Epidurals: What You Need to Know
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More than half of all pregnant women in the USA decide that they want an epidural during childbirth. The problem is most of these women know very little about epidurals, the procedure or the benefits and risks when making that decision. I want every woman to have the desired birth that they want, however, I also want them to be able to understand more about the options that are available to them so that they can make an informed decisions. Below I’m sharing the frequently asked questions that I get asked about epidurals as well as the answers. Hopefully this will help more women when they are making their decision — epidural or no epidural.
*Disclaimer: This post is not written to be medical advice. As a birth professional myself, I get asked a lot of these questions regularly and I wanted to provide the answers that I have found through the years of attending births, speaking to medical professionals, birth workers, and doing research. I am not saying that I am for or against this procedure. There are plenty of births that I recommend epidurals because they are medically necessary and/or because that it was the patient wants. I wanted to provide information to women so that they feel a bit more prepared before signing any release forms without reading the information.
What is an epidural?
An epidural is when anesthetic medicine is injected into the lower part of your spine through a small catheter inserted in your lower back. This small tube is placed in the space called the ‘epidural space’ to help stop the pain of the contractions during labor. This medication that is continuously going through the small catheter blocks the pain of your contractions by numbing the nerves around your lower abdomen and pelvic floor.
How is an epidural performed?
Once you have requested an epidural and the anesthesiologist has come into your room, all of your guests will be asked to leave your labor and delivery room except hospital staff. In most hospitals, only medical staff are allowed in the room during the procedure. Your nurse will then help you lie on your side or sit leaning forward on a pillow to prepare for the procedure. (More than likely you will not be given a choice.)
First, the anesthesiologist will clean your back with a cold liquid (iodine), then he will numb your lower back with a shot using lidocaine. (This shot will feel like a bee sting.) They do this first because they need your back numb before inserting the epidural catheter.
Once your back is numb, the doctor will insert a hollow needle between the vertebrae in your lower back. (You will feel a bit of pressure when this is taking place.) A thin tube will then be passed through the middle of the needle and placed in your epidural space. Then the needle will be taken away, leaving the tube in place. (You should feel no pain or possibly a funny sensation running down one of your legs for a second or two. It’s described as ‘hitting your funny bone’ sensation or like a rush or waterfall feel down one leg.)
The catheter will then be taped up your back so it can stay in place no matter what direction you move in. Anaesthetic will be continuously administered slowly through the catheter since it will be connected to a pump to numb the lower part of your abdomen. You will be told to push the button attached to the pump every hour to control your dosage. (This will only allow you to press it once every hour so that you don’t overmedicate yourself.)
What drugs are in an epidural?
Each anesthesiologist has their own “recipe” for an epidural. What is most commonly used is local anesthetic (like lidocaine or bupivacaine), maybe a pain reliever (like fentanyl), and something that boosts the effectiveness of those drugs (like epinephrine).
What happens if I move or have a contraction during an epidural?
Contractions can be spaced out (3-5 minutes or more), or they could be back-to-back. However slow or fast your contractions are, an epidural can still be placed. If your contractions are more spread out, the anesthesiologist will wait until you are finished with a contraction to do the procedure. But if you are having contractions back-to-back, you can still get an epidural. The procedure is not so delicate that you have to remain at a complete standstill. The doctor will still be able to place your epidural with small movement. Your nurse will help you through each contraction as it’s being placed to remain as still as possible.
How long does it take for the pain from the contractions to stop?
Sometimes it can take an hour (or longer) just for the anesthesiologist to arrive in your delivery room once you’ve requested an epidural. (This is worst case scenario.) You also may need extra time to take in IV fluid first (this prevents your blood pressure from dropping too low) before the anesthesiologist can come in and get started. An experienced anesthesiologist can take just five minutes to insert the epidural; a less experienced doctor could take up to 30-40 minutes. You should feel some of the effects within the first 5-10 minutes. You will feel the full effect of the epidural after 20 minutes.
Does it always work?
Not always. A good majority of them work for your entire labor, however, I’ve had several of my own clients receive epidurals and after a few hours of it working, it started wearing off. The anesthesiologist will come in to readjust it or replace it and it should numb you and work again. I will warn that I’ve seen even after the second placement epidurals not working. It could only numb one side of the body or not work at all. Again, this is rare, but it does happen so I recommend that you be prepared with other coping techniques just in case.
Will I be able to walk around after the epidural?
No. Your lower body will be pretty numb (even if you feel like you can move your legs and feet) so you will not have the ability to carry yourself upright and walk with an epidural. Also, the hospital staff will not allow you to get out of the hospital bed once your epidural is in place since you will have a bladder catheter in and the blood pressure cuff on. They will want to continuously monitor your baby’s heartbeat and your contractions as well as your blood pressure every 15 minutes so you will need to stay put.
