Epidural Administration

First

Before you can receive an epidural medication, your blood will be drawn and evaluated. This is usually done upon admission to the hospital, but if you are expecting an epidural right away when you arrive be aware that you will most likely need to wait for the results.

If you have not already, you will begin receiving IV fluids to prevent a drop in blood pressure. You will be attached to an electronic fetal monitor to obtain a baseline strip recording your baby's heart rate. The monitor will remain attached to you until your baby is born.

The Epidural

Once everything is set up, you will need to get into a position either lying on your side or hunching over so your back is arched and must not move during the procedure which will last about two contractions (5 to 10 minutes). Your back will be washed with an antiseptic and covered with a sterile drape. You will receive a small amount of anesthetic to numb the injection sight. Once your skin is numbed, a large needle is pushed between two of your vertebrae just above your waist.

The anesthesiologist will guide the needle into the correct spot, and then test to make sure the needle is properly positioned. Once the needle is in the right space, a thin flexible tube is fed through the needle. The needle is withdrawn, leaving the tube in place. The medication is inserted through the tube, and the tube is looped and taped to your back to ensure it does not pull out.

After the tube is in place you will be assisted into a comfortable reclining position. You will be asked to rate the effectiveness of the pain relief, and depending on your questions you may receive more medication or be shifted to a different position. Depending on the preference of your care team, your tube may be connected to a pump that continuously infuses more medication into the epidural, or you may receive top up doses at regular intervals.

Monitoring

While the epidural is evaluated, you will be attached to a variety of machines that will monitor your response to the medications. An electronic fetal monitor will record your baby's heart rate. An automatic blood pressure cuff will record your blood pressure at regular intervals. A pulse meter will be placed on your finger to measure your heart rate.

Effectiveness

If at any time you experience a "window" of pain anywhere on your body, you should alert the nursing staff. Often the window can be eliminated by changing positions. Other times it is possible to increase the dose of the medication.

References:
Enkin, Keirse, Nilson, Crowther, Duley, Hodnett and Hofmeyr. A guide to effective care in pregnancy and childbirth Third Edition. 2000. Oxford: Oxford University Press.
Simkin, Penny. The Birth Partner: Everything You Need to Know to Help a Woman Through Childbirth. 2001. Boston: Harvard Common Press.

You May Also Be Interested In: What changes are being assessed during a cervical exam. The Natural Childbirth Directory can help you find more information about birth and locate childbirth professionals. The Coach's Notebook helps you learn tools and techniques to manage labor. Do some self exploration to discover how you will act in labor. Find out how exercise and nutrition can help you achieve your birth plan goals.

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