Q: How early in labor can I get my epidural?
A: Epidurals are not usually started until a good active pattern of labor is present. Most commonly they are started when a patient is approximately 4-6 cms dilated. When a patient requests an epidural the obstetrician will decide if the time is appropriate.
Q: What happens if the epidural does not give me full relief?
A: Epidurals can be of great benefit in significantly reducing the pain experienced during labor and delivery. It is unrealistic, however, to believe that it will take away all pain or discomfort during the process. Some epidurals work better than others, and even a well functioning epidural usually does not take away the intense pressure felt during the delivery itself. The anesthesiologist will work with the obstetrician and the labor nurse to make the mother as comfortable as possible.
Q: Do the medications used reach the baby?
A: Medications given via the epidural do not go directly in the blood stream, they go into a space which surrounds the nerves coming off the spinal column. Only a very small amount of medication gets absorbed into the mother’s blood and not in an amount thought to affect the baby. The epidural may lower the mother’s blood pressure, however, and that can affect the blood flow to the baby, and that is why blood pressure is monitored very closely after epidural insertion
Q: Is there a point where I cannot get an epidural?
A: There is preparation time required prior to an epidural to start an iv and administer fluids. It also takes time to briefly review the patients history, insert the epidural, and time for the medication to start working. This time in total is typically 20-45 minutes. Therefore, if a patient is likely to deliver the baby within the next 30-45 minutes it is probably too late to have an epidural.
Q: Does an epidural slow down labor?
A: Epidurals can slow down labor, especially during the 2nd stage (pushing phase) of labor. The increase in comfort over this time, however, may outweigh the increase in duration.
Q: What happens if I get an epidural then need a caesarian section?
A: An epidural that is used for labor can also be used for anesthesia if a c-section becomes necessary. Additional more concentrated local anesthesia is usually injected into the epidural just prior to the operation. Spinal or general anesthesia is also available for backup if deemed necessary in the judgment of the anesthesiologist.
Q: Will a lower back tattoo affect my ability to have an epidural?
A: A tattoo should not interfere with having an epidural as long as it is not new and still healing. There is not much research on tattoos and epidurals, however, and there may be a slight risk of tracking pigment from under the skin into the epidural space which could cause irritation or infection. The epidural puncture site may also produce a small scar which could change how the tattoo looks in the future. For those reasons we try to avoid putting the needle directly through the ink, if possible.
Q: If I have mild scoliosis can I get an epidural?
A: Scoliosis does not prevent someone from having an epidural, however, the more severe the curvature, the more difficult it may be to get the epidural in place. It may take longer to insert, but failure is uncommon. People who have had rods surgically inserted in their backs to correct scoliosis are a different story, and those patients should talk to an anesthesiologist during their pregnancy to see if the location of the rods rules out having an epidural.
Q: What is Grand View’s policy regarding the support person staying in the room while the patient is being given the epidural?
A. One support person is allowed to stay in the room but must sit down on a stool directly in front of the patient.
Q: How long is the urinary catheter in place?
A: The decision to insert a urinary catheter is made by the obstetrician and can happen whether an epidural is in place or not. Typically the catheter is inserted to drain the bladder and then immediately removed, but this varies with individual patients.
Please contact the Grand View Anesthesia Department at (215) 453-4809 if you have additional questions that were not answered here.