A Dad's Guide to Epidurals

Here is an explanation of epidural anesthesia for dads. It consists of medications given through a catheter placed in the spinal canal. The pro of epidurals is obvious: They decrease pain. They do have other benefits as well, in some cases. For example:

• Epidurals can help a tense mom relax. Tension can slow labor; women who are especially tense may benefit from an epidural to help them relax.

• Epidurals provide continuous pain relief. In many cases, a continuous infusion of medication prevents the medication from wearing off.

Basics of medications used in epidurals explained for dads

Several different types of medication are used in epidural anesthesia. Anesthetics such as lidocaine or bupivacaine may be combined with narcotics such as fentanyl or morphine. Narcotics decrease the amount of local anesthetics needed to achieve adequate comfort. Narcotics given in an epidural don't cause drowsiness the way sedatives do.

What to expect during your partner's epidural placement

An epidural can be given at any stage of labor but usually isn't given in very early labor because it can slow progress. Some doctors will start oxytocin, a drug used to induce labor, when epidural anesthesia is given in early labor.

A large amount of IV fluid, approximately one bag, is infused rapidly to offset the drop in blood pressure that may occur with epidural anesthesia. This infusion can be uncomfortable because the fluid is at room temperature and feels cold.

Dads are very much in demand during epidural placement to give mom a person to lean on so she can get into the proper "curled shrimp" position for catheter placement. The epidural catheter is placed into the epidural space on the midback by inserting a metal needle into the epidural space and then threading the catheter through the needle.

Only the soft plastic catheter remains in the back. She must remain sitting up and still, even through contractions, for a period of five to ten minutes while the catheter is placed.

After the catheter is taped in place, the anesthesiologist assists her back to a lying down position and assesses her blood pressure and comfort level for several minutes. In many centers, the epidural catheter is attached to an infusion pump that delivers a continuous infusion during labor to help maintain adequate pain relief.

If you feel at all shaky or nervous while your partner receives the epidural, or if you start to get lightheaded from standing in one position too long, ask someone else to take over supporting mom so you can sit down before you fall down.

Sometimes placing the catheter is difficult because of your partner's anatomy, and more than one needle stick may be necessary. This isn't anyone's fault, and getting the catheter placed correctly is important. You can help by staying calm and keeping your partner calm, too.

Credit: Illustration by Kathryn Born, MA

When the catheter is in place, a test dose is given, and your partner's blood pressure is carefully assessed because epidural anesthesia can cause blood pressure to drop. She has to wear an automatic blood-pressure cuff on her arm for a short period, and she may find this very uncomfortable. If her blood pressure is low, she may be tilted slightly to her left side.

Explanation of possible side effects of an epidural for dads

Following are some of the side effects of epidural anesthesia:

• Difficulty urinating: Most women can't urinate well after the epidural is given, and a full bladder can get in the way of the baby's head and slow the pushing stage of labor. A Foley catheter may be placed to drain urine or the bladder may be emptied intermittently.

• Hot spots: Sometimes women have an area that doesn't "take" to the epidural, and they need to change positions so that the anesthesia goes to a different area and numbs the nerves that haven't been numbed well. In the worst-case scenario, the epidural may need to be re-placed.

• Nausea and/or vomiting: These symptoms may also occur in labors without epidurals.

• A rise in temperature: It's difficult to tell whether infection or the epidural is causing a rise in temperature, so intravenous antibiotics must be given to avoid complications in case an infection is present. Any time mom runs a fever, the fetus may also develop one, from the increase in womb temperature.

• Shivering: The fluid infusion or the epidural can cause shivering. Your partner will appreciate extra blankets, especially if they're straight out of the warmer.