Are you pregnant and considering an epidural for pain relief during childbirth? You are not alone. More than 60 percent of women giving birth at hospitals opt for the procedure. To help you make sense of the procedure and figure out if it’s is the right pain-management method for you, we wanted to tell you how epidurals really work and give you some tips!
Here are 8 questions about epidurals, answered:
1. When do I ask for an epidural? You can ask for an epidural at any point in your labor. If you can, it’s better to wait until you’re in active labor since getting one in early labor can increase your chances of a cesarian section. An epidural can take time (from 15 minutes to two hours) to be administered depending on the availability of the anesthesiologist. So keep that in mind, and if the contractions are getting more painful while you wait, plan to cope with any discomfort using breathing, massage and relaxation techniques. Pro Tip: Ask what the wait time is when you get to the hospital so you can plan in advance.
2. How is an epidural placed? You’ll be asked to sit on the edge of the bed, leaning against a nurse or a partner, and be still. After a local anesthetic is administered, a catheter delivering the medication is placed in your lower spine. You’ll start to feel the effects of the medication 15 minutes or so later. After it’s turned off, the numbing effects wear off in an hour or two.
3. Can I move after getting an epidural? You can move, but your lower half will be numb to a degree, so you’ll be required to stay in bed, even with lower dosage ‘walking’ epidurals. Being in a supine position for an extended period of time can lead to baby presenting ‘sunny side up’ (which in turn could lead to a longer labors and use of episiotomy, vacuum or forceps assisted delivery) and affect oxygen to baby’s brain. So turn from side to side every 20 to 30 minutes to help open your pelvis and get baby moving - it works like a side squat! You can use pillows or, even better, use a peanut ball between your legs. Ask your care practitioner about hospital policies about moving and eating after an epidural is placed.
4. What other procedures are involved? Whether you have an epidural or not, most hospitals and birth centers will require you to have an IV, usually inserted in your non-dominant arm. If you choose not to have an epidural, you can ask for a hep-lock instead, so you don’t have to carry the IV bag around with you. However, if you get an epidural, a continuous IV will be placed. Doctors will also insert a urinary catheter to help empty your bladder since you can’t get up to go to the bathroom. They’ll put the catheter once you’re numb and take it out before you push.
5. How much medication will I get? You can ask for the button to control your own epidural medication. Studies have shown that when self-medicated, patients give themselves smaller dosages!
6. What’s in an epidural? An epidural is a regional anesthesia that blocks pain to a specific part of the body. The medications used in the procedure fall into a class of drugs called local anesthetics. They include bupivacaine, chloroprocaine and lidocaine, among others. If your doctor wants to decrease the required dose of local anesthetic and give you pain relief with minimal effects, he or she can deliver an epidural with a combination of opioids or narcotics, such as fentanyl and sufentanil. The anesthesiologist may also combine it with epinephrine, fentanyl, morphine, or clonidine to prolong the epidural effects or to stabilize the mother’s blood pressure.
7. Will I feel pain? You shouldn’t feel any pain. The lower half of your body will be numb, but you may be able to feel pressure of vaginal exams and baby’s head as you push. If you want more sensation while pushing, which can help prevent pelvic injuries, you may be able to ask your care provider to reduce the dosage as you push to have better awareness. Occasionally, the epidural may be uneven, with more feeling in one leg or the other. Let your care provider know as soon as possible, if that is the case.
8. What are the risks? Epidurals are safe but, like any medical procedure, come with a few risks. An epidural may cause soreness in the area of administration, a low-grade fever, and a decrease in blood pressure, which can in turn slow down baby’s heartbeat. Many patients get the shivers or shakes from an epidural, in which case squeezing a stress ball can help. Occasionally, some people are allergic to the medication. There isn’t a good way to test for the allergy, but you can ask for it to be administered in small test doses to start. Epidural anesthesia can slow down the second stage of labor, which can then result in further medical interventions, like Pitocin administration and instrument-assisted delivery. In rare cases, women can experience severe headaches due to leakage of spinal fluid. If symptoms persist, your doctor will inject some of your blood in the epidural space -- a procedure called “blood patch.” Serious and life-threatening risks are rare, but can happen. They include slurred speech, drowsiness, convulsions. Death are very rare, but when they happen it's usually because of cardiac arrest, abscesses or blood clots.
My professional recommendation? Use your breathing, massage and movement techniques as long as you can to make sure your labor builds momentum. When you get to a point where you’re no longer able to relax through contractions and start to tense up, fight and resist them, or if you’ve been in labor for a really long time and are sleep deprived and exhausted, an epidural is a great option to help you get rest and sleep!
Illustration by Shanequa Simpson for Well Rounded.