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If you elect to have an epidural, your doctor will first give you one to two liters of fluids intravenously to help maintain your blood pressure. He or she will then have you roll over onto your side or sit up with your knees pulled to your chest and your chin to your knees. The lower part of your back will be wiped with an antiseptic solution and then numbed with an local anesthetic. A larger needle will then be placed through the numbed area and into the epidural space and the catheter is inserted. Your doctor will administer a “test dose” of the medicine and you will be asked if you become dizzy, experience a funny taste in your mouth, a rapid heart beat or numbness. These symptoms may indicate that the anesthetic has accidentally been injected in one of the veins in the epidural space. If you do not notice any of these symptoms, a full dose of the anesthetic will be given and you will begin to feel the effects in approximately three to five minutes, with full effect in approximately 10. Once the initial dose begins to wear off, another dose can be given. In some hospitals, women are able to self-administer the medication by pushing a button attached to a pump. If you have an epidural, you must be hooked up to a fetal monitor, IV, and blood pressure monitor, which may limit your mobility.

A new type of epidural, combining a spinal block with an epidural, provides faster pain relief and may allow you to walk around. This so-called "walking epidural" involves injecting an anesthetic into the spinal sac, which takes effect immediately, before the epidural is administered. The anesthetic lasts for two to three hours and may make the epidural unnecessary if you deliver before it wears off.

The amount of feeling you retain after the epidural depends on the medication used, where the epidural was inserted, and other factors. Lower concentrations of medication are often used today, which may allow you to stand or even walk if you wish. You should be able to push with your contractions when the time comes; however, if too much medication is given you may not be able to feel any contractions and need assistance pushing, or forceps or a vacuum may be used to help the baby through the birth canal.

Because the anesthetic used in an epidural is not injected into a vein or into a muscle, it does not enter your bloodstream and your baby is unlikely to be affected (however, more research is necessary to conclusively rule out any affect on your baby).

Once your baby is born, the catheter will be removed and the effects of the anesthesia usually wear off completely in one or two hours.

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