Regional Anesthesia (epidural) Regional blocks (epidural, spinal, and combined spinalepidural) are administered through an injection in the lower back. They numb the lower part of the body to varying degrees depending on the medication administered. Epidurals, spinals, and combined spinalepidurals may be safely administered to women for labor analgesia and cesarean section without causing sedation to you or your baby. 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. Placement of the epidural is performed with you sitting or lying on your side. It is important to remain still during the placement of the epidural. After a sterile cleansing of the low back, a small injection of local anesthetic will be given to numb the area where the epidural needle is inserted. Careful advancement of the epidural needle will allow access into the epidural space where a flexible, plastic catheter can be placed.

Occasionally, a tingle may be felt down one leg or the other when the catheter is passed. This is not harmful. The needle is then removed with nothing metallic or sharp remaining in your back. The soft, flexible catheter will be secured with tape. All further medications will be given through this catheter much the way intravenous medications are given through an intravenous catheter. An initial test dose of medicine will verify that the catheter was properly placed. Within five to 15 minutes, the pain of labor will subside.

Your blood pressure will be monitored closely at this time since it occasionally decreases upon initial epidural placement. A drop in blood pressure is easily treated when it occurs. Labor pain will significantly decrease, but you should still expect to feel some pressure with contractions. The lower half of the body may feel tingly or warm, but some motor strength will remain. Anesthetic requirements vary from person to person, but the ideal labor analgesia should provide pain relief without completely blocking pressure sensation or motor strength in the lower body. This allows you to push effectively when the time comes to deliver the baby. A mother who is completely numb can still push effectively but it can take longer to figure out which muscles to work. A continuous infusion will help achieve a steady level of epidural block, but for longer labors, sometimes additional bolus medication is required.

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