Getting an epidural

Giving birth is an exciting time, but it can also be stressful with a lot of questions. Perhaps one of the big ones is just exactly how much pain there will be. Which of course leads to questions about the many ways to manage pain. We wanted to give you an in-depth look at one method, the epidural, so we sat down with Dr. Bret LeSueur to get your questions answered.

Dr. LeSueur has been delivering babies in Utah County for 17 years. He received his undergraduate degree at Brigham Young University-Hawaii and then went to Kirksville College of Osteopathic Medicine. He currently works in Springville. Utah where he delivers about 6 or 7 babies per month. He's also a dad to 4 children of his own-though he didn't deliver them personally. Email questions to: doctor@utahbabyguide.com.

With many women getting epidurals these days, we wanted to help expecting women know what to expect. We took all your questions to a pro, Dr. Bret LeSueur. He is a family doctor who has been delivering babies in Utah county for over 17 years.

What can I expect from the procedure?

Dr. LeSueur: An anesthesiologist does the procedure. The nice thing is most hospitals have an anesthesiologist in house all the time and they do these all the time so they're very good at them. They will prep the skin with Iodine to prevent infection. Then they put a little local anesthetic on the skin to numb up the area. They will have the patient lay on their side or sitting up bent over depending on the anesthesiologist's preference. They insert a needle along with a tiny catheter into the spinal canal. The catheter is so they can re-dose it without having to stick another needle in. Then they give the medication to block the nerves below that level. The goal is to make it so you can move your legs, feel pressure, and feel the baby descend but not feel the labor pains.

What percentage of your patients get an epidural versus not get one?

Dr. LeSueur: 80 to 90 percent of my patients get an epidural. Probably closer to the 90 percent.

Are there any risks associated with an epidural?

Dr. LeSueur: The 4 risks are that it won't work, it only numbs part(s) of the uterus, it wears off, or you could get an infection at the injection site. I've never seen anyone get an infection at the epidural injection site and I've delivered a lot of babies.

The most common side effect, when I say common I mean 2-5%, would be what is called a post spinal headache. The pressure of the spinal fluid in your head goes down a little because of the loss of a little fluid. This causes a little inflammation at the injection site and a headache. It's generally a pretty nasty headache. What they do for that is what is a called a blood patch. This patches that hole and is usually curative immediately.

Are there any crazy side effects like paralysis?

Dr. LeSueur: I have never seen it, never heard of it. The spinal canal is solid until a certain place where it fans out into individual nerves. They place the needle down lower so it's in one of those individual nerves. You would really have to try hard.

Does it hurt?

Dr. LeSueur: There is some pressure with it. It's usually not very painful, just pressure. Although, I've never had one so I can not tell you from personal experience, but that is what I've been told. Sometimes there is a sharp pain. This is because they may touch a nerve and you will get a jolt down the leg. When you're in pain, you are more jumpy or jittery.

How long after delivery does it take for the numbness to wear off?

Dr. LeSueur: It can take anywhere from 30 minutes to several hours.

What determines how much medicine they give you?

It's a standard dose. Then if you don't respond they give you more.

How does it differ if you get an epidural and then have to have a c-section?

Dr. LeSueur: We're glad you had the epidural at that point. They give you more or different medicine, but there are no extra needles.

What effect does the medication have on the baby?

Dr. LeSueur: We don't believe any. If we dose very heavy for an emergency c-section, the biggest risk is the heart rate in the baby would decrease. When epidurals first came out, there were ideas that epidurals prolong your labor or increase you risk of c-sections, but they've now disproved those with studies. There is one study that says an epidural may decrease the risk of c-section. It is my personal opinion that this is because the woman can relax.

What conditions, like scoliosis, would make it so you could not get an epidural?

Dr. LeSueur: This is rare. It would have to be very severe scoliosis. People who have rods in their back or need rods due to scoliosis can still get an epidural. If the nurse anesthetist is doing it, ask for an anesthesiologist, the chief anesthesiologist. I've had women who have had back surgeries still get epidurals. It's hard, but the anesthesiologists are good at them. I've not yet had one that they wouldn't do.

When can I get the epidural and when is it too late?

Dr. LeSueur: They will do it when you have progressed far enough along, for example at 4 centimeters or maybe a little further. They won't do it if you are too far, at 9 centimeters, because the baby may come out before they even get the needle in.

How long after delivery does it take for the numbness to wear off?

Dr. LeSueur: It can take anywhere from 30 minutes to several hours.

For women who are thinking about not getting an epidural, what are the other pain medication options for them?

Dr. LeSueur: For women who want to go without an epidural, it's a good option if they have a long way to go. They can give you 2 different drugs in the I.V. These drugs work well but don't work for very long. There are actually more risks to the baby with those than with the epidural. If you get a dose and deliver very rapidly, then the baby will have that medication in him and the baby's respiratory drive won't be very good, and he won't breathe very well. They never give any just before delivery no matter how much pain the woman is feeling.