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If you opt for an epidural, the doctor should explain the procedure to you, and you should have the opportunity to ask the anesthesiologist any questions.
Before starting the epidural, a plastic tube will be placed in a vein in the back of your hand or in your arm, to which an IV containing fluid will be connected. You are given fluids during an epidural to stop your blood pressure from dropping. The doctor will then help you into the correct position to receive the epidural, which will either be sitting up with your legs over the side of the bed leaning forward, or curled up on your side on the edge of the bed. The position may depend on the preference of the anesthesiologist.
Your lower back will be cleaned with antiseptic and a drape placed over the rest of your back to reduce the risk of infection. Before the epidural needle is inserted, a local anesthetic will be given into the skin and surrounding tissues. This creates a numb patch to ensure that the insertion of the large epidural needle is not painful. When the local anesthetic is injected, you may feel a scratching sensation and experience a very short-lived sting in the area between the vertebrae bones
Since it's important for you to remain still during the procedure, the anesthesiologist will insert the epidural between your contractions. If this is difficult, you should try to concentrate on your breathing and remain as still as possible until the procedure is completed. You will feel a pushing sensation in your back while the anesthesiologist is trying to find the very small epidural space with the hollow needle. When the space is located, a tiny plastic tube will be fed into it through the needle. The epidural needle is then removed and the tube, which is secured onto your back with sticky tape, remains in the epidural space. The tube remains in place until your baby is delivered and, because it is very thin, soft, and pliable, it is perfectly safe to lie on the tube and to move around.
Once the epidural tube is successfully in place, the anesthesiologist will give the first dose of medication through it by means of a syringe. Once she is satisfied that the epidural is in the correct position and is working effectively, all subsequent doses, or "top ups," can be given without another injection. Your blood pressure will be taken once the epidural is in place and will be monitored for the next half an hour or so, and then regularly thereafter, including after each top up. Each dose of medication takes around 10-20 minutes to take its full effect and can last between one and two hours. The epidural will be topped up as required, usually around every three to four hours, to keep you comfortable throughout your labor. An anesthesiologist should be available 24 hours a day to manage any concerns or problems that may arise with the epidural.
Excerpted from Pregnancy Day by Day.
Copyright ©2009 Dorling Kindersley Limited.
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