- Does the medication affect the baby?
With the exception of the PCA, no. Spinal and epidurals can cause the mother’s blood pressure to decrease in the first few minutes after they are placed. The anesthesia team and the patient’s nurse will closely monitor the mother’s vital signs for the duration of each anesthetic.
- Does the epidural/spinal hurt?
The anesthesiologist makes every effort to insure each patient’s comfort during the placement of an epidural or spinal. This involves alerting the patient to each step of the process, generous use of local anesthetic (“Novocain”), and reassurance and support from the labor room nurse. Of course each patient’s perception and pain threshold is different, but in general epidural/spinal placement is not painful.
- How long does it take the epidural to work?
It usually takes 10 to 15 minutes before the full anesthetic effect is reached. Often there are signs within the first 5 to 10 minutes that relief is on the way. For women who receive the epidural in the active stage of labor, analgesia can take up to 20 minutes to be fully achieved; often additional medication is administered to speed up this process.
- Will I be numb?
Most patients often experience numbness after the initial dose of medication. This gradually gives way to less numbness, but the pain relief effect continues. After a bolus, numbness may recur. Keep in mind that every patient is different and experiences differ, but the goal of epidural analgesia is pain relief not numbness. The reason for this is that significant numbness often leads to decreased ability to push.
- Will the epidural/spinal last long enough?
Yes. Epidural catheters are connected to a continuous infusion of medication that is stopped only after the baby is delivered. Except in rare circumstances, spinal anesthetics greatly exceed the time required for a cesarean section.
- What if the epidural does not work?
The anesthesia team will assess the patient’s response to the initial dose of medication. If the relief is not satisfactory, the epidural is reassessed. Options include administering additional medication, adjusting the catheter, or replacing the catheter. “Windows” can develop after epidural insertion. Every effort will be made to alleviate the window; including replacing the catheter, but rarely windows can be persistent despite multiple actions to minimize them.
- Will I feel my contractions?
Most patients often experience numbness after the initial dose of medication. This gradually gives way to less numbness, but the pain relief effect continues. Patients are often aware of their contractions, but they should not be painful. As labor progresses, especially close to delivery, the mother often experiences intense pressure. This pressure is difficult to alleviate and attempts to do so can lead to ineffective pushing, which can delay delivery.
- What is a window?
A window is a small area of the mother’s body that is not relieved by the epidural. It is thought to result from an inability to deliver the epidural medication to the corresponding location of the spinal column. To overcome the window, the anesthesiologist or CRNA may decide to administer additional medication, adjust the catheter, or replace the catheter. Rarely, windows can be persistent despite multiple actions to minimize them.
- What is a bolus?
A bolus is the administration of additional medication(s) to alleviate pain.
- What is PCEA?
PCEA, or Patient Controlled Epidural Anesthesia, combines the PCA and Epidural Analgesia techniques. After the epidural is placed, the catheter is connected to a programmable pump that delivers a continuous infusion of pain-relieving medication and allows the patient to self-administer extra medication (a “bolus”).
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