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Epidurals What is an epidural? Who will insert my epidural? An anesthesiologist, or a resident doctor training in anesthesiology will insert your epidural I have a tattoo on my lower back; can I get an epidural? Yes, usually you can still get an epidural if you have a tattoo on your lower back. An epidural is a medical procedure used to decrease pain during labour How does an epidural decrease pain? Location of the epidural How is an epidural performed? The skin on your back is cleaned with an antiseptic solution Freezing solution is injected to numb the skin on your back A needle is placed in-between the bones of your lower back An epidural tube (catheter) is placed through the needle The needle is removed The tube stays in your back so you can get medication Pain in labour comes from irritation of nerves around your uterus and vagina The nerves send pain signals through the spinal cord to your brain The medication given through your epidural tube stops your nerves from sending pain signals to your brain When can I get an epidural? You can get an epidural any time once you are in labour and these things have been done: A nurse has been assigned to your care An intravenous line giving you fluids is in place While we try to get your epidural as soon aspossible, you may have to wait for your epidural if the anesthesiologist on call is busy with other patients. How long does it take to work? An epidural takes 15-20 minutes to be inserted, and 15-20 minutes for the medication to work. Size of the epidural needle Will I be able to push with my contractions? Most women are numb from the belly button down and don’t feel contractions well. If this happens, the monitor on your belly will show when you are having a contraction and the nurses will tell you to push. Will the epidural prolong my labour? Yes, some studies have shown that epidurals may prolong labour, particularly the pushing stage of labour. For women who get epidurals this stage takes on average 15 minutes longer. Will the epidural increase my chance of needing a cesarean section? Studies have shown that there is no increased risk of needing a cesarean section if you get an epidural. However, there is a small increased chance you will need a vacuum or forceps assisted delivery if you get an epidural. What are the side effects of an epidural? 30% of women may get low blood pressure 1-26% of women experience itchiness 15% of women develop a mild fever What are the complications of an epidural? What are the advantages of an epidural? Epidurals provide excellent pain relief Pain relief can give you time to rest until it is time to push When you get an epidural less stress hormones are released and blood flow to your baby is increased An epidural can be used for anesthesia if you require a cesarean section Will the epidural affect my baby? Most studies have not shown any negative effects on babies whose mothers get epidurals. Complication Headache Frequency 1 in 100 Infection 9 in 1,000,000 Bleeding 5 in 1,000,000 Permanent paralysis 4 in 1,000,000 When should I be concerned about these side effects and complications? Headaches: if you have a severe headache that gets better when you lay down, talk to your doctor Infection: if you develop a stiff neck, fever and headache, see your doctor Severe back pain: if you develop severe back pain over the epidural site see your doctor Please speak with your healthcare team if you have any further questions about epidurals. Epidurals This pamphlet was prepared by Chelsey King, BSc, MSc & Dr. Dolores McKeen MD MSc FRCPC, IWK Health Centre, Department of Women’s & Obstetric Anesthesia, Dalhousie University Medical School References: 1. Anim-Somuah M., Smyth RMD.,& Jones L. (2011) Epidural versus non-epidural or no analgesia in labour. Cochrane Database of Systematic Reviews, 12, CD000331. 2. Ruppen, W., Derry, S., McQuay, H., & Moore, RA. (2006). Incidence of epidural hematoma, infection and neurologic injury in obstetrics patients with epidural analgesia/anesthesia. Anesthesiology, 105(2):394-393 3. Eltzschig, HK., Ellice, MD., Lieberman, ES., &Camann, WR. (2003). Regional anesthesia and Analgesia for Labor and Delivery. New England Journal of Medicine, 348(4):319-332 IWK Department of Women’s & Obstetric Anesthesia, Halifax, N.S. PL-0803 Last Update: 10/13 Next Review: October 2016