When to Get an Epidural During Labor
When thinking about your birth experience, you might be thinking about getting an epidural when you’re in labor. If you don’t know what an epidural is, an epidural delivers pain relief medication continuously to your lower body and blocks labor pain. The medicine goes through a catheter, which is a very thin and flexible tube. The catheter is inserted into the laboring mother’s epidural space in her lower back by an anesthesiologist.
Epidurals are the most commonly used method of pain relief for labor in the United States. Many women plan on getting an epidural for pain management when they go into labor. Here are some benefits of getting an epidural (from the American Pregnancy Association).
- It allows you to rest if your labor is lasting too long.
- It helps reduce the discomforts of childbirth so women can have a more comfortable and positive birth experience.
- If you deliver by cesarean, an epidural will allow you to stay awake to see your baby.
- After a cesarean, an epidural will also provide effective pain relief during recovery.
- If you tear during pushing, your epidural helps numb your perineum while your doctor is stitching.
- When other types of coping techniques are no longer helping, an epidural can help you deal with exhaustion, irritability, and fatigue.
- An epidural can allow you to rest, relax, get focused, and give you the strength to move forward in your birth experience.
- The use of epidural anesthesia during childbirth is continually being refined and much of its success depends on the skill with which it is administered.
As like any intervention, epidurals also have risks. Here are some of the risks when getting an epidural (from the American Pregnancy Association).
- Epidurals may cause your blood pressure to drop. For this reason, your blood pressure will be routinely checked. This happens usually every 15 to 30 minutes. Your medical team wants to ensure that there is an adequate blood flow to your baby. If there is a sudden drop in blood pressure, you may need to be treated with IV fluids, medications, and oxygen.
- You may experience a severe headache caused by leakage of spinal fluid. (Less than 1% of women experience this side effect.) If symptoms persist, a procedure called a “blood patch”, which is an injection of your blood into the epidural space, can be performed to relieve the headache.
- After your epidural is placed, you will need to alternate sides while lying in bed. You will also have continuous fetal monitoring to check for changes in fetal heart rate.
- Rotating sides ensures that your epidural medication is being evenly dispersed throughout your lower body. Due to gravity, if you lay on one side for too long the bottom side of your body will become very numb and heavy while the top side regains more feeling.
- Lying in one position for too long can also potentially cause baby to get into an unfavorable pushing position (like posterior, also known as sunny-side up). Remaining in one position for too long can also sometimes cause labor to slow down or stop. This is why oftentimes epidurals come with Pitocin, the synthetic form of oxytocin that causes contractions.
- You might experience the following side effects with an epidural: shivering/shaking, ringing of the ears, itching, backache, soreness where the needle is inserted, nausea, or difficulty urinating.
- You could find that your epidural makes pushing more difficult. Because of this additional medications or interventions may be needed such as a vacuum, episiotomy, forceps or cesarean. Talk to your doctor when creating your birth plan about what interventions he or she generally uses in such cases. (You can also request for the epidural to be turned off when pushing. This allows you to feel more of where to push and how to push so that you can push more effectively. This can help you avoid other second stage interventions.)
- For a few hours after the birth, the lower half of your body may feel numb. Numbness will require you to walk with assistance.
- In rare instances, permanent nerve damage may result in the area where the catheter was inserted.
- Though research is somewhat ambiguous, most studies suggest that some babies will have trouble “latching on” causing breastfeeding difficulties. Other studies suggest that a 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.
Alright, you now know some of the benefits and risks to having an epidural. If you have decided that you want an epidural during labor, the question is: When is the right time to get one in labor? Is there really a right time to get it? One doctor may say that it’s fine to get an epidural as soon as you get to the hospital. However, another may say that you need to be in active labor and at least 3, 4 or 5 centimeters dilated before they will call the anesthesiologist. So what’s the right answer? Honestly, both answers are correct. Here’s why:
Waiting to Get an Epidural
Having been to many, many hospital births and supporting women through all types of deliveries, I’ve noticed similar patterns and outcomes when women get epidurals too early. I’ve seen that it is beneficial to wait until you are in active labor and your cervix has dilated to at least 4 centimeters before you call for an epidural. At this point your body has established active labor. This means strong, continuous contractions. Because of that it’s more likely for things to continue to progress. You are reducing your chances of needing more interventions as well as reducing your chances of a C-section. If you get an epidural too soon, it can potentially 1) slow your labor, 2) stop your labor all together if you don’t have Pitocin, and 3) it increases your chances of needing other interventions including a C-section.
1. Slows Your Labor
Ladies who have received an epidural before they had a strong, consistent labor pattern and minimal cervical dilation have experienced their labors slow down. This resulted in them needing Pitocin to help increase and strengthen their contractions. When your labor slows down, this prolongs your labor and your baby’s birth. This then leaves more time for potential problems to arise.
2. Can Stop Your Labor
Some women who have gone to the hospital at the very beginning of their labor and received an epidural shortly after have experienced their contractions not only slow down but also come to a complete stop. In situations like this, sometimes even Pitocin can’t help the body get into a good labor pattern. Your receptors in your body might not respond to the Pitocin. The epidural is making your body slow down and relax and the Pitocin is telling your body to hurry up and have a baby. If this happens to you then your doctor might try to break your water (if your water has not already broken) to increase your contractions. The problem is, breaking your water is not always a reliable form of induction and doesn’t always cause more and stronger contractions.
3. Increases Your Chances of a C-Section
The earlier you receive an epidural, the higher your chances are that you will need more interventions and that it could possibly result in a C-section. If your body is not able to progress to get you to pushing, you will need cesarean birth.
Not Waiting to Get an Epidural
At the end of the day, this is your body, your baby, and your birth experience. You get to choose when you want an epidural. Your care provider might give you their opinion, but it’s ultimately your choice. And now that you know all of this information, you can make an informed decision. You have a better understanding of what is right for you. I recommend listening to your body and making the best choice for you whatever and whenever that is. This is why I say that whenever you decide to get an epidural–whether at the beginning of labor or later in labor–both options are right . . . because you have made the best decision for you.