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What is an epidural catheter?
If you decide you want to use spinal anesthesia for pain relief during labor, you will most likely be given an epidural block, often referred to simply as “an epidural.” Epidurals are very safe and are the most effective form of pain medication available for use in labor. Up to two thirds of laboring people in the United States chose to get them.
Epidurals work by using medication to numb the midsection of your body, from about the bottom of your ribs, down through your legs. When your midsection is numbed, it reduces the nerve signals (a.k.a. painful sensations) sent from your contracting uterus to your brain.
Epidurals are usually placed in active labor and are used continuously until shortly after delivery. But how does the medication get to -- and stay in -- the right place?That’s where the epidural catheter comes in! Here’s what we’ll cover:
- Catheters in Medicine
- Epidural Placement
- After the Procedure
- Can I walk?
- What about a urinary catheter?
Catheters in Medicine
“Catheter” is a word that refers to a flexible plastic tube. In the context of healthcare, they are used to move fluids into and out of the body. You may be most familiar with a urinary catheter, which drains urine from the bladder.
The catheter used for an epidural is much smaller than a urinary catheter, typically around 1mm in diameter, which is thinner than a piece of uncooked spaghetti.
The epidural catheter is placed into the epidural space between two of the vertebrae in your lower back, and medication is delivered via a pump through the catheter to maintain the numbness that helps ease the pain of contractions.
Epidural Placement
If you decide you want an epidural during labor, the procedure to place the catheter will be performed by an anesthesiologist or a nurse anesthetist.
Epidurals involve a bit more than just a shot in the back. First, you will be positioned to create the most space between the vertebrae in your lower back where the catheter will go.
Then the anesthesiologist will numb the skin around the area with a local anesthetic, and insert a hollow needle with a hole wide enough to allow the thin epidural catheter to pass through. The tip of the needle should enter the epidural space, allowing the medicine from the catheter to reach the targeted nerves.
After the Procedure
Once the catheter is threaded through the needle, the needle is removed and the catheter remains in place. It is taped along your back with soft medical tape to ensure the catheter stays put even when you move around and change positions.
Can I walk with an epidural catheter in place?
The term “walking epidural” is a bit of a misnomer. It refers to a lighter epidural, meaning one that uses less of the numbing medication than a standard epidural, which allows the laboring person to retain more sensation in their legs.
A light epidural has the benefit of greater freedom of movement during labor, but even if your legs aren’t completely numb, you still will be required to stay in bed with an epidural catheter in place. This is standard hospital policy to keep you safe from falls, since even a light epidural will cause you to be unsteady on your feet.
Typically the epidural infusion pump is turned off a few minutes after your baby is delivered. As the medication clears your system you will notice a gradual return of sensation to the parts of your body that were numbed. About 1-2 hours after the medication is stopped the catheter will be removed by your nurse, and you should be able to get up and walk around without issue.
What about that urinary catheter?
At the beginning of the article, we mentioned that you might be most familiar with a urinary catheter. These kinds of catheters are often used during labor as well.
Since you are restricted to the bed while laboring with an epidural in place, you will not be able to get up to use the bathroom. Once the epidural medication has numbed your lower body, you can expect to have a urinary catheter placed to keep your bladder empty. The good news is that the pain relief from the epidural ensures you won’t experience any discomfort from the urinary catheter.
Sources:
Lowdermilk, D. L. (2012). Chapter 17 Pain Management. In Maternity & women's health care
