An L&D Nurse Explains: Epidural Catheters, Epidural Placement, Epidural Needle Size, and More!

I often receive direct messages about epidurals, and today we unpacked some frequently asked questions (FAQs) regarding the placement of epidurals. One question that came up is how much the needle for the epidural hurts.

It is beneficial to have a comprehensive understanding of all available alternatives, as the process of childbirth may commence unexpectedly due to alterations in plans. It is crucial for pregnant individuals to acquire extensive knowledge about epidurals, regardless of whether it is included in their birth plan or not.

If you’re curious about how it all goes down, I’ve seen hundreds of epidurals as a nurse during delivery and labor. There’s more to learn about reading.


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What is an epidural?

Placement of an epidural is an injection that is placed in the space behind your back to eliminate back pain. The epidural space is one of the areas that surrounds your spinal cord. The placement of the epidural is always done by the anesthesia team rather than your delivery provider.

The ability to seemingly eliminate the sensation of pain that comes with birth (if not all, most) is often referred to as the “gold standard” in pain management during birth and labor.

Epidural catheter

Many people mistakenly believe that getting an epidural involves a long, wire-like catheter placed in their back during labor, but in reality, it is just a one-time shot in the back that requires no prolonged stay.

This is how magic actually works – relieving pain in other words. The other end of the catheter will be connected to a pump that continuously distributes medication. This epidural catheter is actually only about 10-12 centimeters long, but it will stay in your back for approximately 90 centimeters.

Wait, so how exactly does an epidural work?

The purpose of an epidural is to temporarily provide numbness by blocking the signals of pain through contractions, which travel from your spinal cord to your brain.

Now, as the pain signals are being obstructed, I would like to caution you that you will still likely experience sensation.

Some women feel pain and experience extreme pressure while others do not feel this sensation with epidurals. A lot of pressure occurs in your rectum and pubic bone, as the baby descends into your lower pelvis, as you can see.

If you feel the pressure and panic when your epidural stops working, you can focus on pushing effectively by pushing at the right time instead. So, it is actually a good thing to have pressure because it can help guide your pushing. Epidurals are not actually intended to take away the pressure.

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When is it too late to get an epidural?

When you ask for an epidural, a member of the anesthesia team will come to your bedside and gather the necessary supplies. It usually takes about 30-45 minutes for you to receive the IV fluid. However, you should still be able to sit comfortably as long as the epidural is safely placed.

If your labor is advancing rapidly, there is a possibility it might not have sufficient time to take effect if you are able to remain motionless for a while to undergo the procedure. After the procedure is performed, it may also require an extra 20-30 minutes to experience the complete impact of the epidural.

When is the best time to get an epidural?

The best time truly is unique for each mother and birth. Contrary to popular belief, there is no magic number of hours in labor or number of centimeters dilated in order to get an epidural. Unfortunately, I cannot provide an answer to the million-dollar question.

Prior to receiving an epidural, these three occurrences should take place in my personal observation. There exist certain indicators to aid you in determining the optimal moment for you; nevertheless, I will not abandon you completely uncertain!

  • You should be experiencing painful contractions.
  • Your cervix should be opening.
  • You should not be delivering your baby.
  • If you are experiencing painful contractions while dilating and you feel ready for it, you can freely ask for an epidural, whether it’s at 9 centimeters or 3 centimeters.

    Depending on the size of the hospital, you may not have access to anesthesia services 24/7. Please keep in mind that it may take some time to request an epidural placement.

    Epidural placement process

    It may seem bad in your head, but this promise isn’t as scary as it can be with needles. I understand that it gives a lot of anxiety to women, and this is a part of it. Now, let’s talk about the actual placement of the epidural, alright.

    Let’s go through it gradually to eliminate the unfamiliarity and help you feel more self-assured.

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    Step 1: Epidural preparation

    If you request an epidural, even though you have already been admitted, it will be done soon. Before you can get the epidural, there are a few things that need to be done.

    However, if you have recently arrived at the hospital and promptly ask for an epidural, here is what you can anticipate:

  • One of the most frequent adverse effects from an epidural is hypotension, or reduced blood pressure.
  • One method we combat this decrease in blood pressure is by providing you with additional intravenous fluid.
  • If your blood pressure drops despite the additional fluid, we can quickly give you other medications to bring it back up.
  • All of this to say that receiving an intravenous (IV) before the placement of an epidural is absolutely necessary.
  • During the IV placement process, we will also gather a blood sample to examine your platelet level.
  • Before administering an epidural, it is important to be mindful of the fact that having a low platelet count is a contraindication.
  • Once the laboratory receives your blood sample, it typically takes about 15-30 minutes for your results to be returned, varying based on the particular facility.
  • Intravenous fluid is administered prior to the placement of your epidural in order to prevent a substantial decrease in your blood pressure.
  • The epidural is inserted while the fluids are actively flowing, although some members of the anesthesia team prefer the entire IV fluid bag to be infused beforehand.
  • It can take anywhere from 20-60 minutes to receive a complete bag of fluids.
  • Collect materials Your nurse will be responsible for gathering the materials that will be required to administer your epidural.
  • Once everything is prepared, anesthesia will be summoned to your room to perform the actual placement!
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    Step 2: Giving consent

    Depending on the preference of anesthesia, you will either be seated on the edge of the bed with your legs hanging or lying on your side. Once anesthesia arrives, we will assist you in getting into the appropriate position. Rest assured, relief is imminent!

