An epidural is usually given by:

• An anesthesiologist (a doctor who specializes in pain relief) or
• A nurse anesthetist (a registered nurse with special training in pain relief).

Before giving you the injection, the doctor or nurse will numb your lower back with a local anesthetic. While you are sitting or lying on your side with your back curved outward, the doctor or nurse will insert the needle for the epidural. He or she will then pass a small flexible tube called a catheter through the needle. You will probably feel some pressure as the needle is inserted, but it usually isn't painful. The needle is then removed, leaving the tube in place so you can receive more medication as needed.

An epidural takes about 20 minutes to administer and another 20 minutes to take effect. Although an epidural block will make you more comfortable, you may still be aware of  contractions. You also may feel your doctor's examinations as labor progresses.

The epidural may cause temporary numbness or heaviness or weakness in the legs. So you probably won't be able to walk around once the epidural takes effect. But there is an option called a “walking epidural.” It provides pain relief, but leaves you with enough strength in your leg muscles to walk during labor.

Advantages
Advantages include:

• The epidural blocks pain in the lower body.
• It can be used for several hours.
• It does not slow labor very much.
• You remain awake and alert.

Drawbacks
An epidural block has some disadvantages. One problem is that it may provide uneven pain relief, affecting one side of the body more than the other.

While complications or side effects from epidurals are rare, the following risks are possible:

• Your blood pressure can drop during an epidural. This may slow your baby's heartbeat. To prevent this, you will receive extra fluids through an intravenous (IV) tube. You may also need to lie on your side to improve blood flow.
• If you receive extra fluids, the risk of shivering increases. Even without an epidural, shivering can occur during labor and delivery. Covering up with a blanket often helps.
• After delivery, you may be sore from the epidural injection. This usually lasts just a few days. An epidural should not cause long-term back pain.
• You may get a bad headache. If not treated, this “spinal headache” may last for days. Fortunately, this rarely happens.
• If an epidural is given late in labor or a lot of anesthetic is used, you may find it hard to push your baby through the birth canal. If this happens, the dosage of medication can be adjusted.

For more information, read Coping with Labor Pain.

January 2007