More than half of all pregnant women in the USA decide to have an epidural during childbirth. The problem is most of these women know little about epidurals, the procedure, or the benefits and risks when making this decision. Of course, I want every woman to have the desired birth that they want. However, I also want women to understand more about the available options to make better-informed decisions. Below I’m sharing frequently asked questions that I get asked about epidurals and the answers. Hopefully, this will help more women decide on — epidural or no epidural.
*Disclaimer: This post is not medical advice. As a birth professional, I regularly get asked many of these questions. I want to provide the answers that I have found through the years of attending births, speaking to medical professionals, birth workers, and researching. I am not saying that I am for or against this procedure. I have recommended and encouraged epidurals at many births because they are medically necessary and/or best for the patient. I am providing information for women to feel 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, thin catheter inserted into your lower back. An anesthesiologist will place a small tube in the ‘epidural space’ to help stop contraction pain during labor. Medication continuously flows through the small catheter, blocking 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 the 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 up, leaning forward on a pillow to curve your spin to prepare for the procedure. (More than likely, you will not be given a choice of which position you’d prefer.)
First, the anesthesiologist will clean your back with a cold liquid (iodine), then he will numb your lower back with a shot using lidocaine. The shot will feel like a bee sting. They do this first because they need your back to be 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 pressure in your lower back when this is taking place. The doctor will then insert a thin tube through the middle of the needle and place it in your epidural space. He will then remove the needle, leaving the tube in place. You should feel no pain (only labor pain) or possibly a funny sensation running down one of your legs for a second or two. It’s described as a ‘hitting your funny bone’ feeling or like a rush or waterfall feeling down one leg.
A nurse will then tape the catheter up your back to stay in place. A pump connected to the catheter will continuously administer the anesthetic into the lower part of your abdomen to numb your lower body. You will be told to push the button attached to the pump every hour to control your dosage. This machine will only allow you to press it once every hour, so 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 a 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. Thankfully, the procedure is not so delicate that you must remain at a complete standstill. The doctor will still be able to place your epidural with slight movement. Your nurse will help you through each contraction as the epidural is being placed to help you 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 a worst-case scenario. Hopefully, they will arrive within 20 minutes. You also may need extra time to take in IV fluid first, which 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 10-15 minutes after the procedure. You will feel the full effect of the epidural after 20-30 minutes.
Does it always work?
Not always. A good majority of them work for your entire labor. However, I’ve had several of my doula 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 you that I’ve seen epidurals fail even after the second placement. It could only numb one side of the body or not work at all. Again, this is rare, but it does happen. 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. 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. This is why you will have a bladder catheter in, and you will have the blood pressure cuff on. They will want to continuously monitor your baby’s heartbeat, your contractions, and your blood pressure every 15 to 30 minutes, so you will need to stay put.
How do I go to the bathroom?
An epidural causes numbness, so you won’t feel or know when your bladder is full. Instead, a nurse will insert a bladder catheter once your epidural is in place to ensure 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, also known as “walking epidurals,” you should be able to move your position. However, you are still not allowed to walk or get out of bed with this epidural. This type of epidural will enable you to move your legs and toes so that you can 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:
- 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 have 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 precisely 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 15-20 minutes.
- Some women experience longer pushing stages when having an epidural since it reduces the urge to push. You may not feel an urge to push at all. This could mean that you’ll have 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 rare cases, a poorly inserted epidural could become infected.
- Paralysis or long-term disability due to an epidural is extremely rare, and several safety measures will prevent that from happening. However, it is still a risk as with any medical procedure.
- Epidurals can slow down labor if given in early labor, which may increase your chances of needing a C-section.
- Some women get a severe headache for several days afterward, 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.
- 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 (chorioamnionitis).
- Some women claim that they have had minor to severe backache and back pain later on for weeks, months, even years.
With any medical intervention, there are risks. But, for a lot of women, the benefits outweigh the risks. This is your decision, and now you know what to expect, including the benefits and risks.
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 helps you understand what you are signing before 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 have trouble “latching on,” causing breastfeeding difficulties. Other studies indicate that the baby might experience respiratory depression, fetal malpositioning, and increased fetal heart rate variability. This can increase 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. However, most women choose to have one during active labor when they’re around 4-5 cm dilated or more.
If you ask for one very late in labor – at 8 or 9 cms dilated (transition labor) – 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 could slow 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 and ready to push. Of course, 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 when an epidural wouldn’t be possible. These include 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, weight, or back problems). Or, if you have an infection of the back, you are an unlikely candidate.
Epidurals are an excellent choice if you have a long, difficult birth and want pain relief. However, some people see the risks and decide 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.