    Prior to the onset of labor (such as when formulating your birth plan), it is advisable to have a conversation about any inquiries or apprehensions you may have regarding epidurals. If you find yourself experiencing intense, active labor, please bear in mind that this discussion will likely be brief and concise. The member of the anesthesia team will provide a brief explanation of the procedure, encompassing potential risks and advantages, and afford you the opportunity to pose any queries once they arrive.

    Once this is completed, they will request your signature on a consent document, granting them authorization to administer the epidural.

    Additional Reading: Ways to Create a Birth Plan: A Guide from a Labor and Delivery Nurse.

    Step 3: Sitting for your epidural

    Once you provide consent, we will initiate the sterilization process on your back while also monitoring your vital signs through the placement of a blood pressure cuff on your arm and a pulse oximetry probe on your finger.

    Now, your positioning during the epidural placement is SUPER important so here’s a quick overview of how to sit for your epidural:.

  • Sit in a hunched position.
  • Lower your chin towards your chest and bend your head forward.
  • Ease the tension in your shoulders.
  • Rest your arms in your lap.
  • Imagine arching your back like a shrimp or an angry feline.
  • Step 4: Placing the epidural

    Your back will be placed on a sticky drape and cleaned with an antiseptic solution once you are in the correct position.

    Afterwards, you will experience the anesthesia team member applying pressure to your back in order to identify the optimal location for insertion.

    Frequently, the most unpleasant aspect is the sensation similar to that of a bee sting. You will experience a numbing sensation when they insert a small needle.

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    (Rewritten) The depth at which the needle needs to go to hit the spot that varies depending on the individual’s body type, but it’s usually within a range of 4-8 cm. The larger needle will be inserted slowly into the epidural space and positioned into your back, numbing it as soon as possible.

    Once the needle is taken out, the catheter wire-like super, which is approximately 10-12 cm long, will be threaded into your back at a spot that the anesthesia team member will locate, approximately 90 cm in length. Remember, the needle goes into your back and the catheter goes back in.

    The remaining sum is allocated for flexibility to connect the pump that will consistently administer medication during your labor.

    Step 5: Testing the epidural

    If it’s in the wrong place, the catheter might need to be removed and replaced (luckily, this doesn’t happen too often!). Next, to make sure the catheter is in the right place, anesthesia will be given to test the dose of medicine.

    The entire process of steps 3-5 normally takes around 10-15 minutes, but it may take longer if there are difficulties inserting the needle into the epidural space.

    The process is slow and usually takes around 15-20 minutes, but for many women, relief can be felt within 5 minutes. If a larger dose of medication is administered, it will numb your back and the epidural catheter will be taped securely, ensuring it lasts for a long time.

    Related Reading: 12 Crucial Epidural Side Effects and Facts You Might Not Be Aware Of!

    How big is the epidural needle? What’s the epidural needle size and length?

    This is another common question. The length and size of the epidural needle varies depending on the size of the patient. The truth is that the size of the epidural needle is usually either 18-gauge or 17-gauge. The gauge refers to the diameter of the needle. The higher the gauge, the smaller the diameter.

    The typical epidural needle length is about 3.5 inches for a normal-weight adult and up to 6 inches for an obese adult.

    Does getting an epidural hurt?

    Many individuals claim that the numbing medication resembles the sensation of a bee sting. However, I have not personally encountered this occurrence. As mentioned earlier, the majority of individuals state that the most unpleasant aspect of an epidural placement is the numbing medication.

    The spinal needle is inserted, so you can anticipate experiencing some force in your lower back. While the catheter is being threaded, you may also sense a tingling sensation travel down one or both of your legs (it feels similar to hitting your funny bone!).

    If you are feeling discomfort during the placement, inform your anesthesia provider immediately so that they can promptly address it.

    How long does an epidural last?

    You should have adequate pain relief from epidural throughout your entire labor. Then, a catheter will be connected to a pump that will continuously infuse pain medication until you deliver. Once we determine that your epidural is in the right place, it will be taped to your back.

    As I mentioned previously, it is not uncommon for the baby to feel a sensation of pressure as it moves lower down into your pelvis and gets closer to coming out. The epidural is functioning perfectly in this case.

    When the moment arrives, pressure assists in directing your body on when and how to exert force. The pressure sensation is not intended to eliminate, but the epidural is designed to alleviate intense contraction discomfort.

    Wrapping up

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