It's perfectly natural for a pregnant woman to be curious or even worried about pain during delivery.
Many things can help with labor pain such as setting up the right physical environment,
using breathing exercises, having good emotional support, and medications. It's okay if you don't
know what your labor will be like. Your providers want you to have the information you need to make
pain control choices that are right for you. Today I'm going to answer some very common
questions about epidurals since approximately 70 percent of laboring women in the United States
choose to have an epidural. What is an epidural? An epidural is a small plastic
tube that can deliver low doses of numbing and pain medicine the whole time you're in labor.
The medicine temporarily blocks the nerves that send pain signals from your uterus and cervix
up your spine and into your brain. Epidurals decrease pain but you will still feel touch
and pressure. They are safe for both you and your baby. By reducing your pain an epidural
can help you rest during labor and save precious energy for pushing and taking care of your baby.
How is an epidural given? After meeting you and discussing your options your providers can help
you get an epidural. First, they will help you sit up or lay on your side and clean your lower back.
Then, they will numb the skin with local anesthesia so you will only feel pressure while the epidural
is placed. The brain and spinal cord sit in fluid called cerebral spinal fluid and the space outside
this fluid sac is called the epidural space. Using a very thin needle, they will carefully find the
epidural space and place a small tube called the catheter through the needle. The needle
is then carefully removed and the soft plastic catheter is taped to your back to keep it in place.
The catheter is then attached to a pump which provides medication until the baby is delivered.
How long will it take to start feeling effects of the epidural? It takes about 15 to 20 minutes
to set up and place the epidural. Then, it depends on what medication is given.
The faster medications start to work within just a few minutes, and the slower medications can
take somewhere between 15 to 30 minutes to fully work. How long does an epidural last?
An epidural can last for as long as you need it to as long as medication is running through
the epidural pump. If needed we can run a labor epidural for several days. After the epidural pump
is turned off and the catheter is removed the medication usually wears off within a few hours.
How big is the epidural needle in catheter? Epidural needles are very thin, just wide
enough for the catheter to fit through. Some people find it helpful to visualize them as
about the same size as a guitar string or angel hair pasta. Who can get an epidural?
Almost anyone in labor can choose to get an epidural. There are some uncommon conditions where
people can't get one such as: certain bleeding disorders or some brain or spine conditions which
your provider can talk to you about. Also, if your labor is progressing very quickly
there might not be enough time for the medication to fully work before your baby is delivered.
Can receiving an epidural lead to a cesarean section?
Some people worry that epidurals cause cesareans, but large well-conducted studies do not support this.
In the past people who had complicated labors and probably needed a cesarean were more
likely to receive epidurals which contributed to the belief that these two things are related.
Can an epidural slow down labor? There is no scientific evidence that an epidural will slow
down the cervical dilation. Some studies have found the pushing time might be a bit longer
with an epidural, but with more manageable pain. There's actually some evidence that
epidurals can speed labor by relieving pain and allowing a pregnant person to rest.
What is the difference between an epidural and spinal anesthesia? These are similar procedures with the
same goal of pain control, but the medications are injected into slightly different places.
The epidural medication goes into the epidural space which is just outside the cerebral spinal
fluid sac. Whereas spinal medication goes directly into the fluid. The medication starts working a bit
faster but since it is a single injection it only works for a certain amount of time.
Epidural medication takes a bit longer to work, but it can be continued for as long as it is needed.
Epidurals are also unique in that they can be turned up or down depending on what is needed.
For example, different amounts of labor pain or even for a cesarean delivery. What are the most
common side effects of epidurals? The most common side effects of epidurals include mild itching,
difficulty passing urine, and heaviness or decreased feeling in the stomach or legs until the
medication wears off- which is usually a few hours. I have heard that epidurals can cause paralysis is
that true? Some patients are worried that epidurals can cause back pain or problems like paralysis.
Serious complications are extremely, extremely, rare. But of course we recognize that you might have
questions or concerns. When your provider meets you they can see if an epidural is safe for you
and answer any questions you have. What are the alternatives to receiving an epidural for pain
relief during labor? There are good alternatives to epidurals for pain relief during labor.
However, none of them work as well as an epidural for labor pain. That said they are still worth
considering medication options include IV pain medication or breathing nitrous oxide or
laughing gas during contractions. There are also many non-medication options that can be helpful.
These include labor support, massage or pressure, movement using a birthing ball, position changes,
and temperature changes with hot or cold packs, or taking a bath or shower.
Also changing the environment may help- using things like dim lighting ,your preferred music, or
aromatherapy. Other things that might help include breathing techniques, meditation virtual reality,
and even self-hypnosis. What happens if I got an epidural but now I need a cesarean section?
The same epidural catheter that was previously inserted for labor
can be used to give a stronger type of medicine to block the pain from surgery while allowing
you to be awake for the birth. Similar to labor you will still feel touch pressure and movement.
Can an epidural affect my baby? Epidurals are very safe for newborns. Studies have shown that
babies after epidural deliveries and non-epidural deliveries have equal Apgar scores which is a test
of well-being based on how your baby looks after birth. Talk to your providers ahead of time about
the different options available to you for labor pain relief. This will allow you to be
fully informed and make the choices that feel right to you during your labor experience.