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Doctors, patients like epidural for labor pain control

Less pain and more gain is what care givers at New Ulm Medical Center say will be the result of the introduction of epidurals as a method of pain control for laboring mothers-to-be.

OB/GYN physicians Byron Gatlin, MD and Marc Burkhart, MD are both enthusiastic supporters of this procedure.

“This is a procedure that women want,” Gatlin said. “I have many patients who ask if we have epidurals – they have researched the various methods of pain control and they want this option to be available to them.”

“I think this will be a tremendous asset for the moms who come in,” Burkhart agreed.

Gatlin explained how the procedure works. “An epidural is a form of regional anesthesia where drugs are injected through a very small catheter tube directly into the epidural space in the mother’s spine. The drugs cause both a loss of sensation and a loss of pain by blocking the transmission of pain signals through the spinal cord nerves,” he said.

Gatlin further described the usual steps in the epidural process:

Once it has been determined by the nurses and doctor that the patient is ready for an epidural, the patient is positioned either sitting or lying on their side. An antiseptic solution is used to wash the lower part of the back to prevent infection and a small amount of local anesthetic is injected into the skin on the back to numb the area where the catheter will be inserted into the spine. Then a special needle is inserted through the numbed area into the epidural space of the spine and a very small tube or catheter is threaded through the needle into the epidural space. The needle is removed, leaving the catheter in place in the spinal space and finally, the catheter is secured to the patient’s back with tape. The medication can then be administered continuously to the patient through the catheter during the remainder of the labor and delivery. The patient usually begins to notice pain relief in about 7-10 minutes and maximum pain relief may take up to 20 minutes. The epidural catheter is removed after the baby is born.

From a nursing perspective, OB Nurse Manager Jennifer Brehmer, RN, says nurses may be able to testify to the benefits of the epidural better than anyone. “The nurses spend a lot of time at the patient’s bedside during labor and if the moms are more relaxed, it gives the nurse a better opportunity to work with the patient,” Brehmer said.

According to Brehmer, nurses have always tried to make labor more comfortable for patients through breathing and relaxation techniques. Being able to offer both the epidural and intrathecal, Brehmer said, “gives the patient peace of mind to know that there are options available to them – whether they choose to use it or not. In the back of their mind, they know it is available and they will be able to control their pain.”

Epidurals are in addition to intrathecal injections, which is what the medical center has offered in the past and will continue to offer. “The pain relief is about the same, but with the epidural it is continuous, whereas with the intrathecal you may have to repeat it after four to six hours if the mom hasn’t delivered yet,” Gatlin said.

When an epidural is placed, the medication is delivered continuously through a small tube known as a catheter. An intrathecal is a one-time injection which is why, when the medication wears off after several hours, the injection has to be repeated to continue pain control. With an epidural, the catheter is left in place and no second injection is needed.

For women who are going to go through labor quickly – such as women who have had babies previously or who are fully dilated – the intrathecal may be sufficient for them.

“The epidural is more appropriate for first time moms, long inductions, the patients you know will take longer. They can get pain relief for eight, ten or even 18 hours,” Burkhart said.

Of course, there is always the exception. For instance, when patient Nikki Horner came in recently to deliver her third baby, she assumed it would go quickly since her second baby had delivered fairly quickly.

But, every baby is different and this one took his time. She was in labor for over 14 hours. About half way through, she decided to use the epidural option.

“I questioned how I was going to know when to push if I was numb and had no feeling,” Horner said. “But when I was dilated to 9 centimeters, Dr. Gatlin cut the medication dosage in half and I had no problems pushing.”

After 20 minutes of pushing, her son was born. “I would definitely recommend the epidural. I was really able to relax and get a break from the pain. And, I know everyone is different, but I didn’t have any side effects from the epidural,” Horner said.

Many women have that fear that an epidural will numb them so much that they will not be able to feel their legs and not be able to push. Gatlin said that is not necessarily the case.

“It all depends on how the medication is dosed. Usually when a woman is in real labor, they don’t walk much, but they should be able to feel their legs and feel the urge to push,” Gatlin said.

Epidural anesthesia has been successfully used for some time during labor without major complications. However, as with any medication, potential side effects are reviewed with the patient and together, the patient and physician make the decision about the best kind of pain relief. Side effects can include a decrease in blood pressure, shivering due to decrease in body temperature or a headache. An epidural does not have any direct harmful effects on the baby as the medication does not enter the baby’s system in a significant amount.

Gatlin also envisions that the move toward epidurals will help to decrease the number of c-sections performed at the Medical Center.

“If you give the mom a chance to relax, it gives the cervix a chance to dilate further,” Gatlin said. “However if a c-section is necessary, the epidural is also advantageous because the epidural catheter is already in place. The anesthetist may be able to change the medication, rather than performing another spinal injection.”

Epidurals join intrathecals, breathing techniques and intravenous pain medications as options for laboring women at NUMC. “I think this is really going to benefit first time moms and those who need to be induced. It is a fantastic procedure we can use to help make the labor and delivery experience even more positive,” Gatlin said.

New Ulm Medical Center
1324 Fifth St. N.
New Ulm, MN 56073
507-233-1000
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First published: 11/27/2006
Last updated: 11/27/2006

Reviewed by: Jennifer Brehmer, RN, Marc Burkhart, MD, Byron Gatlin, MD