Epidural Analgesia and Childbirth FAQ
If you are pregnant, you probably have a lot of questions about pain relief for childbirth. This section provides links to definitions of special terms, as well as answers to frequently asked questions (FAQ). If you have any further questions about pain relief or anesthesia during childbirth, your doctor or midwife can arrange an individual consultation with an anesthesiologist.
- Analgesia versus anesthesia
- Epidural analgesia
- Combined Spinal-Epidural (C.S.E.)
- Walking epidural
- Patient Controlled Epidural Analgesia (PCEA)
- Epidural side effects and complications
Answers to these frequently asked questions are given below.
- Must I have an epidural?
- Is it painful having an epidural?
- Will the epidural slow my labour?
- When should I have my epidural?
- What other methods of pain relief are available?
- Are there any patients who cannot have an epidural?
- What type of anesthetic should I have if I am going to have a caesarean section?
- What side effects and complications can happen with an epidural?
A: No. Epidural is one of several pain relieving methods available during labour. It is usually done at your request. In the unusual instance that an epidural is necessary for medical reasons, it would be done at the request of your doctor or midwife, but only if you consent.
A: Local anesthetic ("freezing") is injected under the skin before the epidural. This stings for about 5 seconds, but makes having an epidural less uncomfortable. Some women experience a feeling of "pressure in the back" during insertion of the epidural. Most women say that they find the pain of their contractions worse than having an epidural inserted.
A: Not necessarily. The dose and timing of epidural medication are carefully tailored to suit your labour. In fact, an epidural can improve the descent of your baby by relieving pain and relaxing the pelvic muscles.
A: Your epidural is typically begun when you are in established labour (determined by your doctor or midwife) and provided you are having regular, painful contractions. If you are having an induced labour, you may have an epidural for the induction. Even late in labour, it may be appropriate to receive an epidural, although pushing may be delayed.
A: Alternative or complementary methods such as massage and breathing techniques may be adequate for some women. Others may wish to try transcutaneous electrical nerve stimulation (TENS). Equipment for this is available through the Physiotherapy Department and can be arranged at your request by your family doctor, obstetrician or midwife. This must be arranged before you go into labour, as you must learn how to use the machine most effectively.
Narcotic drugs such as meperidine (Demerol®), nalbuphine (Nubaine®) and morphine are also available, although pain relief may be less complete than with epidural analgesia. The nurse usually injects these drugs into a muscle, but they may be given intravenously by a physician or, in special circumstances, by a patient controlled device. Your doctor can administer injections of local anesthetic to the birth canal at the time of delivery.
A: Patients with medical conditions such as bleeding disorders and infections at the site of epidural insertion may be advised not to have an epidural. Any woman with a history of back problems or disease of the nervous system should discuss her problem with the anesthesiologist, although it is usually still possible to have an epidural.
A: The choice of anesthetic depends on the reason for the operation, your wishes, and the advice of your anesthesiologist and obstetrician. Caesarean sections are usually done under epidural or spinal anesthesia. This means that you are frozen from the level of the nipple line down, but remain awake during the birth of your baby. Your partner is encouraged to be present as well.
General anesthesia (going to sleep) is sometimes necessary for medical reasons that would rule out epidural or spinal anesthesia, or if the baby must be delivered quickly. In about 2-5% of patients, epidural or spinal anesthesia fail to work adequately for caesarean section, and then a general anesthetic is offered.
Location and contact
Division of Obstetrical Anesthesia
Department of Anesthesia
Sunnybrook Health Sciences Centre
2075 Bayview Avenue,
M-wing, 5th floor, room M5 318
Toronto ON M4N 3M5
Phone: 416-480-6100 ext. 87757
2009 Annual Report:
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