Epidural

Many women are steadfast in their desire to deliver their babies as naturally as possible, without the use of pain medication; many others go so far as to schedule their elective c-section months in advance; but most women fall somewhere in between. The decision of how to give birth to your baby is a completely personal one and there is no “right way.” Before your big day arrives, sit down with your partner or delivery support team and consider all your options, talk to your doctor or midwife, and let him or her know your thoughts and feelings on the subject. Whether you want the full childbirth experience or just want to focus on the end result (your beautiful, healthy baby), setting expectations ahead of time will help you have the birth experience you desire.

Two things are true of labor pains: every woman feels them differently and they are unpredictable. What determines your level of discomfort includes your ability to tolerate pain, your baby’s position, the strength of your contractions, and if you’ve ever given birth before. Many women achieve sufficient pain management from relaxation, breathing, positioning, and visualization techniques they learned in childbirth classes. However, if the pain becomes unmanageable, it can increase anxiety, which can lead to muscle tension and a prolonged labor. In some cases, numbing can relax the mother and speed labor.

What is an epidural?

An epidural is used to provide pain relief, rather than total lack of sensation. Having an epidural during labor allows you to be fully conscious and aware of the entire labor and delivery experience, with a minimal amount of discomfort.

Epidural anesthesia is considered to be the most effective pain medication for childbirth. Doctors may use it to fully or partially numb the lower body. In the case of a partial, or light epidural, you may be able to walk or stand and actively push during contractions. A full epidural can be used during a c-section to fully numb the lower body but keep you awake and aware.

An epidural is administered during active labor, characterized by strong, regular contractions and cervical dilation of at least 4 centimeters. It is administered through a catheter (a thin tube) inserted into your lower back, in the area just in front of the sac containing the spinal fluid (epidural space).

If you elect to have an epidural, your doctor will first give you one to two liters of fluids intravenously to help maintain your blood pressure. He or she will then have you roll over onto your side or sit up with your knees pulled to your chest and your chin to your knees. The lower part of your back will be wiped with an antiseptic solution and then numbed with an local anesthetic. A larger needle will then be placed through the numbed area and into the epidural space and the catheter is inserted. Your doctor will administer a “test dose” of the medicine and you will be asked if you become dizzy, experience a funny taste in your mouth, a rapid heart beat or numbness. These symptoms may indicate that the anesthetic has accidentally been injected in one of the veins in the epidural space. If you do not notice any of these symptoms, a full dose of the anesthetic will be given and you will begin to feel the effects in approximately three to five minutes, with full effect in approximately 10. Once the initial dose begins to wear off, another dose can be given. In some hospitals, women are able to self-administer the medication by pushing a button attached to a pump. If you have an epidural, you must be hooked up to a fetal monitor, IV, and blood pressure monitor, which may limit your mobility.

A new type of epidural, combining a spinal block with an epidural, provides faster pain relief and may allow you to walk around. This so-called "walking epidural" involves injecting an anesthetic into the spinal sac, which takes effect immediately, before the epidural is administered. The anesthetic lasts for two to three hours and may make the epidural unnecessary if you deliver before it wears off.

The amount of feeling you retain after the epidural depends on the medication used, where the epidural was inserted, and other factors. Lower concentrations of medication are often used today, which may allow you to stand or even walk if you wish. You should be able to push with your contractions when the time comes; however, if too much medication is given you may not be able to feel any contractions and need assistance pushing, or forceps or a vacuum may be used to help the baby through the birth canal.

Because the anesthetic used in an epidural is not injected into a vein or into a muscle, it does not enter your bloodstream and your baby is unlikely to be affected (however, more research is necessary to conclusively rule out any affect on your baby).

Once your baby is born, the catheter will be removed and the effects of the anesthesia usually wear off completely in one or two hours.

Benefits and Risks

While an epidural has obvious benefits for many women, it is not without risks. An epidural may cause:

• A prolonged labor. Some research has shown that epidural labor takes, on average, an hour longer than natural childbirth. If labor stalls after the epidural, your doctor may inject pitocin to make your contractions stronger, which can overstimulate your uterus and cause severe contractions.
• Your blood pressure to drop severely. This happens in approximately one to two percent of cases and can cause your baby’s heart rate to drop. Your doctor will give you intravenous fluids before the epidural and throughout the rest of your labor to prevent this.
• You to be unable to feel contractions or push. This may necessitate the use of forceps or vacuum to deliver your baby and increases the likelihood of having a c-section.
• Your baby to move into the wrong position (malposition) due to relaxed uterine and pelvic muscles. However, some experts believe that the baby may already be in the wrong position, causing additional pain that prompts the woman to ask for an epidural.
• You to have a seizure. However, this happens very rarely.

You may also experience so-called "hot spots," or areas where you can still feel pain, and may experience shivering. Side effects after delivery are rare, but they can occur. Some women report soreness at the catheter site during recovery, while others have a severe, prolonged headache after delivery (often called a spinal headache). The headache may be relieved by taking pain medication, lying flat, and drinking plenty of fluids. If the pain persists, an anesthesiologist can treat it with an injection.

Some women are not candidates for an epidural due to medical conditions, bleeding disorders, and certain complications of pregnancy. If you are considering an epidural, talk to your doctor or midwife ahead of time to make sure it is safe for you and your baby.