While epidural seems to be the popular choice for childbirth pain management, is it right for you? Find out here.
In this article:
- What Is an Epidural?
- How Does It Work?
- How Do They Administer It?
- When Do They Administer It?
- Why Do Women Choose Epidurals? What Are the Benefits?
- What Are the Risks and Side Effects?
- Who Aren’t Good Candidates for Epidurals?
Everything You Need to Know About Epidurals
What Is an Epidural?
An epidural is a popular pain management option for women who are in labor. There are two types of epidurals:
- Regular epidural
- Combined spinal-epidural (CSE)
Both types use similar narcotics and anesthetics to help manage the pain. Though, they may differ in the dosage of the drugs.
What are narcotics? A kind of drug that helps relieve pain and may induce drowsiness.
What is an anesthetic? Any substance that causes insensitivity to pain. It leads to a loss in sensation in the area where it is applied.
Usually, regular epidurals will require the expectant mom to stay in bed. But the CSE is administered in a manner that allows for more mobility and that’s why it’s also known as a walking epidural.
Unlike in general anesthesia where you lose complete consciousness, both types allow you to stay awake, alert, and comfortable during your labor and delivery.
How Does It Work?
An epidural is a regional form of anesthesia. This means it provides pain relief in localized areas.
When it’s administered for childbirth, it’s supposed to relieve pain in the lower half of the body or everything below the belly button. This makes it very effective in blocking the pain you may feel from contractions and delivery.
How Do They Administer It?
An anesthesiologist usually administers the epidural. The administration only takes a few minutes and usually involves the following steps:
- before the procedure, fluids are usually administered intravenously
- you will need to arch your back by laying on your side and curling up into a ball or by sitting and bending forward on a pillow
- the nurse or doctor will put an antiseptic solution on your back to prevent infection
- the doctor will inject a local anesthetic in the skin of your lower back
- in between contractions, the doctor will insert a needle between the bones of your spine
- the doctor will thread a small tube or catheter on the needle until it gets to the epidural space (the area just outside of the spinal cord membrane)
- once the catheter is in place, the doctor will remove the needle and may tape the catheter down to prevent it from coming off
- the doctor will deliver the drugs through the catheter to provide pain relief
Most of this takes place in between contractions because it’s important to remain very still during the procedure. Once it’s in, it can take 10-20 minutes before you feel the numbing effect.
The catheter is left in until the baby has been delivered so that the drugs are continually administered. The dosage, type of drugs, and duration of the administration will depend on your preference and your doctor’s orders.
When Do They Administer It?
Most doctors wait until active labor before they administer an epidural. Active labor is the second phase of the first stage of labor.
A woman is in active labor when:
- her cervix is 4-6 cm dilated
- she is experiencing longer, more frequent, and more intense contractions
Apart from the contractions, women in active labor may also experience leg cramps, nausea, and increased pressure on their backs.
Theoretically, you can get an epidural during any stage of your labor. But since you need to stay still during the procedure, you may not want to wait until your contractions are too close together.
And since it takes about 10-20 minutes for most women to feel its effect, it’s best to have your doctor administer it before the second stage of labor or the pushing stage.
Why Do Women Choose Epidurals? What Are the Benefits?
Epidurals are an effective and safe way to manage pain during labor and delivery. Here are some other benefits of having an epidural:
- Gives you time to rest, especially if your labor is long (and it tends to be longer for first-time moms)
- Less pain and anxiety during labor and delivery leads to a more positive childbirth experience
- Epidurals allow you to stay alert and participate actively in labor and delivery, even if you end up having a cesarean section
- The dosage isn’t set in stone, so you can talk to your doctor about how much pain medication you prefer
With these benefits, it’s no wonder that many women choose to have epidurals.
What Are the Risks and Side Effects?
Like all medical procedures, there are some risks and side effects associated with epidurals. Here are some things you may want to take into consideration:
- it may make you feel cold or itchy
- some women feel weakness in their legs for a few hours
- it may cause nausea or vomiting
- if you don’t feel your contractions, it may make it more difficult to push during delivery. This may lead to a forceps-assisted delivery, a vacuum-assisted delivery, or even a cesarean section
- some women temporarily have a difficult time urinating and will require a urinary catheter
- it may cause a skin infection
- after six hours on the epidural, you may develop a fever
- it may lead to hypotension, where the expectant mom’s blood pressure drops significantly
- if the mother has hypotension, it may slow down the baby’s heartbeat and put it into distress
- less than 1% of women develop a bad headache 24-48 hours after having an epidural
- rarely, a very small number of women develop permanent nerve damage
One of the main disadvantages of an epidural is it requires constant monitoring once it has been administered. This usually means that mom has to stay in bed while machines monitor her blood pressure and her baby’s heart rate.
While epidurals are generally effective for most women, a small number of women (less than 5%) report that the epidural had little to no effect on their pain.
Who Aren’t Good Candidates for Epidurals?
For some women, epidurals may not be an option. Here are some cases where an epidural may put the expectant mom at risk:
- expectant mom used blood thinners
- evidence of hemorrhaging or shock
- expectant mom has a low platelet count
- expectant mom has a back or blood infection
- the cervix is not dilated enough (less than 4 cm)
- if the doctor can’t locate the epidural space
In some cases, especially for mom’s who have had vaginal births before, labor might progress too quickly, and they may not have enough time to administer the epidural and wait for it to take effect.
Find out more about the process of an epidural in this video from Bupa Health UK:
It’s important to learn about your pain management options before you give birth. An epidural is just one of the many options you have to help manage pain during childbirth.
Take some time to talk to your doctor about your options before your due date. Otherwise, it may be difficult to make these decisions when you’re in the middle of labor.
How do you plan on managing pain during your labor? Let us know in the comments section.