The decision to receive an epidural anesthetic is between a woman, her obstetrician/midwife and her anesthesiologist. Epidural analgesia is generally given when a woman has begun active labor with regular painful uterine contractions. Woman can discuss her pain relief options before she is in severe pain. Telling the anesthesiologist her preference or signing a consent form for anesthesia does not obligate her to get an epidural anesthetic. She may later decide that she would rather have natural childbirth or another method of pain relief Coppejans, Vercauteren, Corthouts, Heyning, Jorens, 2003).
Many factors determine when a woman can get an epidural, including the position of the baby in the birth canal, or whether this is her first baby or a later child. Some obstetricians/midwives would prefer that she be dilated at least four centimeters prior to getting an epidural. These obstetricians/midwives believe that an early epidural may slow her labor, but the available data on this topic is controversial (Camann, Norris, Rawal, Crowhurst, Vercauteren, Holmstrom, 2000).
Certain medical conditions, however, may favor earlier commencement of epidural analgesia. Once the obstetrician/midwife gives his/her permission for her to get an epidural anesthetic, the anesthesiologist will place the epidural. If she has not seen an anesthesiologist in advance, an abbreviated history and physical, and consent for the procedure will be obtained (Camann, Norris, Rawal, Crowhurst, Vercauteren, Holmstrom, 2000).
It is almost never too late to get an epidural unless the head of the baby is visible (crowning). Even if a woman has initially attempted natural childbirth and never saw an anesthesiologist, she may change her mind later on if she finds labor to be extremely painful. It is my recommendation that a woman should attend childbirth education classes and listens to a lecture about the available forms of pain relief. It is important that she keeps an open mind.................
