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Dr. Reitzel describes what occurs once a woman goes into labor.
Dr. Reitzel:
Typically speaking the questions that people often ask are, all right, my water broke, okay, now what? Or, I am in labor. I don’t know what to do.
Well, the first thing I got to tell you is when you come into the hospital, dads especially, drive the speed limit. You don’t need to get into an accident. Number two, moms, wear your seatbelts please, okay? I can’t tell you how many car accidents we see with moms not wearing seatbelts. It’s ridiculous.
Anyways, once you get in and you’ve driven the speed limit and you haven’t caused a crash on the highway on the way in, you’d register. Oh, that’s the other thing, pre-register. Come to the hospital tour. They have tours.
Come check out things. Ask your questions then. Have your paperwork already situated so when things do happen quickly you’re in the system, you are already ready to go.
Come in to triage. They will check you in. They will make sure that everything is okay, who you are and they are not going to take you up for an appendix or something like that. They’ll get your ID bands placed.
They will typically start an IV for you. At that point they will take you out of the triage holding area. They bring you over to labor and delivery. At that point if you are ready for your epidural they will go ahead and give you some fluids as well as they will start to position you.
Positioning – one of two ways to be done. One is sitting up and the common way that they sit up is to lean forward and trying to put your elbows on your knees. Notice I said try. Okay, you don’t have to.
Obviously you have something that’s obstructing your ability to lean forward but obviously anything that you can do to lean forward helps to open up the space that the anesthesiologist is looking for.
Sometimes the anesthesiologist may have you do it in a lateral position laying your side and what you do is you curl up like a cat, a scarred Halloween cat, and again that’s to open up the spaces in your back so that the placement of the epidural goes very smoothly.
At that point the anesthesiologist hopefully will have come and saw you before you are sitting there ready for your epidural but anyways, say hello, ask your questions, ask you a bunch of questions about allergies, medicines, past medical history, all those kind of things and at the same time will give you the opportunity to review epidurals, what they are, the risks that are associated with them and answer all your questions.
When all that is agreed upon typically speaking what they will do then is they will go ahead and put on a hat, mask, sterile gloves and they will wash your back off with cold, scratchy soap, emphasis on the word ‘cold’, okay?
Our Bostonian friends, we call that wicked bad cold but it’s just cold and scratchy. At that point we take a sterile drape to again, to make a sterile clean area and they put it over the back area and then the anesthesiologist will typically take a piece of gauge and wipe off the excess amount of iodine or Hibiclens, depending on if you have an iodine allergy or not.
At that point they will feel for the structures that they are looking for and they will take that numbing medicine like the dentist uses on your teeth and they will put a little injection in the middle of your back.
At that point you shouldn’t feel much more than pressure. From the time that the anesthesiologist actually opens up the epidural kit, preps everything, to the time the epidural is actually placed should only be between five to seven minutes at most, okay?
At that point when the epidural is in place they will secure it. Typically speaking there’s a multiple ways of being able to secure your epidural, most common is tape. Warning – most people don’t realize it but everybody has these little tiny micro hairs on your back.
The wax is free. So when you go to take the tape off remember about the good analgesia you had and try not to be too upset about that.
But anyways, they tape it on your back so that it doesn’t fall out because once it gets in we don’t want to have to come back and replace it, which raises another very important question.
When you have an epidural and you are nice and calm, if you have to rotate from one side to the other, and you will have to rotate, it is better to sit up, move and lay back than it is to scrape your back across the bed.
Because if you lift the tape up then you can dislodge the epidural and that goes back to that sometimes they just don’t work, sometimes if you are moving a lot and do what I call the butt walk up the bed, the epidural can migrate out of the epidural space and then we have to replace it.
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.