What Is An Epidural and How Does It Work?
Epidural anesthesia has been widely used during labor and delivery since the 1980’s. Although it is a common intervention, it is not the only option for pain management. If you are pregnant and wondering if you should choose an epidural during labor, it can be helpful to understand how they work, how they’re administered, as well as benefits, risks and potential side effects. The more knowledge you have, the more confident you can be in your decision-making when it comes to getting an epidural.
What is epidural anesthesia and how does it work?
Epidural anesthesia is a regional anesthetic that is administered through a catheter into a space in the lower part of your spine. It works by numbing only the lower half of your body, from about your belly-button downward.
How is it administered?
It is administered by an anesthesiologist in your labor and delivery room. Typically one support person is allowed to remain in the room during the procedure, so if you have multiple family members or a doula, you will need to choose one person to stay with you. The anesthesiologist will come into the room and explain the procedure, as well as answer any questions you may have. They will then ask you to sit upright towards the middle of the bed with your legs dangling over one side. If you are having contractions, they will wait for the contraction to pass before proceeding with the next step. They will then ask you to curl forward so that your spine is rounded. They will sterilize the area and give an injection of a local anesthetic that numbs just the area where they will place the catheter; you may feel a pinching or uncomfortable burning sensation when the local anesthetic is administered. Next, they will insert a needle that contains the catheter into the “epidural space” around the nerves in your spine; since the local anesthetic has numbed the area, this needle may feel like pressure. The needle is then removed, and the catheter (a very thin, flexible tube) remains in place for the duration of your labor, through delivery. The catheter is connected to a pump that administers the medication at the appropriate rate. A nurse will then test the level of your epidural by putting ice or something cold on different areas of your legs and belly to ensure that the epidural is blocking sensation appropriately.
What happens after the epidural is administered?
After the epidural is administered, you may be asked to lay on your back for about 15-20 minutes while the anesthetic takes full effect. Laying down this way may also help it distribute evenly. After this period of time, the nurse may perform another test to ensure that sensation is still blocked appropriately, and at this time they will also place a catheter into your bladder, since you will not be able to get up out of bed. Your provider may also want to continuously monitor your baby and your contractions after the epidural has been administered, as well as continued periodic checks of blood pressure and temperature.
Will I still be able to move after the epidural?
A good epidural should not block all sensation or inhibit all movement. If your epidural is working appropriately, you will most likely still be able to move your feet and legs. Movement while in bed is a crucial part of laboring with an epidural, a good rule of thumb is to switch positions every 30 minutes to 1 hour. You will need your nurse and/or support person and doula to help you move into each position, but doing so helps keep your pelvis open, working with your uterus to keep your baby descending through the pelvis. Using a peanut ball between your legs for side-lying and even upright sitting positions can help keep the pelvis open.
Will the epidural block the pain of contractions?
A good working epidural should block the pain of contractions, but you should still be able to feel pressure, especially as labor progresses and contractions increase in frequency and intensity. You will most likely also feel pressure and/or an urge when it is time to push.
Will an epidural slow my labor down?
While there is a chance that this intervention can have a negative effect on labor progress, there is not enough conclusive evidence that epidurals do in fact cause labor to slow down. However, sometimes with an epidural, due to lack of movement (compared to no epidural), interference in your body’s natural labor progress as well as introduction of other medications such as pitocin, other issues can arise that may impact labor progress.
Will getting an epidural automatically lead to a c-section?
An epidural is an intervention that can set off a chain reaction of other interventions that may make your birth feel more like a medical event than a natural, physiological process. However, there is no evidence that getting an epidural is the sole cause of labors that end in c-section. An epidural may be a contributing factor based on how your body or baby reacts during the labor process, but sometimes these things cannot necessarily be linked to the epidural itself. Labor can “stall”, babies can become distressed and complications can arise even in unmedicated births.
If I get a c-section after having an epidural, will I need a different anesthetic?
If you require a c-section after laboring with an epidural, when being prepped for surgery, your anesthesiologist will inject a different, stronger anesthetic into your catheter that is more appropriate for surgery. You will still be awake for the surgery but not able to feel the procedure, other than some pulling and pushing pressure. The exception to this would be in a medical emergency requiring a very rapid delivery of the baby, which then would require you to go under general anesthesia.
How long does the anesthesia last?
It should last from the time it administered through the delivery of your baby. After the pump administering the medication is turned off, it usually takes around 2 hours for the medication to wear off. When it is determined it is safe for you to get up and move around, your nurses will remove your catheter and help you get up out of bed and take your first steps. It is normal to feel shaky, be shivering (even if not cold) or still feel weak and wobbly after the epidural. Personal anecdote: after my epidural wore off with my first child, I remember being helped to the bathroom and I almost fell over trying to sit down on the toilet seat, the nurse had to catch me. I have truly never felt more helpless in my life, lol.
What are the risks for me if I opt to get an epidural?
Risks include:
Epidural is the most invasive option for pain management during labor.
Low blood pressure.
The medication does not distribute properly, i.e. you can feel contractions on one side but not the other, or your legs become so heavy you have a hard time moving them at all.
A spinal headache, which is a severe headache caused by spinal fluid leakage (this is rare).
Decreased sensation during pushing which may result in inadequate pushing. Forceps or vacuum may need to be used.
More likely to need Pitocin, a synthetic form of oxytocin used to stimulate the uterus to produce a more regular pattern of productive contractions.
What are the risks for my baby?
Many of the most common risks to the baby have to do with maternal complications from epidural, such as:
Fetal distress or heart rate abnormalities caused by low-blood pressure and low oxygen getting to the baby.
Complications from maternal fever, i.e. poor temperature regulation or infection.
What are the benefits to epidural anesthesia?
Benefits of a good working epidural include:
Epidural is the longest-lasting and most effective option for pain relief during labor.
Ability to rest. If you’ve been struggling to cope with labor contractions, or have been laboring for a long time without getting adequate sleep or rest, getting an epidural will give you respite from the pain of contractions.
You will still have mobility in bed.
You will likely still be able to feel pressure from contractions and when it is time to push.
Risks to mom and baby are relatively low.
How can I decide if the epidural is a good choice for me?
Epidural anesthesia is an extremely common intervention that many women choose to utilize for pain relief during labor. Like everything else, there are risks involved, but it is up to you to decide whether the benefits outweigh the risks. Due to the fact that epidurals can make normal birth a medical event, many women who end up choosing an epidural feel less satisfied with their birth experience due to the amount of interventions involved. On the flipside, a women who forces herself to undergo an unmedicated birth, due to firmly held beliefs, misconceptions, or fear of interventions, may have a more difficult time mitigating pain, coping with labor, and may put more stress on her body and feel dissatisfied with her birth experience as well. In my opinion and experience as a doula, one key part to feeling satisfied with your birth experience regardless of choices, is being informed ahead of time and being able to make a confident decision in the moment, even if it deviates from the preferences or “plan” you laid out in the beginning. Becoming familiar with the risks and benefits, as well as the procedure itself can help you feel confident in your decision when you are faced with the option.