Epidural Anesthesia: Safe, Effective Pain Relief During Labor

[ Music ]>>Hello, my name is Dr. Ellen Steinberg and
I’m the director of obstetric anesthesia here at Stony Brook University Hospital. I am proud to present you this educational video about epidural anesthesia
created by some of our residents. The obstetric anesthesia team is here 24
hours a day, 7 days a week and our goal is to provide you with the best
possible care for you and your baby. Enjoy.>>Hello and congratulations parents to be, it
is an exciting time as you await the arrival of the newest member of your family. Today I want to provide you with more
information about one of the options available for pain relief during labor
called an epidural anesthetic. Hopefully this will make an informed
decision about whether an epidural at Stony Brook is the right choice for you. The goal of the division of obstetric
anesthesiology at Stony Brook is to provide you with a safe and effective pain
relief throughout this exciting time. Epidural anesthesia is a safe and effective
method for providing pain relief during labor. About 80 to 90% of our laboring
patients receive an epidural anesthetic. It involves the placement of a small
plastic catheter or tube into the space between the lumbar vertebrae
or bones in the back. The catheter is introduced through a needle
which is used to identify the correct space. Once that catheter is inserted local anesthetic
agents can be administered continuously to significantly reduce the pain of labor. You will also be able to control your own pain
using what’s called the patient controlled epidural analgesic or PCEA. The epidural pump is programmed
to deliver a small preset dose of medication when you push a button. You don’t have to worry about
giving yourself too much medication as the machine is designed to
prevent this from happening. Current techniques use low concentrations
of local anesthetics and narcotics so that most patients will
have adequate muscle strength to push effectively with the epidural in place.>>Hi, I’m Dr. Smith, the
epidural has many advantages over other forms of labor pain relief. Most importantly, the mother is awake and able
to fully participate in the birth of her baby and the baby is also awake and vigorous. Numerous studies demonstrate that epidural
anesthesia provides superior pain relief compared to all other treatments for labor pain. Furthermore, a reduction in maternal stress
has also been shown to benefit the baby. In addition, if cesarean delivery
becomes necessary a higher concentration of local anesthetic can be given
through the epidural catheter to provide adequate anesthesia for the surgery. Placing an epidural is a sterile procedure,
therefore, we ask that the other parent and all support people to leave the room
while the procedure is being performed. To place an epidural, we will need you to
sit up straight on the edge of the bed. You will relax your shoulders down
and you will arch your lower back out. A nurse will be present to help you maintain
this position throughout the epidural placement. For some women in later labor it may
be difficult to take this position. This position will need to be
maintained for several minutes to ensure safe placement of the epidural. Large movements during the procedure can
make placing an epidural challenging, so it is important to maintain this
position and communicate with your provider. The anesthesia provider will talk you through
each step as he prepares to place the epidural. First, he will clean your back
with a cold cleaning solution. He will prepare you prior to placing
this cleaning solution on your back. After placing the cleaning
solution, he will numb up your back with a local anesthetic and
then place the epidural. A small percentage of patients
may develop a headache, the risk of this happening is about 1 to 3%. While this type of headache is
self-limited it can be frustrating and uncomfortable for the patient. This headache can be treated and the anesthesia
team is always available for this purpose. Backache can occur after epidural anesthesia,
it is important to understand, however, that about 50% of patients will
develop backache after delivery whether or not they have an epidural placed. Other common side effects
include itchiness, a small bruise or scab at the epidural insertion site, and
other serious complications such as reaction to the local anesthetic, nerve injury,
infection and bleeding are extremely rare. Finally, despite our best
efforts an epidural will on occasion not provide adequate pain relief. In such cases the anesthesiologist may replace
the epidural catheter at a different spot. Only certified anesthesia
personnel may place an epidural, this includes the anesthesia
residents, a certified nurse anesthetist or an attending anesthesiologist.>>So, a question we commonly
encounter on the labor and delivery service is can I
eat after I get an epidural. The answer is yes, so after
admitted to labor and delivery and after you receive an epidural you’ll be able
to eat certain things, which will include soda, Jell-O, and some types of juices.>>Following delivery the epidural
removal is an easy procedure. The nurse will help you lean forward slightly
in the bed and the anesthesiologist will come and remove the tape and the
epidural catheter from your back.>>You may have read or heard from your friends that getting an epidural
may increase the likelihood of you needing a cesarean
section, that is simply not true. In fact, this once very controversial issue
has been resolved by many scientific studies that show getting an epidural does not
independently increase the likelihood of you needing a cesarean delivery. While most people can safely receive epidural
anesthesia some patients simply are not suitable candidates. Your anesthesiologist will discuss this with you
in detail if they feel that this is the case. We sincerely hope that you found this
information useful and educational in helping you decide whether or not
epidural anesthesia is right for you. If you have any further questions, please follow
up with your obstetrician and if they feel so necessary they will refer
you to an anesthesiologist prior to the delivery date to speak with you more. [ Music ]

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