Should I get an epidural?

Are you pregnant and considering an epidural for pain relief during childbirth? You are not alone. More than 60 percent of women giving birth at hospitals opt for the procedure. To help you make sense of the procedure and figure out if it’s is the right pain-management method for you, we wanted to tell you how epidurals really work and give you some tips!

Here are 8 questions about epidurals, answered:

1. When do I ask for an epidural? You can ask for an epidural at any point in your labor. If you can, it’s better to wait until you’re in active labor since getting one in early labor can increase your chances of a cesarian section. An epidural can take time (from 15 minutes to two hours) to be administered depending on the availability of the anesthesiologist. So keep that in mind, and if the contractions are getting more painful while you wait, plan to cope with any discomfort using breathing, massage and relaxation techniques. Pro Tip: Ask what the wait time is when you get to the hospital so you can plan in advance.

2. How is an epidural placed? You’ll be asked to sit on the edge of the bed, leaning against a nurse or a partner, and be still. After a local anesthetic is administered, a catheter delivering the medication is placed in your lower spine. You’ll start to feel the effects of the medication 15 minutes or so later. After it’s turned off, the numbing effects wear off in an hour or two.

3. Can I move after getting an epidural? You can move, but your lower half will be numb to a degree, so you’ll be required to stay in bed, even with lower dosage ‘walking’ epidurals. Being in a supine position for an extended period of time can lead to baby presenting ‘sunny side up’ (which in turn could lead to a longer labors and use of episiotomy, vacuum or forceps assisted delivery) and affect oxygen to baby’s brain. So turn from side to side every 20 to 30 minutes to help open your pelvis and get baby moving – it works like a side squat! You can use pillows or, even better, use a peanut ball between your legs. Ask your care practitioner about hospital policies about moving and eating after an epidural is placed.

4. What other procedures are involved? Whether you have an epidural or not, most hospitals and birth centers will require you to have an IV, usually inserted in your non-dominant arm. If you choose not to have an epidural, you can ask for a hep-lock instead, so you don’t have to carry the IV bag around with you. However, if you get an epidural, a continuous IV will be placed. Doctors will also insert a urinary catheter to help empty your bladder since you can’t get up to go to the bathroom. They’ll put the catheter once you’re numb and take it out before you push.

5. How much medication will I get? You can ask for the button to control your own epidural medication. Studies have shown that when self-medicated, patients give themselves smaller dosages!

6. What’s in an epidural? An epidural is a regional anesthesia that blocks pain to a specific part of the body. The medications used in the procedure fall into a class of drugs called local anesthetics. They include bupivacaine, chloroprocaine and lidocaine, among others. If your doctor wants to decrease the required dose of local anesthetic and give you pain relief with minimal effects, he or she can deliver an epidural with a combination of opioids or narcotics, such as fentanyl and sufentanil. The anesthesiologist may also combine it with epinephrine, fentanyl, morphine, or clonidine to prolong the epidural effects or to stabilize the mother’s blood pressure.

7. Will I feel pain? You shouldn’t feel any pain. The lower half of your body will be numb, but you may be able to feel pressure of vaginal exams and baby’s head as you push. If you want more sensation while pushing, which can help prevent pelvic injuries, you may be able to ask your care provider to reduce the dosage as you push to have better awareness. Occasionally, the epidural may be uneven, with more feeling in one leg or the other. Let your care provider know as soon as possible, if that is the case.

8. What are the risks? Epidurals are safe but, like any medical procedure, come with a few risks. An epidural side effects may cause soreness in the area of administration, a low-grade fever, and a decrease in blood pressure, which can in turn slow down baby’s heartbeat. Many patients get the shivers or shakes from an epidural, in which case squeezing a stress ball can help. Occasionally, some people are allergic to the medication. There isn’t a good way to test for the allergy, but you can ask for it to be administered in small test doses to start. Epidural anesthesia can slow down the second stage of labor, which can then result in further medical interventions, like Pitocin administration and instrument-assisted delivery. In rare cases, women can experience severe headaches due to leakage of spinal fluid. If symptoms persist, your doctor will inject some of your blood in the epidural space — a procedure called “blood patch.” Serious and life-threatening risks are rare, but can happen. They include slurred speech, drowsiness, convulsions. Death are very rare, but when they happen it’s usually because of cardiac arrest, abscesses or blood clots.

My professional recommendation? Use your breathing, massage and movement techniques as long as you can to make sure your labor builds momentum. When you get to a point where you’re no longer able to relax through contractions and start to tense up, fight and resist them, or if you’ve been in labor for a really long time and are sleep deprived and exhausted, an epidural is a great option to help you get rest and sleep!

Illustration by Shanequa Simpson for Well Rounded.

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To learn more details about an epidural, click here: Epidural Anesthesia – StatPearls – NCBI Bookshelf (nih.gov)

The Pros of Epidurals

Epidurals offer numerous benefits to women during childbirth. Let’s explore the advantages of opting for an epidural:

1. Pain Relief: Epidurals provide effective pain relief during labor, allowing women to manage the intense contractions and discomfort associated with childbirth.
2. Ability to Remain Awake and Alert: Unlike other pain management options, epidurals do not cause drowsiness or sedation, allowing women to remain awake and alert throughout the birthing process.
3. Minimal Impact on Baby: Epidurals have minimal to no effect on the baby’s well-being during labor, ensuring that the baby’s heart rate remains stable.
4. Emergency C-Section: In the event of an emergency C-section, an epidural can provide immediate pain relief and numbness, allowing doctors to perform the procedure without delay.
5. Reduced Risk of Postpartum Depression: Some studies have suggested a link between lower instances of postpartum depression and the use of epidurals during childbirth.

