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Understanding Epidurals

Having a baby is hard work, but it doesn't have to be excruciatingly painful. More than 75 percent of new moms delivering at Virginia Hospital Center take advantage of patient-controlled epidural anesthesia, which allows them to take charge of their own pain management with the push of a button.

"Early in prenatal care I start having discussions with my patients about how they want to deliver," says OB/GYN J. Jeffrey Elliott, MD. "For a new mom, the idea of labor can be scary. If she knows ahead of time that she'll be able to mitigate the pain through a patient-controlled analgesic, this can alleviate some fear and anxiety. Every woman has a different pain threshold, so we listen to what she is telling us and individualize the therapy for her."

An epidural catheter is a tiny tube inserted at hip level, below the spinal cord, which delivers a constant flow of regional anesthesia. The epidural can be administered at any time during labor as long as the mom is able to sit up and until the point when the baby's head crowns. Moms receive the least amount of medication necessary to achieve the desired effect.

Often women are unprepared for the pain during labor. "With the modern epidural we want you to feel your contractions, but allow you to achieve your own comfort level. This enables you to focus on the delivery and not the pain," explains anesthesiologist Laura Roland, MD, who completed a fellowship in obstetric anesthesiology at Stanford University. Dr. Roland specializes in complicated cases, including moms who have had heart transplants, pacemakers, back surgery involving implanted hardware, or who are on blood thinners.

While epidurals are most often prescribed for pain management, the procedure may also be administered as a precaution for high-risk deliveriesthat could ultimately require Cesarean section, or for women with high blood pressure at the time of delivery, notes Dr. Roland.

Side effects of epidural anesthesia are minor—the most common complaint is itchiness and less than one percent of moms experience spinal headaches. Because the new epidurals use such a small amount of anesthesia, there is only a minimal effect on the baby.

"Recent studies have found no correlation between epidural and the length of labor, the rate of Cesarean delivery, or breastfeeding success," Dr. Elliott says. "It may increase the amount of time you spend pushing, but you will be more comfortable. It's called labor because it's work, but it's more pleasant work if you're not in terrible pain."

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