary catheter inserted into the bladder to drain their urine.
• Headache. Headaches from epidurals or spinals are caused by leakage of spinal fluid through the hole in the dura created by the epidural or spinal needle. The dura is the layer of tissue that surrounds the spinal fluid and keeps it in place. With an epidural, there is usually no hole created in the dura because every attempt is made, while inserting the epidural needle into the epidural space, to avoid puncturing the dura with the epidural needle. Despite best efforts, though, puncturing the dura with an epidural needle during epidural insertion still happens 1%-2% of the time. Should this happen, leakage of spinal fluid through the hole created in the dura usually results in a headache. With a spinal, even though a hole is created in the dura by the spinal needle to allow for medication to be injected into the spinal fluid, because the spinal needle has a very small diameter, the hole made in the dura is relatively small. That is why the chance of a headache with a spinal is very small. The headache from an epidural or spinal is usually worse when you sit or stand, so lying down relieves the headache. If left untreated, the headache will usually disappear on its own within 1 to 2 weeks as the hole in the dura heals. If the headache is mild, caffeinated beverages, medication such as ibuprofen and/or other over-the-counter pain relievers and bed rest will usually help relieve the headache. If the headache is severe, what is recommended is an epidural blood patch. An epidural blood patch is performed by drawing some blood from your vein and injecting it into the epidural space. The blood forms a clot to plug the hole in the dura and prevent further spinal fluid from leaking out. This usually relieves the headache.
• Back Soreness. You may feel soreness in the lower back at the place where the epidural needle was inserted. This soreness is similar to a bruise and usually fades away in a couple of days. It may be treated with acetaminophen. A heating pad may also be helpful.

Epidural medications do not remove the feeling of this pressure 100% of the time; it is important that you communicate clearly and often with your anesthesia providers if your sensations become painful so that they may adjust the dose and volume of the medication being delivered through your epidural catheter. The other approach to treating labor pain is to give pain medication into your bloodstream by injecting the medication through your IV. Medication given this way cannot block pain messages from reaching your brain. It can only blunt the perception of pain in the brain. Therefore, it is not very effective in treating the pain of labor when compared to an epidural. That said, there are instances when you may still feel the pain of labor after getting an epidural. Should this happen, every effort will be made to make you comfortable.

• Monitoring. Before you get an epidural, two devices will be placed on you to monitor your vital signs: a blood pressure cuff and a pulse oximeter probe. A blood pressure cuff will be placed around your upper arm. When the device takes your blood pressure, the cuff will briefly squeeze your arm very tightly. Your blood pressure will be taken every 5 minutes for about 30 minutes. A pulse oximeter probe, which resembles a cushioned clothespin, will be placed on one of your fingertips to measure the amount of oxygen in your blood and your pulse rate. Your baby’s heart rate will also be monitored while you get an epidural.
• Positioning. You will be positioned in one of two ways, either sitting or lying on your side. The purpose of both positions is to help you round out your lower back as much as possible. This outwardly curled position of your lower back widens the spaces between the spinous processes. Spinous processes are the little bumps that you can feel running down the center of your back. When the spaces between your spinous processes are widened, it is easier for the epidural needle to be directed toward the epidural space. If you are in a sitting position, you will be asked to dangle your arms in front of you. This relaxes your shoulders forward and helps push out your lower back. If you are lying on your side, you will be asked to curl into a fetal position.
• Cleaning and Numbing. Once you are in position, your back will be cleaned with an antiseptic solution. This solution will feel cold on your back. Then a drape will be placed over your back. The skin over the area of your back where the epidural needle will be inserted will be numbed by injecting a small amount of numbing medicine into the skin. As the numbing medicine is injected, you will feel a slight sting and burn for just a few seconds. Most women say that this is the only uncomfortable part of the epidural procedure and that it hurts less than having an IV inserted.
• Epidural Needle Insertion. After the skin over your back has been numbed, the epidural needle will be inserted through the numb area. You will feel a sensation of pressure when the needle is inserted, but you shouldn’t feel pain. If you do feel pain, you should tell the anesthesia provider so that he or she can give you more numbing medicine. Once the epidural needle is in the epidural space, a tiny catheter will be threaded through the needle into the epidural space. This catheter is a thin and flexible tube through which medication will be given into the epidural space. As this catheter is being inserted into the epidural space, you may experience a “funny bone”-like sensation in your back, hip or leg. If this happens, it will pass quickly and should be no cause for alarm. After the catheter is inserted, the needle will be removed, leaving a few inches of catheter in the epidural space. Then the portion of the catheter that is outside your back will be secured to your back with adhesive tape.
• Delivery of Pain Medication. The end of the catheter that is outside your back will be attached to a device that will continuously deliver medication into the epidural space to maintain continuous pain relief throughout your labor and delivery. With an epidural catheter in your back, you do not have to worry about lying on your back or moving around.

• You May Need More Medication. The standard dose of medication that is given will provide pain relief in most women. However, certain women may experience greater labor pain than the dose of medication that is given. If this is the case, you will be given more medication to help relieve the greater pain you experience.
• The Position of Your Baby. If your baby’s face is looking in the direction of the ceiling and the back of the head is facing the opposite direction, you may experience pain in your lower back that may be difficult to treat with an epidural. Also, if your baby happens to be pressing directly on a nerve, it may be difficult to treat this type of pain with an epidural. However, every effort will be made to make you more comfortable.
• Rapid Progression of Your Labor. The more labor advances, the more it hurts. In most women, the dose of epidural medication that is given is sufficient to alleviate the increasing pain they experience as their labor progresses. However, on occasion labor may advance so rapidly that the dose of medication given may not be enough for the rapidly increasing labor pain. Should this happen, you will be given more medication to make you more comfortable.
• Pain Relief on Only One Side of Your Body. If the tip of the epidural catheter is too far over to one side in the epidural space, then medication may get only to one side of the spinal cord. In this instance, you may still experience pain on the other side of your body. Should this happen, the epidural catheter will be pulled out a bit to bring the tip closer to the center to deliver medication to both sides of the spinal cord and achieve pain relief on both sides of the body.
• Dislodging of the Epidural Catheter. If an epidural stops working after some time, it may be because the epidural catheter may have come out of the epidural space. If this happens, the catheter will be reinserted.