In this blog post I want to walk you through several aspects of epidurals including: pros and cons, safety, effectiveness, alternatives, what to expect and how they work. I will also tell you up front that I think it is a wise strategy to read through this blog and gain knowledge of epidurals regardless of if you plan to get one or not. As we all know, the nature of birth is unpredictable which is why I feel it is important to learn about interventions you could be offered in case they come up in your birth.
Hear this when I say it mamas, FEELING INVOLVED in the decision making throughout your labor is linked to having a more POSITIVE BIRTH EXPERIENCE. Deciding you want an epidural requires you to take an active role in your birth experience.
Let’s get into it…. What you need to know about epidurals to be able to make decisions about it and stay involved in your birth.
When deciding if an epidural will be part of your birth plan ask yourself this question. Why do I think I need an epidural? When you can get clear on why you want an epidural or even why you do not want one, you can better make decisions around it. Whatever your reason is, it will help you decide when you should get one and give you the mental courage and strength to sit still through the insertion procedure. What is your why and how important is it to you? Let that be your guide for making decisions about your epidural.⠀
Are there other similar options to try first?
Short answer is no. There is no other pain relieving option for a laboring woman that compares to an epidural. Epidurals are a regional pain reliever giving effect to the area of your body where the nerves go. Which in the case of an epidural for labor pain, the nerves that are targeted cover pain receptors from mama’s abdomen down to her toes. This type of nerve block only happens with administration of medication directly into the spine.
Would there ever be a situation where I can’t get an epidural or that it would be too late for an epidural?
The most common reasons a provider would not be willing or able to place an epidural would be due to mama having a low blood platelet count or mama having a structural barrier. What I mean by structural barrier is if you have had spinal surgery with hardware placement near the spot the epidural catheter needs to be inserted or if you have spinal curvature (scoliosis) severe enough to prevent safe catheter insertion. A blood draw is done to check mama’s platelet count and if it is below a certain number there is a risk that inserting a catheter into the epidural space will cause bleeding into the epidural space which would not be a good thing.
I have seen many births which mama missed the window of opportunity to get an epidural. This would be if the baby is inevitably going to be delivered in the case of rapid labor or waiting until the baby is too far down into the pelvis to get the epidural because you cannot sit still enough for the procedure. Also, if you would likely birth the baby within the amount of time it would take to place the epidural and it needs to start to take effect then you will most likely be told it is too late.
Is this safe for me and my baby?⠀⠀
Epidurals are found to cause less side effects and give more satisfaction to mamas than other pain relief options. Studies have found that babies born to mamas with epidurals are more alert, breathe better, have better muscle tone and have overall higher APGAR scores at birth than mamas who received intravenous pain medications throughout labor (Simkin, 2018, p.263).
Are there side effects?
Possible side effects of an epidural include but are not limited to:
- Drop in mama’s blood pressure
- Longer stage 2 of labor (the pushing stage)
- Fever sometimes occurs in mama
- 1 in 100 mamas report severe headache after epidural placement
- May slow labor and therefore lead to pitocin augmentation to stimulate labor again
- Itching
- Nausea
- Pain at the insertion site
Does an epidural affect my baby?
Studies have found that babies born to mamas with epidurals are more alert, breathe better, have better muscle tone and have overall higher APGAR scores at birth than mamas who received intravenous pain medications throughout labor (Simkin, 2018, p.263). To say they don’t affect your baby would not be a true statement, but typically if your baby is affected it is the result of a side effect shown in mama. To give an example, if mamas blood pressure drops after epidural placement, it is possible that the baby’s heart rate can be affected and lead to interventions to correct mama’s blood pressure as well as baby’s heart rate abnormality.
What can I expect during epidural insertion?
