The Epidural

While we do epidurals for many surgeries, when most people think of the epidural, they think of pain management for labor and delivery. Right now, I find the procedure a little challenging, but I know it will get easier. Like IV placement, intubation, spinals, and other hands-on things we do, it simply takes practice and repetition. In a laboring woman, placing the epidural is a little more challenging because we have to do the procedure in between contractions. The procedure itself is quite safe and I am becoming more and more facile with it, so the question becomes: when should we do it?

I get asked this a lot, equally by patients as by other healthcare providers. Should I get an epidural or not? There's no easy one-fits-all answer to this. If a patient feels strongly one way or the other, I support them completely. Some people want as much pain relief as possible; others want the natural childbirth experience; I am happy with either. If she is uncertain, I don't press too hard but always leave the option available. Some people like to say, "If I were in your place..." or "If you were my mother, sister, or daughter..." but I never do that; I'd never be so presumptuous as to pretend to know what it's like to be pregnant, nor to recommend to a family member what to do in this situation. (I do use the "If you were my mother, sister, daughter," phrase in cases where I feel something is medically clear-cut such as whether to go to surgery for life-threatening appendicitis).

There are few scenarios in which anesthesia can empower a patient, but here is one; the choice is always up to the patient. For most surgeries, I don't ask the patient what kind of anesthetic technique he'd like; when I present risks, benefits, and alternatives, the alternative is not to do the surgery. But here, it is perfectly reasonable to choose an epidural or not, and so part of resident learning is presenting the options in the most appropriate fashion.

Image of an epidural catheter shown under Creative Commons Attribution Share-Alike License, from Wikipedia.