Once the anaesthetist has washed their hands and put on sterile clothing they will set up the rest of their equipment (often your caregiver will do most of the preparation before the anaesthetist arrives). Then the following will happen:
Positioning the woman
Inserting the needle
Testing for the location
Inserting the epidural catheter and medications
Taping the catheter in place
Positioning the woman. The woman is helped to lie on the bed on her side (right or left). Some anaesthetists prefer the woman to sit up on the side of the bed leaning over a pillow on her lap, with feet resting on a chair or a footstool. Either way the woman needs to curl up in the fetal position (like an 'angry cat') on her side or over the pillow, to curve her back and help separate the spaces in the bones of her spine. This will help the anaesthetist pass the epidural needle between the bones, to reach the epidural space.
Image 8-14 shows the woman curling up in preparation for the insertion of the epidural.
When the needle is inserted, this position will need to be maintained with the woman staying as still as possible for a short period (but can be for up to 1 to 3 contractions), while the anaesthetist locates the epidural space and inserts the epidural catheter. It may be that the partner or another caregiver will help to gently 'hold' the woman in position while the procedure is being performed. The anaesthetist will usually try as much as possible to carry out this procedure during the rest periods between the contractions. The procedure may take longer if the contractions are very close together and the time between them is limited.
Inserting the needle. The woman's back is washed down with cool antiseptic solution and covered with green sterile drapes. It is important that no one contaminates the sterile area by touching the green drapes.