The epidural is a helpful tool, and whether you want one or not is a deeply personal decision. Used mindfully and with an understanding of risks, benefits and process, an epidural can be the impetus for much needed rest and even a vaginal birth in the event that you need to relax in order to progress.
It is a mixture of local anesthetics, such as lidocaine and bupivacaine, and opioids or narcotics, such fentanyl. Hospitals and anesthesiologists will differ on the dosages and combinations of medication.
How does it work and what to expect?
Epidurals block the nerve impulses from the lower spinal segments. This results in decreased sensation in the lower half of the body.
You will be required to get an IV for fluids, which can take 20 minutes. Your doula and any additional people to your partner will be asked to leave. You will sit on the bed hunched over a pillow. The anesthesiologist will insert a large hollow needle in between your vertebrae, then string a thin flexible tube that delivers the medicine into the spine. This tube is taped in place and you will be able to increase dosage of medicine as needed.
You will also need to get a urinary catheter since you can’t feel your bottom half, or get up to go to bathroom.
How effective is it in relieving pain?
An epidural is very effective in relieving pain and allows for relaxation and rest, however, 10% of people do not respond to epidurals as expected. This means that they can still feel one half of their body or they can fully or partially feel all sensations.
Benefits
Provides rest during a long labor and is generally very effective.
Safer for the baby, compared to giving pain medications through an IV.
Can lead to more satisfying birth experience if birthing person is in distress over contractions.
Reduces maternal stress reactions, improving blood supply to the baby
Risks
Restricted to the bed. Lying in one position can cause labor to slow down, so your doula will help you try new positions to keep baby shifting down into pelvis.
Can reduce your blood pressure, which can reduce baby’s heart rate, which can lead to a c-section
May require pitocin if your body slows the production of oxytocin (which is produced by the response to feeling contractions)
More monitoring (blood pressure and oxygen)
IV fluids which can be an issue with breastfeeding
Due to lack of feeling, may need help of forceps, vacuum or cesarean
Occasionally (1% of the time), women experience a severe headache from leakage of spinal fluid.
side effects: shivering, a ringing of the ears, backache, soreness where the needle is inserted, nausea, or difficulty urinating.
Listen, epidurals are truly amazing (I can attest to that), but they aren’t candy. They absolutely come with some baggage. The main reason to hold off on receiving an epidural is the movement piece. An earlier epidural means that you’ll be in bed longer and not working with gravity and movement to get baby down. The second is that it may interfere with the hormone feedback cycle in which your body may slow down oxytocin production.
We recommend that you prepare with strategies on how and when to use them. Maybe set a milestone before getting one, like 7 cm, or practice epidural labor positions before hand, or ask your OB about a walking epidural option.
Additionally, be prepared to experience labor without an epidural. Most hospitals require you to be 4 cm dilated before getting one, so you will undoubtedly feel contractions even with the plan to get an epidural. As mentioned, epidurals don’t work in 10% of cases, so another reason to have alternative coping tools in your back pocket.
For more information on epidurals visit: https://evidencebasedbirth.com/epidural-during-labor-pain-management/
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