The epidural procedure
Ever wonder how an epidural is put in?
First, youll likely have an IV and about a quart of fluid to try and prevent a fall in blood pressure. The electronic fetal monitor will be used to pick up any problems that may arise (this is the external device that attaches to your belly with the stretchy bands). Your blood pressure will be closely monitored – in most hospitals the cuff will be placed and automatically take your blood pressure. You will be asked to get into position – either sitting on the edge of the bed or lying on your side. Your back will be cleaned off with antiseptic and covered with a sterile drape.
You will be asked to arch your back as a local anesthetic is injected, then a large needle will push between two vertebrae just above the level of your waist. It is vitally important that you hold absolutely still for this, even during contractions which are likely to occur during this time period. The needle will be guided in slowly and carefully feeling for the epidural space. Once placed, the anesthesiologist will perform one or more tests to ensure that the needle has not #1 pierced a blood vessel nor #2 gone below the epidural space which can cause life-threatening complications.
If all seems well, the anesthesiologist will guide a tiny flexible plastic catheter through the needle and remove the needle. Then the full dose of anesthetic will be injected, the catheter will be looped and taped to your back.
The quality of the anesthetic will be assessed. If it is unsatisfactory, you will be asked to shift position to redistribute the dose, or more may be injected. The area under anesthetic will be tested with pinpricks or ice.
If you are getting continuous infusion the catheter will be hooked up to a syringe which will be hooked up to a pump to deliver a continuous flow of anesthetic. Or, you may instead get periodic top-ups where the additional anesthetic is injected when you feel the return of pain.
Ideally, you’ll feel no pain with the epidural. However, some women experience pain only on one side of their body or windows of no anesthesia.
Ideally, when it comes time to push the anesthetic will be reduced so you can have a chance to push effectively.
The pain relief may not come for another 15-30 minutes after the epidural has been placed. This means you will be contracting during the procedure and for a while afterward. In many cases, the anesthesiologist is not available immediately when you request an epidural, so there may be a wait before s/he even gets to your room. If the epidural was not placed correctly, or the anesthesiologist has to make several attempts, relief will take even longer.
In the next segment, I’ll discuss the trade-off of epidurals. Stay tuned!