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Dr. Reitzel explains when it is too late to administer an epidural during labor.
Dr. Reitzel:
The only time that it is too late to actually receive some form of analgesia is when the baby is actually coming out. Obviously the more time I have to practice my craft the better job I can do, but up until the baby is actually coming out we can actually give you some form of analgesia.
There is a limit however to how quickly the medicine can come on board. It takes us about, if we are in a real hurry, about 3 to 5 minutes to get some form of analgesia.
Now obviously some is not all, okay? So the more time that we have to administer a medicine and do things safely the better chance that we can get good analgesia for you.
As a spin off from that, a common question is, when can I get my epidural? That is actually a very important point. Typically speaking we would like to wait for our women to get epidurals when they are in adequate labor.
And now adequate labor is defined as number one, a change in your cervix and that could be from a fingertip to one to three, three to five, one to nine, whatever it takes, as well as three contractions in ten minutes.
Now as long as those two criteria are met then there’s absolutely no problem with getting an epidural. The concern is that if we put epidurals in too early, meaning that you haven’t met one of those two criteria, the amount of fluids that we give you to hydrate you as well as the baby, can actually increase the duration of your pregnancy, meaning the duration of your labor.
So as a consequence we want to make sure that you are in adequate labor, and again, it used to be in the old days they used to say, you can’t have your epidural until you are four centimeters.
Well, that’s not really true. As long as there’s a change in the cervix and at least three contractions in ten nights is perfectly acceptable with your epidural.
Typically they has shown that as long as you are in adequate labor when your epidural is placed there is absolutely no correlation, well let me back up. As long as you can wiggle your toes and bend your knees, the pelvic floor, the muscles staying nice and taught, babies are able to rotate when it engages, and as a consequence, mom has the expulsive effort to be able to push adequately.
So as long as mom has those physical characteristics then there’s absolutely no problem with that.
About Dr. Keith E. Reitzel:
Dr. Keith Eric Reitzel, M.D., is the Clinical Director at Anesthesia Resources, Ltd. in Tempe, Arizona. Dr. Reitzel is certified by the American Board of Anesthesiology and he is certified in Advanced Cardiac Life Support (ACLS). Additionally, he is on the Anesthesia, Critical Care, and Surgery Committees at Banner Desert Medical Center. Dr. Reitzel is licensed in Arizona, as well as North Carolina.