To receive an epidural, a woman lies on her side, her body curled. The anesthesiologist then numbs the skin before placing a thin tube or catheter into the epidural space between the spinal bone and the spinal cord. This tube remains in place so that pain medication can be administered as needed.
"The drawbacks to [epidurals] are not inconsequential," says Dr. Viscomi. "They include a risk of severe headache after the childbirth (approximately one-percent risk), and a remote risk of nerve injury from the technique (approximately a one in 20,000 risk)," reports Dr. Viscomi.
Instead of offering localized pain relief, analgesics work on the entire body. Demerol, Nubain, and Stadol are the commercial names of narcotics sometimes given to relieve labor pain. These medications travel through the body in the bloodstream. "The effectiveness of these drugs is somewhat variable, but on average decrease pain by 25 to 30 percent," cites Dr. Viscomi. (Analgesics are most often injected into an IV or a major muscle, such as your bottom.)
All About Epidurals
Perhaps the most significant change in pain relief has taken place with epidurals. "When I first started practicing 22 years ago, the amount of medication used in the epidural left the woman's legs paralyzed for the entire labor. Today we use about a fifth to a tenth the amount of medication that we used to," says Dr. William Camann, Director of Obstetric Anesthesia at Brigham and Women's Hospital at Harvard Medical School.
There is a variety of epidurals available. Here's a rundown of the most commonly used:
Traditional or Basic EpiduralMedication injected into the lower spine takes effect in 10 to 20 minutes, numbing the body below the waist. The legs can sometimes become numb to the point of being immobile.
Instead of requiring a tube in the back to administer pain relief, a spinal block involves one injection into the lower spine for instant pain relief that will last for several hours. A spinal block may cause immobility.
Combined Spinal Epidural (CSE)
A CSE brings together the instant relief of a spinal block with varying medication amounts of an epidural. The anesthesiologist inserts a tube in the back as with a traditional epidural, but the laboring woman is given a spinal injection first for instant pain relief. Lower dosages of pain relief can then be administered as needed.