Can anyone get an epidural?

Most patient that deliver are normal, healthy patients.  There are some patients who may not be eligible for regional anesthesia  because of co-existing medical conditions. Women who have bleeding disorders should not receive regional anesthesia because the procedure can cause bleeding into the epidural space, which may cause nerve injury. Women with severe infection can also develop nerve injury after regional anesthesia because of the introduction of bacteria into the epidural space.

Complicated back surgeries such as Harrington rods and spinal fusion can present unique challenges for the anesthesiologist and should be discussed in advance whenever possible. The anesthesiologist may need to request surgical notes or X-rays in advance of your labor. If you have a concern regarding one of  these issues, we will be happy to consult with you on the phone or in person.

When can I have my epidural?  

The timing of epidural placement may vary from woman to woman. Your obstetrician and the anesthesiologist will help you make this decision based on your health, progress of labor, past labor experience and the status of your baby. 

How long will the epidural pain medication last?

After an epidural is placed and medication is given, pain relief occurs within the first 5 to 15 minutes.  After pain relief is achieved, an epidural infusion is started to help achieve a steady level of epidural block for the entire labor.  For longer labors, sometimes additional bolus medication is required and anesthesia staff are readily available to care for your additional pain relief needs.  

Do I have to stay in bed once my epidural is started?  

As the epidural block begins to take effect, you will notice a warm tingly sensation in your legs and lower abdomen, as well as a “heaviness” in your legs.  It is not safe for you to ambulate after these changes take effect.  We therefore require all patients with epidural anesthesia to remain in bed.  

A CSE is a combination of an epidural and a spinal anesthetic.  The epidural is placed and a spinal narcotic is given through a separate needle before the epidural catheter is inserted.  This allows for a very light dose of pain relief to be given early and leaves the epidural catheter in place for additional pain medication that may be needed as labor continues. 

What is a “walking” epidural?

A “walking” epidural is a very light dose of epidural medication which results in minimal leg weakness.  Though we sometimes give these types of anesthetics, our patients do not actually ambulate.  Studies show walking with an epidural does not decrease the length of labor, therefore we routinely keep patients in bed after getting even  a “light” epidural. 

What if I need a Cesarean Section?  

If your epidural is in place from labor and you find you need surgery, we will need to increase the dosage of epidural medication to assure your comfort during the procedure.  As the dosage of your medication is increased you will notice that  your legs and lower body will become increasingly more difficult to move and you will loose sensation from your breast line to your toes.  This occurs over a twenty minute time period. 

When we assure you are ready for your surgery and we move you to the operating room.  Your surgeon will put a sterile drape over your abdomen and will check again that you are adequately anesthetized before proceeding with surgery. 

During the surgery, it is possible that your will notice some “pushing” on your abdomen, especially during the delivery process.  This is normal and there is no need to be alarmed if this occurs. 

If you are “scheduled” for an elective Cesarean Section, an epidural would be placed as described in the brochure and the increased dose of epidural would be used for surgery.

Someone from anesthesia will remain at your side from the initiation of your  anesthetic for surgery, throughout the surgery, and into the recovery room.

Some patients will have a  PCA (Patient Controlled Analgesia ) narcotic infusion that is delivered through the I.V.  

Other patients may receive pain relief through their epidural.  This accomplished by two different techniques:

        1. Single Shot Narcotic: a single dose of narcotic is given through the epidural before it is
            removed at the end of surgery.

        2. Epidural Narcotic Infusion (POPS): The epidural catheter can remain in after surgery for 24-48
            hours with a narcotic infusion.

Decisions regarding post-operative analgesia will be discussed with you at the time of your operation. 

What complications can occur from regional anesthesia (epidural)?

Although uncommon, complications can be associated with regional anesthesia. The occurrence of a headache after epidural or spinal is approximately 1 percent. Sometimes these headaches can become severe, but they are treatable and have no long-term consequences. Nerve injuries from catheter placement, infection, or hematoma are exceedingly rare, but usually resolve spontaneously or with medical intervention. Rarely, an intravascular or spinal catheter may go undetected, which may have serious effects on the mother’s heart or respirations. This unlikely event is avoided by careful observation and use of a “test dose.” Shivering and backache can both be associated with epidural, but occur in laboring and postpartum patients without epidural as well.

 Does insurance pay for me to have anesthesia?

 Services provided by your obstetric anesthesiologist are billed separately from hospital charges from St. John’s Mercy in the same way your obstetrician bills separately for his or her services. Most of your obstetrical anesthesia services will be covered by your insurance. Our office will bill the insurance company directly. You will only receive a statement for your applicable deductible or co-pay as determined by your insurance carrier. If you have questions regarding billing issues, our office is happy to assist you. Contact number is (314) 469-6800.