How to receive an epidural

Considering an epidural for the birth of your baby? The following are the steps in receiving one.

Instructions

Difficulty: Challenging

1. Discuss with your care provider and anesthesiologist the risks and benefits of an epidural. Amongst some of the benefits will be the total loss of sensation in your abdomen, allowing you to progress through labor painlessly. For the risks, your baby's ability to breastfeed may be inhibited for up to 6 weeks after birth, you may lose sensation in more than just your abdomen, it may be completely inaffective, you may inadvertently receive a spinal which can lead to a spinal headache, and (this one is not agreed on universally) you may increase the likelihood of cesarean if you receive the epidural too soon. There are other side effects, some more serious, and you should discuss these with your care provider, or even do some research on your own before labor.
2. Dilate to at least 5 cm. The research on epidurals affecting progress in labor is a bit controversial right now and different parts of the birthing community have very differing opinions. If you'd like to ensure that you are on the safe side and you want to avoid a cesarean, wait until you are at least 5 cm before receiving an epidural.
3. Receive a foley catheter. You will be unable to get up and walk around with an epidural because you wont have adequate control of your legs.
4. When the anesthesiologist arrives and you're finished discussing everything with them, sit at the side of your bed with your feet on a chair. At this point, your partner may be asked to sit down or even leave the room. if you do not want your partner to leave the room, insist that they do not. Remember, you are the one in charge.
   
   *This whole process will last through several contractions. Because of your position while you're receiving the epidural, these contractions will be likely to be considerably more painful than ones before. Have your doula, partner or labor nurse support you through them.
5. The anesthesiologist will then clean your lower-middle back area, probably with an iodine solution.
6. The will then use a small needle to give you a small amount of numbing medication so that you do not feel the larger epidural needle.
7. At this point, you will be asked to hug your belly/legs so that your back is rounded out. This will increase the amount of space between your vertibrae and allow the doctor to more easily reach the epidural space.
8. The doctor will then insert the epidural needle. At the most, you should only feel a touch of pressure as the entire area will be numb.
9. As the doctor reaches the epidural space, they will withdraw a tiny bit of fluid from the space they have inserted the needle into. This is to ensure that they have, in fact, reached the right place. If any blood goes into the needle, they know that they have "overshot their landing" and may need to adjust the needle's placement.
10. The needle will then be removed, leaving a tiny catheter in its place. At this point, you will also be given a tiny test dose of the medication so that the doctor can ensure you will not have an adverse reaction to the drug.
11. The catheter will then be taped along your back and over your shoulder so that the pump containing the medication can be placed nearby and continuously send medication through the catheter while you labor.
12. REST!!!! By the time you get to that magical 5 cm number, you may be a bit exhausted. Or perhaps you got to that point pretty quickly. Regardless, there will still be more hours ahead of you, and when you reach the point that it is time to push, its very important that you be ready for it. Pushing can last a half hour, it can last 3 hours. It just depends on your baby and your body, so you need to be well rested if you can be.

Tips & Warnings

• It is likely you will immediately feel a slight difference, but it could take up to a half hour before you feel complete relief.
• The epidural is named for its placement in the space existing before your dural space in your spine. If you were to receive a spinal, you would get that in your dural space and it would work more quickly. During labor, epidurals are likely to be safer for you.
• In a low risk, normal labor and delivery, unmedicated is always most effective and safest for you and your baby. While there is a lot of research out there, there will never be 100% definitive research defending the point that an epidural in no way effects baby short or long term. So weigh the benefits and consequences thoroughly, and if you're hoping to avoid an epidural, rally up the right support for your labor experience. Take your partner to a childbirth class and be sure to hire a doula (the only thing proven to reduce the incidence of cesarean and shorten the length of labor). For more on doulas, visit http://www.dona.org.