Epidural labor Delivery

About Epidural Labor

In response to the wishes of expectant mothers, we offer “epidural labor”, using epidural anesthesia, and we hope that you understand the risks, costs, and benefits of this procedure before making a decision.
Obstetricians, anesthesiologists, and midwives work together to ensure safe delivery. The involvement of an anesthesiologist who understands obstetric anesthesia is essential for providing a safe, high-quality, and pain-relieving delivery. We are able to meet the needs of many patients who opt for epidural labor by planning delivery and ensuring that labor occurs during weekdays from Monday to Friday, when the obstetric anesthesia team is available in the wards. We do our best to accommodate the spontaneous onset of labor during the daytime, but please be aware that epidural labor may not be possible at certain times, and as a rule, we cannot accommodate contingencies at night or on holidays.

Our method for pain relief during labor

After the onset of labor pains, a thin catheter is inserted through the back, called epidural anesthesia, and local anesthetics are injected to provide adjustable and continuous pain relief. From the start of anesthesia until delivery, a self-pain management device (PCA device) was used to provide additional pain relief that can be adjusted according to the level of pain experienced by the pregnant woman. An anesthesiologist will visit regularly to help manage pain and improve the birthing experience. Pain relief in facilities where anesthesiologists are involved is generally provided through epidural anesthesia.

What is a planned delivery?

For those who wish to have epidural labor, delivery is planned at approximately around 40 weeks for first-time mothers and approximately 39 weeks for multipara women. We will discuss the timing of delivery with expectant mothers at prenatal checkups, depending on how ready the uterine cervix is for delivery, and the delivery may be scheduled earlier due to medical reasons.

Day of admission: Cervical dilatation is performed if required.
Day after admission: In the morning, intravenous labor-inducing drugs or intravaginal placement of cervical ripening agents are administered. Epidural anesthesia is initiated when labor contractions with pain occur.

What are the advantages of epidural labor?

Epidural anesthesia relieves the pain associated with childbirth (labor pains), allowing the patient to relax and face the birth itself rather than the pain. It is especially beneficial for those with pre-existing medical conditions, such as heart and blood vessel diseases, breathing disorders, and neurological disorders that may be adversely affected by hyperventilation, and high blood pressure, which may require reduction during the stress of childbirth. However, epidural anesthesia may be difficult if the patient is on medication that prevents blood from clotting and ineffective if the patient has a medical condition with a severely deformed spine. It is also expected to provide pain relief during procedures, such as suturing wounds after childbirth.

What are the risks of epidural labor?

1) Effect on delivery
The delivery time could be longer than that for those who did not have epidural labor. Additionally, there is an increased likelihood that forceps or vacuum extraction (a method of pulling the baby out using an instrument) may be necessary if the baby cannot be delivered by pushing. Even in this scenario, this approach should be considered as a supplement to pushing .

2) Effects on the baby
There are almost no direct effects of epidural labor on babies. We believe that it is important to ensure the safety of the mother, as a drop inof the mother’s blood pressure may affect the baby. If the baby requires medical attention, the pediatrician in charge administers medical care.

3) Effects on the mother
There are effects of the epidural labor procedure, as well as those associated with a longer delivery time. During anesthesia for epidural labor, low blood pressure and numbness, and difficulty in moving the legs often occur. Less than 1% of patients experience post-dural puncture headaches, which can last up to a week and can be treated with rest and pain medication. Sickness, itching, fever, tremors, and difficulty passing urine may be more common with epidural labor than with non-anesthesia delivery. Depending on the intensity of the symptoms, medication or catheterization may be required. More information on complications can be found here. PDF

Cost of epidural labor

In addition to the normal delivery fee, an additional fee (at your own expense) of 120,000 yen will be charged if the anesthesia lasts less than 10 hours, and 150,000 yen if the anesthesia lasts longer than 10 hours. This fee is incurred when epidural anesthesia is initiated. The anesthesia fee does not vary depending on the efficacy of anesthesia, but the hospitalization cost depends on the length of hospitalization stay. If a cesarean section is chosen during epidural labor, the cost of the cesarean section will be covered by insurance.
If you wish to undergo epidural labor, please inform your doctor at the time of your pregnancy checkup, and they will provide you with an explanation and consent form. The application can be made by submitting the consent form to the doctor at the time of pregnancy checkup. Please submit the form by 37 weeks of pregnancy at the latest to schedule a planned delivery.

Message from the Obstetric Anesthesia Team

The obstetric anesthesia team works to provide safe anesthesia throughout the perinatal period, focusing not only on epidural labor, but also on pre-operative consultations for patients undergoing cesarean sections and post-operative rounds to assess the status of the patient. If you have any questions about anesthesia during pregnancy or childbirth, including epidural labor, cesarean section, or anything else, please feel free to consult our obstetric anesthesia team. The University of Tokyo Hospital, a comprehensive perinatal center, handles a wide range of births, from normal births to those with a high risk of hemorrhage and complications. However, our team works together with obstetricians and midwives to provide expectant mothers with the safest and most comfortable birth experience.