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Considering that at least 60 percent of American women today have an epidural for pain relief during labor, it’s surprising how misunderstood this procedure is. For starters, even doctors use the word “epidural” generically, to encompass three similar, yet distinct procedures: epidurals, spinals and a more recently perfected procedure, the combined spinal epidural (CSE), or “walking” epidural. Since deciding whether or not to have an epidural means becoming informed about the benefits and risks well before labor begins, here are the facts to help you make sense of some misconceptions.
Perception An epidural and a spinal are the same.
Reality An epidural involves injecting pain-blocking medication into a space between the vertebrae and the spinal fluid; it usually takes about 15 minutes to work and lasts as long as needed. A spinal is an injection directly into the spinal fluid; it is given as part of the CSE technique and takes effect in five minutes. With either an epidural or CSE, the catheter that delivers the drug is left in the epidural space until the baby is born so the medication can be administered continuously
“But what medication is given, how much and for how long all vary depending on the individual and the hospital; some routinely combine epidurals with spinals and some do not,” says Laura Riley, M.D., a high-risk obstetrician at Massachusetts General Hospital in Boston. Different techniques, medications and doses have different results and risks, so being educated about the procedures used where you will deliver can help you make a decision that is right for you.
Perception The needle used is gigantic, and it hurts when inserted.
Reality The epidural needle is left in place for only a minute or two—just long enough to insert a skinny, flexible catheter the size of a pencil lead into the epidural space. The spinal needle is much smaller—the width of a thick piece of hair. But before this happens, the injection site is numbed with a local anesthetic, at which point you will feel a pinch and sting for about 10 seconds. You’ll feel pressure, but not pain, when the epidural and/or spinal itself is given.
Perception An epidural makes pushing difficult.
Reality “One advantage of combining spinals with epidurals is that it typically allows for less medication to be given than with an epidural, so you get pain relief without total numbness,” says William Camann, M.D., director of obstetric anesthesia at Brigham and Women’s Hospital in Boston and co-author with Kathryn Alexander of Easy Labor (due out in winter 2006 from Random House). This lower dose makes pushing easier than with a higher-dose epidural, reducing the likelihood of a forceps- or vacuum-assisted delivery.