Q: What is an epidural?

A: An epidural is a procedure which involves placing a small catheter into the lower portion of your back to relieve the pain from contractions. It is placed while you are experiencing pain from contractions.

Q: How is an epidural placed?

A: Your anesthesiologist will have you sitting up or laying on your side. After cleaning your back with a cleaning solution, a small numbing shot will be injected. Following this, a longer needle will be used to place  a small catheter into your back. This catheter will be taped to your back to prevent it from becoming dislodged.

Q: How long does the epidural take to work and how long will it last?

A: An epidural does not take effect immediately, and may take 5 to 10 minutes for full effect. The epidural will last for the duration of your pregnancy and will be removed shortly after you deliver.

Q: Does the epidural hurt?

A: Each woman has a different tolerance to pain, but most will say the overall experience was not as bad as they had imagined. A large part of the anxiety is not knowing what to expect during the epidural placement.

Q: Are epidurals safe?

A: Complications are extremely rare. However, every medical procedure has associated risks. Potential complications include bleeding or infection in the epidural space, nerve injury to one or multiple nerves, sudden drop in blood pressure, an epidural that extends too high compromising breathing, headache, seizures or cardiac arrest.

Q: Can I walk after an epidural?

A: Because your legs may become numb and weak, you will not be allowed to ambulate. Some women are still able to move their legs and have full sensation, but most will have some degree of numbness and weakness.

Q: Will I have any pain after my epidural is placed?

A: Epidurals are very effective for relieving labor pain. Most women will feel little, if any, pain with contractions whereas some women may feel mild cramping or pressure with contractions. As your labor progresses, your anesthesiologist may have to give you an additional dose.

Q. Will I feel pain during the "pushing" stage?

A: After your cervix has fully dilated, you will begin the pushing phase of labor, also known as Stage 2. At this point, it is very common to feel pressure in the vaginal area. Feeling some of the contractions is necessary to assist you with pushing. Your anesthesiologist will attempt to achieve a balance between making you comfortable while not making you so numb you are unable to push.

Q: What if I had an epidural placed for labor, but now need a Cesarean Section?

A: Your anesthesiologist will use the epidural for the surgery. This involves a larger dose of medication which will make your entire abdomen numb. Occasionally, if the epidural does not provide enough pain relief, your doctor may elect to place another epidural, a spinal block or administer general anesthesia.

Q: Can I get a headache after an epidural?

A: Headaches after an epidural, also called a spinal headache or post dural puncture headache, are a known complication. Fortunately, they rarely lead to any long term problems. They usually occur anywhere form 1 to 3 days after the epidural. The most distinctive feature is pain which increases dramatically in the upright position or with walking and almost completely resolves when laying down. If no treatment is taken, most headaches will improve after 1 to 2 weeks.

Q. Is there any treatment for an epidural headache?

A. Yes. The first option is conservative management which involves staying well hydrated, liberal intake of caffeine and pain medications. Unfortunately, only a small portion of patients have adequate pain relief with this treatment. The second option is an epidural blood patch. This is performed by your anesthesiologist and is similar to the epidural placed during labor, but instead of placing a catheter into your back, blood collected from your arm is injected into the epidural space. The effect is rapid and you should feel significant pain relief in 5 to 10 minutes.

Q: Will the blood patch always relieve my headache?

A: An epidural blood patch has a high rate of success. But like most medical treatments, success is not guaranteed. Some patients may initially experience pain relief but have a recurrence a few days later, which may require a second blood patch.

Q. Are there any complications with a blood patch?

A: As with an epidural, a blood patch is very safe, but complications may occur on rare occasions. In addition to the usual complications as detailed above, additional complications include contaminated blood injected into the epidural space, back pain, adhesive arachnoiditis leading to chronic pain and/or weakness or worsening headache.

Q: Is there anything I should tell my anesthesiologist prior to my epidural?

A: You should notify your physician if you are taking any blood thinning medications such as heparin or low molecular weight heparin (Lovenox). If you are taking these in combination with aspirin, notify your anesthesiologist as well. If you have any spine abnormalities such as spina bifida also notify your doctor.