Here is what you can expect during the epidural insertion procedure and once it is in place and working properly. All visitors will likely be asked to leave the room during the procedure. During epidural placement, you will be asked to maintain 1 of 2 possible insertion positions for about 10 minutes. The first position you could be asked to get into for insertion is a sitting, hunchback sort of position where your feet dangle off the bed and you hunch forward pressing the center of your back out behind you. Another way to think about this position is like a mad cat’s back or the exact opposite of an arched back position. While in this position, likely your nurse will stand in front of you helping support you. The 2nd position you could be asked to get into for the insertion is this same hunchback position except you are laying on your side on the bed rather than sitting up at the edge of the bed with your feet dangling off. Once in position the anesthesia provider places sterile draping on your back and does a sterilizing scrub on the lower spine where the catheter will be placed into your back. Then, a small needle is inserted into your back and a catheter is then threaded into the space and then the needle is removed. A test dosing of medication is given to ensure proper placement of the epidural. The insertion site and catheter is then secured to your back using surgical tape to keep it in place and safe from anything pulling on it. Then you are laid back onto the bed and given starting doses of medications by the anesthesia provider through the catheter that was just placed. After about 10 to 15 minutes mamas usually report that their epidural is taking effect.
What happens after I just got my epidural?
Once the epidural is placed you will require repeated blood pressure and pulse oximetry monitoring at designated intervals, continuous electronic fetal monitoring of the baby’s heart rate, continuous contraction monitoring, intravenous fluids will be started or continued and food and fluids will likely be restricted. Most mamas will be unable to empty their bladders adequately on their own due to decreased control and sensation which will require your care provider to place either an indwelling urinary catheter or intermittently catheterize mama to empty the bladder.
Will I feel anything or will I be completely numb?
For most mamas an effective epidural makes you feel like you are numb from about the belly button down to your toes. This makes your legs feel heavy and likely you cannot move them safely on your own. Mamas report feeling tingly and numb when they are touched. Also, epidurals do not block sensations of pressure. So as the baby moves down and out of the pelvis, you will still feel the pressure that comes with that in the vagina and rectum. Most likely you will also still feel the normal sensation of vaginal burning (the ring of fire) as the baby’s head emerges.
How does an epidural affect my mobility?
Mama will have reduced mobility and even need assistance changing positions while in bed. Having this decreased ability to move your legs, you will be confined to the bed. This is why you will probably be offered a peanut ball to help maintain optimal pelvic opening to help labor progress and help the baby move lower into your pelvis. If it’s not offered, request one!
Does it affect positions I can use when pushing my baby out?
Epidurals do decrease your leg mobility and sensation. For that reason, getting into upright positions or positions that require you to be out of bed are not a safe option.
Does it always work? ⠀⠀⠀⠀⠀⠀⠀⠀⠀
Epidurals are effective for about 90% of mamas. Some mamas report having “windows” of pain that break through where the contraction pain never goes away in a small spot on the abdomen or in your back. This is sometimes correctable and sometimes not. Some mamas also report to have a decreased effectiveness of their epidural the longer it is in place. This is also sometimes correctable and sometimes not.
Here are short lists of pros and cons to keep in mind:
Pros
- Can help when labor is prolonged and mama is exhausted and feeling like she cannot go on proving pain relief enough for her to relax and possible stimulate labor
- Contractions created by pitocin in labor can be especially more challenging and an epidural can provide pain relief for mamas having augmented labors
- Believed to be and most reported to be the best, effective means of pain relief for laboring women; thus, increasing birth satisfaction
- Less effect on your baby. Babies are born more awake and alert. Breathe better and have better muscle tone when compared to intravenous narcotic pain relief.
- If a mama is need of a cesarean section, having an epidural already in place will decrease her chance of needing to be put to sleep under general anesthesia for birth of the baby
Cons
- If given too soon, it can slow labor. Oftentimes a mama may need pitocin augmentation in this situation.
- It can be hard to get the baby into the right position if mama has an epidural and the baby isn’t already in the right position and her movement is now limited by the epidural
- Often lead to more interventions
- Mama’s mobility is altered and typically mama is confined to bed
- Mama will likely experience loss of bladder control
- Eating and drinking will likely be restricted
Well mama, if you’ve read through this blog you now know a lot more about epidurals than most other mamas. I commend you for taking the time to learn about what epidurals have to offer. I encourage you to continue learning about birth so that you can feel informed and increase your chances of having a positive birth experience.
References:
Simkin, P., Whalley, J., Keppler, A., Durham, J., & Bolding, A. (2018). Pregnancy, Childbirth, and the Newborn: The Complete Guide (5th ed.). New York, NY: Da Capo Press, Incorporated.
