Epidural and spinal are general terms for techniques for administration of pain medications. They refer to the location of the administration, either the epidural or spinal space. There are a variety of medications that are administered by regional block techniques, and there are variations in how the medications are administered including combining two or more medications.
The number of women who use an epidural during labor varies around the world, and even in different hospitals in the same area. Because it is an advanced anesthetic technique, it is only available to women in developed countries and in some countries is only available to the wealthy. The World Health Organization does not consider an epidural to be essential for care in normal birth.
According to the statistics from each individual governments, New Zealand has a 24.2% epidural rate; Canada has a 45.4% epidural rate. Other governments do not report the use of epidurals in an easy to use format. However, it is important to remember that different areas within the same country can have very different statistics. The Listening to Mothers II survey reported a 76% epidural rate among women giving birth vaginally.
Before you can receive an epidural medication, your blood will be drawn and evaluated. This is usually done upon admission to the hospital. If you have not already, you will begin receiving IV fluids to prevent a drop in blood pressure. You will be attached to an electronic fetal monitor to obtain a baseline strip recording of your baby’s heart rate. The monitor will remain attached to you until your baby is born. It can be helpful to include any special information that may affect your satisfaction with an epidural in your birth plan. This may include drug allergies, unplesant reactions or a history of substance abuse or aquired tolerance. This information helps the anesthesiologist plan medications and doses.
Once everything is set up, you will need to get into a position either lying on your side or hunching over so your back is arched. You must not move during the procedure which will last about two contractions (5 to 10 minutes). Your back will be washed with an antiseptic and covered with a sterile drape. You will receive a small amount of anesthetic to numb the injection sight. Once your skin is numbed, a large needle is pushed between two of your vertebrae just above your waist. The anesthesiologist will guide the needle into the correct spot, and then test to make sure the needle is properly positioned. Once the needle is in the right space, a thin flexible tube is fed through the needle. The needle is withdrawn, leaving the tube in place. The medication is inserted through the tube, and the tube is looped and taped to your back to ensure it does not pull out.
After the tube is in place you will be assisted into a comfortable reclining position. You will be asked to rate the effectiveness of the pain relief, and depending on your questions you may receive more medication or be shifted to a different position. Depending on the preference of your care team, your tube may be connected to a pump that continuously infuses more medication into the epidural, or you may receive top up doses at regular intervals.