Neha Arti 
17 Things You Need to Know Before Getting an Epidural
If you’re pregnant, you’re probably researching about your options when it comes to labor. One of the decisions you’ll be faced with is whether you’d like to use an epidural for pain relief.
Before you make this choice, we’re betting you have a lot of questions. We’ve compiled everything you need to know in this post in a simple Q & A format.
What is an epidural?
Epidural administration is a method of injecting medicine into the “epidural space” of the spinal cord.
An epidural provides pain relief to your lower body during labor. Unlike some medicines, which are only administered once, epidural medicine usually constantly flows into your body through a small tube for the duration of your labor.
It allows for decreased sensation while still remaining fully conscious. Epidurals are the most commonly used pain medication during labor in the U.S.
What kind of medicine is administered through an epidural?
The medication used is usually a combination of two different drugs. The first is a local anesthetic, which blocks sensations such as pain, touch and temperature. The second is a narcotic, which also helps kill pain. When both drugs are used together, you’re usually still able to maintain some sensation in your legs and you’re able to move them as needed.
You may consider asking your doctor which specific drugs will be used prior to receiving an epidural.
Are epidurals considered safe?
Epidurals are very safe for most women. However, there are some risks and side effects, as mentioned later in this post.
If you get an epidural, you will be monitored throughout the time that the epidural is being administered. You can expect your blood pressure to be taken every couple of minutes for the first bit to ensure you’re not having any negative side effects to the medication.
Do I need an epidural?
Whether you use an epidural or not is a personal decision. Although many women use an epidural to control pain, it is by no means necessary.
However, you’re not able to have an epidural if you have:
- A bleeding disorder or infection
- Low blood pressure
- A skin infection where the needle would be inserted
- An allergy to anesthetics
- Are taking blood-thinning medication
How is an epidural administered?
An epidural is administered through a catheter, which is a thin and hollow tube. The catheter is inserted outside the membrane surrounding the spinal cord and fluid.
An anesthesiologist or nurse anesthetist will be present to give you the medicine. First, they will ask you to either lie curled on your side or to sit on the edge of the bed. Next, they’ll clean your back and inject a numbing agent. They’ll put a needle into your lower back and pass the catheter through it. Then they’ll take out the needle, taping the catheter in place so the medicine can continue to pass through. Since the catheter is so small, you can lie down normally after it’s administered.
The anesthesiologist will give you a small dose first to ensure it’s being administered correctly.
There are several different types of epidurals. Many mothers use continuous epidural, which provides constant pain relief. There are also intermittent epidural, walking epidurals, spinal analgesia and more. You may wish to ask your healthcare provider ahead of time which epidural you will receive (if you want an epidural).
What is patient-controlled analgesia?
Some women have the choice of controlling how often the epidural medication is released. Depending on their pain levels, they hit a button that releases the drug out of a pump and into the catheter. Of course, there is a limit to how much of the drug can be administered.
When do they give epidural during labor?
Years ago, doctors would administer the epidural only when the woman was in active labor. However, now most doctors will administer the epidural whenever you ask.
When should I ask for the epidural?
When you choose to ask for the epidural is up to you. If you know you want an epidural, you can let the anesthesiologist know as soon as you arrive at the hospital. This way, he or she can be prepared. You can ask for it to be administered right away or you can say you’d rather wait a bit to see how you feel.
Some women may think that it’s safer to wait until active labor, but that’s not necessarily true. As opposed to later administration, early labor epidurals do not make you more at-risk for a c-section, forceps delivery, etc.
How long does it take for the epidural to kick in?
After a few minutes of the first dose, the nerves in your uterus will start numbing. You’ll begin actually noticing the effect within 10 to 20 minutes.
What does labor feel like with an epidural?
In most cases, having an epidural significantly reduces the pain of birth. When contractions occur, you’ll probably feel a sudden pressure instead of pain. However, since pushing may be prolonged due to numbness, that stage may be frustrating.
