The combined spinal epidural (CSE) is a common variation to the regular epidural. The CSE provides an initial dense dose of anesthetic and analgesic through a spinal needle into the outermost membrane covering the spinal cord. The needle is pulled back into the epidural space and withdrawn leaving only the catheter in place. This type of epidural provides enough medication to provide relief but still allows the patient to move freely and change positions in bed. If the initial CSE was not enough, the catheter is in place to inject a traditional epidural.
An anesthesiologist usually administers the epidural. Most doctors will wait until the patient is dilated four to five centimeters. The patient will be required to curl up tightly either on their side or while sitting up. It is crucial to remain very still, which might be hard during active labor. The back is washed with antiseptic solution to reduce the chance of infection. The area is then numbed with a local anesthetic to minimize the pain of the needle being inserted into the spine. It is common to feel a strong pressure as the needle is being inserted.
Although most women are eligible for an epidural, there are several reasons why the procedure can't be performed. Patients taking blood thinners or that have bleeding disorders such as hemophilia are ineligible for epidurals. The doctor can't perform an epidural if your blood work is abnormal or if the area of insertion is infected due to the severe risk of spreading the infection to your spine and other areas of the body. Additionally, excessive weight and spinal abnormalities can prevent insertion point from being located. There are even times when anesthesiologist may not be available. This could result in a delayed epidural or even reaching a point of labor where the doctor or hospital will not allow an epidural to be administered. Expectant mothers should explore alternate pain control methods to prepare themselves if an epidural is not possible.
Like any medical procedure, Epidurals have associated risks. It is not uncommon for the needle to be inserted incorrectly. In most cases, incorrect placement will result in block failure, and a second epidural can be performed. However, incorrect placement can also result in an accidental dural puncture in approximately three percent of needle insertions. This can result in cerebrospinal fluid leaking into the epidural space causing post dural puncture headaches. These headaches can be extremely painful lasting several days, and in some cases weeks or months. In extremely rare cases, hematomas, nerve damage, paraplegia, and death can occur.
All pain relief options should be discussed with your doctor prior to going into labor. There is no method that is 100% effective or safe for everyone. Knowing the options will help eliminate fears resulting in a more enjoyable birthing experience.