The Cons of Epidurals

While epidurals offer significant benefits, it’s essential to consider the potential drawbacks and limitations. Here are some cons to be aware of:

1. Timing and Availability: Epidurals can only be administered once the cervix is at least four centimeters dilated, which means women may have to endure labor pain until they reach this milestone. Additionally, if the cervix is fully dilated, it may be too late to receive an epidural.
2. Insertion Discomfort: The insertion of the epidural needle into the spine can cause discomfort for some women due to its size. However, the discomfort is typically temporary.
3. Loss of Mobility: One of the side effects of an epidural is the temporary loss of mobility in the lower body. While low dosages may allow some women to stand or walk with assistance, higher dosages can completely numb the lower body.
4. Potential Complications: Although rare, there is a small risk of complications associated with epidurals, including permanent neurological damage, chronic pain, and even paralysis in extreme cases.

It’s important to note that the decision to have an epidural should be made in consultation with your healthcare provider, taking into consideration your individual circumstances and preferences.

Potential Side Effects of Epidurals

In addition to the pros and cons, it’s crucial to be aware of the potential side effects that may arise from receiving an epidural. While these side effects are generally temporary, they are worth considering:

1. Tenderness and Bruising: Some tenderness and bruising may occur at the site of the epidural after delivery. This is a normal and expected side effect.
2. Fever: In rare cases, an epidural may cause a slight increase in body temperature, resulting in a low-grade fever. This is usually temporary and resolves on its own.
3. Headache: Occasionally, women may experience a severe headache after receiving an epidural. This headache is typically caused by a leak of spinal fluid and may require additional medical intervention.
4. Urinary Difficulties: Temporary difficulty urinating is another potential side effect of epidurals. This is due to the numbing effect of the epidural on the lower body and usually resolves once the epidural wears off.

Making an Informed Decision

When considering whether to opt for an epidural, it’s essential to weigh the benefits and potential risks. Discuss your options with your healthcare provider, taking into account your unique medical history and preferences. Additionally, consider creating a birth plan that outlines your preferences for pain management and communicates your wishes to your healthcare team.

Remember, childbirth is a deeply personal experience, and there is no one-size-fits-all approach. By educating yourself about the benefits and considerations of epidurals, you can make an informed decision that aligns with your individual needs and desires.

Closing Thoughts

Epidurals have revolutionized the way women experience childbirth by providing effective pain relief and temporary numbness. While they offer significant benefits, it’s important to understand the potential risks and side effects associated with epidurals. By engaging in open and honest conversations with your healthcare provider, you can make a well-informed decision that prioritizes your comfort and safety during this transformative journey of motherhood.

Remember, every birth is unique, and what matters most is finding the approach that feels right for you and your baby. Trust your instincts, lean on your healthcare team for support, and embrace the remarkable journey of bringing new life into the world.

Frequently Asked Questions:

Q1: When should I consider asking for an epidural during labor?

A1: You can ask for an epidural at any point during your labor. However, it’s generally recommended to wait until you’re in active labor to minimize the risk of complications, such as an increased likelihood of cesarean section. Discussing the timing with your healthcare provider and understanding the wait time for administration can help you plan accordingly.

Q2: How is an epidural placed, and how long does it take to start working?

A2: During the procedure, you’ll be asked to sit on the edge of the bed while a catheter delivering the medication is placed in your lower spine after administering a local anesthetic. The effects of the epidural typically start to be felt around 15 minutes after administration, but it may take up to two hours for full relief.

Q3: Can I move after receiving an epidural?

A3: While you can move to some extent, the lower half of your body will be numb, limiting your mobility. It’s important to stay in bed, but you can shift from side to side or use a peanut ball between your legs to help open your pelvis and encourage movement.

Q4: What other procedures are involved with receiving an epidural?

A4: In addition to the epidural administration, most hospitals will require an IV to be inserted, and a urinary catheter may also be necessary to empty your bladder since mobility is limited. Understanding hospital policies regarding these procedures can help you prepare.

Q5: How much control do I have over the medication dosage with an epidural?

A5: You can ask for a button to control your own epidural medication dosage, allowing you to self-medicate. Studies have shown that patients tend to administer smaller dosages when self-medicated.

Q6: What medications are typically used in an epidural?

A6: Epidurals use a combination of local anesthetics such as bupivacaine, chloroprocaine, or lidocaine, along with opioids or narcotics like fentanyl or sufentanil. Additional medications may be added to prolong the effects or stabilize blood pressure.

Q7: Will I feel pain during labor with an epidural?

A7: The lower half of your body will be numb, so you shouldn’t feel pain. However, you may feel pressure during vaginal exams or pushing. It’s possible to adjust the dosage if you want more sensation during pushing.

Q8: What are the potential risks and side effects of epidurals?

A8: While epidurals are generally safe, there are risks and side effects to consider, including tenderness and bruising at the insertion site, fever, headaches, urinary difficulties, and in rare cases, neurological damage or paralysis. Discussing these risks with your healthcare provider can help you make an informed decision.