Ari Brown: I’m Doctor Ari Brown with the
Four‑One‑One on epidurals. With me today I have Miranda, our mom to be who is about
to deliver, and Doctor Steve Rutman who is the chief of anesthesiology at Seton Medical
Center in Austin Texas. Doctor Rutman, first of all we want you to demonstrate where and
how this procedure is done, and also to debunk some of the myths that people have about epidurals.
Steve Rutman: No problem. I’ll start at the beginning. Epidural anesthesia is a very
safe and effective way to provide pain relief for women that are in labor. I have a little
chart that shows you where the medicine is deposited. It uses the same principle as when
you go to the dentist and get local anesthetic for dental work. We deposit the local anesthetic
near the nerves that enervate the uterus as well as the lower part of the body so that
when women have contractions and deliver the baby, they have good pain control and are
able to enjoy the labor process better. As you can see, this is a little complicated,
this is a cross section and this is the woman’s back. The needle gets inserted close to where
the nerve roots are in the spine, but not into the spine.
We deposit the local anesthetic so that it will affect the nerve roots and block the
transmission of pain. I’ll show on our lovely model here exactly
how the epidural is placed. Of course, when you do have it placed yourself, the anesthesiologist
will have gloves and a gown and a mask, but for demonstration purposes I will just use
my hands without a mask. The most important thing when getting an epidural
is to be positioned correctly. She’s doing a great job here. You kind of have to have
bad posture. We ask the women to slump over with their
shoulders slumped as well as their back pressed out. We say either like a mad cat or a piece
of boiled shrimp. That allows us to place the epidural needle in the correct spot very
easily. What you’ll feel when the anesthesiologist
is placing the epidural is first we’ll identify where your hips are.
We’ll squeeze like this until we find the level of the hips, and we also will go across
and find where the mid‑line is. The place where the epidural will be inserted is at
the level of the hips between the vertebrae. You’ll feel the spinous process. We’ll go
down like this until you find the indentation. This one feels like a good spot right there.
So you’ll feel them with their fingers pressing a little bit and at some point they’ll use
their thumb to make a little indentation. That allows us to know exactly where to go.
At this point we’ll have everything ready to go. We’ll take our cleaning solution, which
is usually a betadine alcohol solution, and use a sponge stick like this to clean off
real good. The next point will be to use local anesthetic
just like a lidocaine type medicine. We’ll use a very small needle for this. We would
use the local anesthetic to numb the skin. We’ll make an injection right there. This
will sting a little bit, but most women say that insertion of an epidural does not hurt
any more than getting the IV started, and certainly a lot less than a contraction.
You’ll feel a little burning at the skin that will numb the area. At this point, since the
area is prepped and numb, we will use a larger needle.
It is a larger needle, but it does not stay in. We use this larger needle to identify
where the epidural space is. At this point as we press down on it, you
will feel the pressure of the needle. It shouldn’t be painful but you’ll feel a gritty sensation.
That is just us going through the layers to get to the epidural space.
Once we’re at the epidural space we will inject local anesthetic to get you comfortable. The
local anesthetic is just put in with a syringe. It will feel a little crampy. It’s hard to
explain that, but that’s what women say. They feel a little cramp in their back. It’s
good and bad. We don’t want you to hurt but it also lets us know it’s getting placed in
the right place. So the local anesthetic will get placed there.
Once it’s administered what we’ll do is insert a very small and very flexible and very soft
piece of plastic. Once we find the epidural space using the
needle, we remove the inner cannula, take the plastic tube and slide it in. This allows
us to place the plastic tube in the epidural space at the appropriate distance.
Once it’s there, we remove the needle from the skin like that. This is what’s left under
the skin, about that far, which has holes at the end that allow us to continue to give
the medication throughout the rest of your labor and delivery.
Once the local is administered, and the plastic catheter is placed we’ll just tape the rest
of the catheter to your back. It will come up over your shoulder and we’ll hook it up
to a machine that will continue to give you medicine throughout the rest of the delivery.
Once you’ve delivered your baby we just untape the tape and it slides right out.
People are always concerned about risks with epidurals. Although there are certainly some
serious complications that can happen, most of the time it goes very well without any
problems. It usually will not cause any more back pain
than in women that don’t get epidurals. We feel that it does not cause any problems for
the baby and it’s very safe for the mother as well.
You might notice that you felt like you’ve had a shot in the back, no different than
if you’ve had a shot anywhere else, but that usually resolves within a couple of weeks.