Occasionally, depending on the woman’s body, the medication may not hit all of the necessary areas. If this happens, the pain relief may be spotty.
How long does epidural last during labor?
The drugs administered through an epidural are usually constantly released throughout labor. This means that, as long as your body reacts normally, the pain relieving effects will last as long as the epidural is administered.
After labor, it may take some women up to 6 hours to gain full sensation back. Some may feel lightheaded during this time.
Can an epidural slow down labor?
Having an epidural can make the pushing stage longer. This is because the loss of sensation in that area makes it more difficult to push.
Studies have shown that starting an epidural earlier in labor does not prolong labor.
What happens after I give birth?
Congrats! You’ve given birth and the pain is over, so the catheter will be removed. However, if you need a c-section, the catheter may stay in to help relieve the continued pain.
Are there risks or side effects of epidural during labor?
Having an epidural increases your risk of a vacuum extraction or forceps delivery. This happens if you are not progressing into the pushing stage and you need assistance to get the baby out. If the assistance requires the use of forceps or a vacuum, there is a risk of serious lacerations. Although the risks for your baby are relatively low, there’s still a risk for bruising.
The medication may lower your blood pressure. This can reduce blood flow to your baby and slow his or her heart rate. However, fluids or medications can treat this. The narcotics used can make some women feel nauseated and may cause the face to feel itchy.
An epidural also increases your risk of having a fever. This may be caused by your body not giving off the heat generated by labor (since less pain means less sweating). If this occurs, the doctors may be unsure whether the fever is from an infection or the epidural. If they decide to err on the side of caution, your baby may receive antibiotics.
Those who have epidurals have more babies in the face-up position during delivery, which can mean longer labors and c-sections. However, researchers aren’t sure if this is because epidurals cause babies to end up in this position or if women with babies in this position are more likely to have epidurals to kill pain.
Although rare, 1 in 100 women may get a headache that lasts days due to leaking spinal fluid.
It’s very rare for epidurals to affect breathing or to cause injury or infection.
Will having an epidural affect my baby?
Most studies show that an epidural doesn’t negatively impact a newborn. Some experts say that babies whose mothers had an epidural have trouble latching during breastfeeding. Others argue that the studies that come to this conclusion are low-quality. This topic remains controversial.
What are the pros and cons of giving birth with an epidural?
Pros:
- Effective pain relief throughout entire labor while still awake.
- The medication type and amount can be adjusted according to your pain.
- You may rest as your cervix dilates. This may save energy for the pushing stage.
- If you need a c-section or are having your tubes tied afterward, the epidural is already set up to provide anesthesia medication.
Cons:
- May pose challenges for those afraid of injections or IVs.
- Need constant monitoring of blood pressure and fetus.
- Can make pushing stage longer.
- Increases risk for vacuum extraction or forceps delivery.
- Pain relief not always effective for all areas.
- May lower blood pressure and cause fever.
- Since the anesthetic numbs the area, you may have difficulty knowing when you have to pee. If you can’t pee in the bedpan, you may need a catheter inserted into the urethra.
- Other risks and side effects as noted in the question above.
How do you push during labor with an epidural?
If you don’t feel your contractions because of the numbness in the area, you may have trouble pushing.
Some women wait to push until the baby is further down into the pelvis. This is known as “laboring down” and is thought to help a woman rest and prevent her from exhaustion from pushing.
You may be limited to certain pushing positions since an epidural numbs your lower body. Some good positions may include semi-sitting with leg support, supine with leg supports or side lying.
Have you given birth with an epidural before? If so, comment your experience. If you have any pregnant friends, be sure to share this post with them, too.
P.S. Have you heard of fetal dopplers? These amazing handheld devices allow you to listen to your baby’s heartbeat while she’s still in the womb—pretty amazing, right!?
References:
https://www.babycenter.com/0_epidural-pain-relief-for-labor_1489911.bc
https://www.verywellfamily.com/how-to-push-your-baby-out-with-an-epidural-2759938
http://americanpregnancy.org/labor-and-birth/epidural/
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