How do I go to the bathroom?
No. An epidural causes numbness, so you won’t feel or know when your bladder is full. Your nurse will place a bladder catheter once your epidural is in place to make sure that your bladder is being emptied.
Can I move around at all with an epidural?
You won’t be able to walk around, however, with the somewhat lighter/ low-dose epidural, you should be able to move your position. These are called “walking epidurals”, however you are still not allowed to walk with this epidural. This type of epidural will allow you to move your legs and toes so that you can be able to sit up and move from laying on one side to another and not feel completely numb from the waist down.
What are the positives of an epidural?
There are several benefits of epidurals:
- You will have quick pain relief.
- It is a more effective pain reliever than analgesics (stadol, nubain, demerol, etc.)
- You’ll be able to rest — this is especially helpful if you’re having a long labor.
- It can allow your body to relax and (potentially) open your cervix faster.
- You will be more alert and be able to converse with your guests and hospital staff better.
- It can help lower your blood pressure if it’s high.
- If you need a C-section, you’ll be able to stay awake during the procedure and see your baby right away.
What are the negatives or risks to an epidural?
- Not all women feel total pain relief with epidurals.
- If you don’t feel pain relief within 30-minutes of having the procedure, ask your anesthetist to adjust the dose or try again.
- Sometimes it can take a couple of goes to get the needle and tube in exactly the right place, which can be stressful.
- Because your blood pressure can fall with an epidural, you’ll have to be monitored continuously, with someone monitoring your baby’s heartbeat and taking your blood pressure every 10-15 minutes.
- Some women experience longer pushing stages when they have an epidural, since it reduces the urge to push. You may not feel an urge to push at all. That means you’re at a higher risk of needing an assisted delivery with an episiotomy, forceps or a ventouse, which is a vacuum device.
- You may have side effects like shivering, fever, headache, backache, dizziness, ringing of the ears, soreness, nausea, difficulty urinating or itching.
- In extremely rare cases, a poorly inserted epidural could become infected.
- Paralysis or long-term disability due to an epidural are extremely rare and there are several safety measures that will prevent that from happening, however, it is still a risk as with any medical procedure.
- Epidurals can slow down labor if given too soon which increases your chances of needing a c-section.
- Some women get a severe headache for several days afterwards, which is caused by some spinal fluid leaking out when the needle is removed. This is rare and happens in only one in 100 cases, but it can happen. (This happened to my cousin! She had a debilitating headache for weeks.)
- The procedure also can increase your temperature and increase your chances of developing a fever. This can confuse your doctor, who might not be able to tell whether the increase in temperature is because of the epidural and not cause for concern or due to an underlying infection that could be transferred to your baby (chorioamniontitis).
- Some women claim that they have had minor to severe backache and back pain later on.
With any medical intervention, there are risks. For a lot of women, the benefits outweigh the risks. This is your decision now that you know what to expect.
I do suggest that when you take your hospital tour, see if you can meet with the anesthesiologist, or at least get a copy of the hospital’s consent form. This is really helpful to understand what you are signing before you are dealing with contractions.
What effect will an epidural have on my baby?
As for the health of your baby, research is somewhat ambiguous, but most studies suggest that some babies will have trouble “latching on” causing breastfeeding difficulties. Other studies suggest that the baby might experience respiratory depression, fetal malpositioning, and an increase in fetal heart rate variability, thus increasing the need for forceps, vacuum, cesarean deliveries, and episiotomies.
Researchers haven’t found a significant difference in APGAR scores or the results of other specialized tests of babies born to mothers with labor epidurals and babies born to mothers who did not receive any medications during labor.
When can I have an epidural?
You can have an epidural at any time during labor, but most women who choose to have one get it when they’re around 4-5cm dilated or more — when contractions get more intense and painful.
If you ask for one very late in labour – at 8 or 9cms dilated – your doctor or midwife may advise against it because you are so close to having your baby and there’s a chance that the epidural will slow that process down — especially the pushing stage.
When can’t I have one?
Technically, you can always get an epidural. I’ve seen a woman get an epidural at 10cm ready to push. It’s not the most ideal at that time since you’re about to have your baby, but you can get one if you want one.
There are some conditions where an epidural wouldn’t be possible, such as: if you’re taking certain medications (such as blood thinners), if your blood work isn’t right (like having a low platelet count), if your anesthetist can’t find your epidural space (due to certain types of back surgery, scoliosis, or your weight or back problems), or if you have an infection of the back.
All in all, epidurals are a good choice if you’re having a long, difficult birth and are wanting pain relief. Some people see the risks and decide that they prefer a natural birth (no pain medication). The great thing is — this is all your choice. Talk to your doula or health care provider to find out more information and ask your doctor or midwife whether you’re a good candidate for the procedure.