Epidural analgesia

Epidural analgesia is one of the most modern methods used to ease labor pain.  This has been a well proven and most frequently used method in our sanatorium. The terms used in the following text are explained below.

Analgesia - pain removal, relief, painlessness

Anesthesia – loss of sensitivity, insensitiveness, numbness

Dura mater – is a tough membrane covering/enveloping the brain and spinal cord. .

Epidural space – is a specified area in the spinal canal between the dura mater and the yellow ligament. Spinal cord is protected by spinal membranes (meninges), with the dura mater being the outer protective membrane.

Local anesthetic – medication causing loss of sensation

Analgetic – a pain killing drug/medication 

Epidural analgesia means relieving labor pain by a small dose of medication by means of a special needle applied through the skin into the epidural space in the spinal cord canal. As a result, the sensation of labor pain is alleviated by locally affecting the transmission of impulses of pain from the uterus; however the overall conditions of the woman and her fetus are not affected.

The suitable time for injection is during regular active labor process when the cervix is 3-4 cm open. The time is determined by the obstetrician, and the epidural is given by the anesthesiologist. During this procedure, a good cooperation between the patient and the anesthesiologist is very important.


How is epidural analgesia administered?


Following the routine pre-labor preparation you will sit on the birth bed. The anesthesiologist nurse will take your blood pressure and insert a cannula (a small tube, plastic needle) to your vein for infusion of the appropriate solution. This is done for your safety. Through the cannula, any medication can be administered immediately and at any time. The nurse will help you to arch your back in the right position, lowering your shoulders and keeping your chin as close to your chest as possible. The best site for inserting the epidural needle is between the 2nd and 3rd or 3rd and 4th lumbar vertebra. The anesthesiologist will first wipe the skin with an antiseptic solution and cover the surrounding area with sterile dressing pads. Not to feel pain of the injection in the epidural space, the skin and the layer beneath the skin are numbed by an anesthetic by means of a very thin needle. Then a special needle is inserted in the epidural space through which a thin epidural catheter is threaded through which the necessary medication will be administered. The whole procedure is made strictly in a sterile manner as in the operation room. The catheter is then secured with an adhesive tape. After placement of the catheter and after each anesthetic administration you must remain in horizontal position for 30 minutes. Then you may choose any position of your preference. When getting up from the birth bed, always try to sit up first and only then try to stand up (always with the assistance of your accompanying person or a nurse!). Only if you feel confident and at ease you may walk without any restrictions, but always in the presence of an accompanying person.


How does epidural analgesia work?


Within l5-20 minutes you will feel the contractions are less painful and easier to bear. Some dumb pressure may be felt. Being totally dumb is undesirable because that would slow down your delivery, which will not be free of any pain, but the pain will be under control and more tolerable.

One dose of anesthetic solution of low concentration of analgetic medication is effective for about 60-90 minutes. As soon as you start feeling more pain, you may ask for another dose. And then you can choose any position comfortable for you. And you may walk around with the accompanying person.  

The advantage of this type of pain relief rests in the fact the “urge to push” feeling is not eliminated so that you will be able to cooperate actively during the whole labor process and especially in its final stage. Maybe towards the end the urge to push will be quite painful, which is not in vain, as such feeling will enable your active cooperation and thus end labor in the natural way. For the perineum treatment a more concentrated solution needs to be added in some cases. The anesthesiologist will remove your epidural catheter before transfer to the postnatal department/ward.  


 The advantages of epidural analgesia:


Where pregnancy is complicated due to significant medical conditions of either the mother or the child, epidural analgesia is particularly beneficial for the labor processes and the health of the newborn. These conditions include the following maternal illnesses and conditions:


Other circumstances under which epidural analgesia may favorably affect your delivery include: 


What are the possible risks of epidural analgesia?



In case of headache or nap aches after epidural analgesia, inform your doctor. Treatment is easy and successful.

This procedure may fail when, with regard to bad anatomy of the back or epidural space cannot be identified. Sometimes the catheter cannot be administered because of epidural space adhesions, or when such administration is painful. In these cases the subjective feeling of pain relief is not achieved.


In which cases epidural analgesia is not suitable?


Epidural analgesia is not for the people allergic to local anesthetics. The procedure is barred due to inflammation of the skin near the expected injection site, coagulation disorders (therefore you should inform the doctor if you experience frequent bleeding under your skin - bruising), degenerative neurologic diseases, serious spinal deformities, and also excessive overweight.


What to do in case I would like to have an epidural?


You should have received guidance from the anesthesiologist (every Monday at 9:30 AM at OB/GYN, Partizánska) and presented a full blood count and coagulation test not more than one month old.  If you have not received any guidance, epidural analgesia cannot be administered.

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