Epidurals During Childbirth: The risks, benefits and procedures

Epidurals during labor are commonplace in the United States.  Find out the pro’s/con’s, procedure, risks and benefits.

**As always please take the advice of your physician over any advice on my blog (or frankly, anywhere on the internet).  They know your personal circumstances and health history.**

First off, let me introduce myself.  My name is Hilary and I have worked as a labor and delivery nurse since 2001.  I’ve seen countless epidurals, as well as a similar number of very nervous women to get them.

Let’s calm some fears with some good information.

Epidural During Labour

An epidural during labor is given to help with the pain.  It numbs the nerves from about your bra level to your knees.  The plan is for about 80% of the pain to be taken away with the epidural.

You will still feel pressure.

And, you should still be able to move in your bed to promote the labor process.

Epidural Meaning

An epidural goes in the epidural space.  Your brain and spinal column are covered by several membranes.  They go between two of those in the “epidural space”.  You can see more about it here.

One doctor said it’s like a banana, and you’re trying to slip the medicine between the peel and the banana — which is a pretty good metaphor.

The epidural space is before your spinal cord, so the needle is not going in the same space that holds your spinal column.  Just so you know.

Epidural Side Effects

One of the “side effects” is the numbness and your legs feeling very heavy.

Other common side effects can be itching or your blood pressure falling (which is why your nurse gives you a lot of fluid in your IV before the epidural).  Some people also experience nausea (which we can give medications to help).

Epidural Long Term Side Effects

The most common long term side effect is back pain — like a bruise in the area.  I notice for about 10 days I feel pain when water hits it in the shower.  Similar to the bruise from the IV.

A few people have complained of long term back pain after an epidural, but I haven’t seen any studies showing this is true.

Having a baby is rough on your back.  All the sitting/feeding, picking the baby up, handling the car seat — I believe that likely causes the longer term back pain.

Epidural Risks

Your anesthesiologist should go over this (and many others) before placing it.

The most common risk is a spinal headache (which is due to a small amount of spinal fluid leaking out).  They can do a “blood patch” to help with it.  It happens in about one in 100-200 epidural placements.

Of course, with all elective treatments where the skin is broken, there are risks of infection.

And, like all good informed consents, there is always the possibility of paralysis or death.

That risk is very small — extremely rare — but be aware that a true informed consent requires mentioning it.  Just know that, so when they mention in it — you’re not thrown off guard.

Epidural Pros and Cons

Pros

• It takes away the pain
• It makes vaginal exams less painful
• It can lessen the urge to push so you can “labor down” instead of pushing longer
• It numbs your vagina/perineum in case of a tear
• If you had to have an emergency cesarean, they can numb you through the epidural
• Allows you to get some rest
• It allows you to concentrate during crowning to allow the tissues to stretch

Cons

• You aren’t able to move around as much
• It can lessen the urge to push which can make pushing time longer
• No walking/using the tub
• It only takes away 80% of the pain and some people find that to be still too much
• It sometimes doesn’t work and you have to have it replaced
• Some patients have a “window” that can’t be numbed.
• Epidurals are associated with a higher c-section rate (but that can be due to a variety of factors — so talk to your doctor if you have questions about that)
• You do have to stay still for them to put it in.
• Sometimes they don’t work.
• You have to have a urinary catheter as you can’t get up to the restroom (that’s a tube that goes up to your bladder to drain out your urine — it is removed before/following delivery)

Does an Epidural Hurt

I think the epidural pain is very similar to an IV pain.

A lot of patients think it hurts less (as they are in a lot of pain already when they get it).

The basic process looks like this

**The epidural is placed by an anesthesiologist or a nurse anesthetist, not your OB**

1. You sit on the edge of the bed (some doctors also do it side-lying)
2. Curl around your baby (think of a mad cat, or a boiled shrimp)
3. The Doctor will prep the area with special soaps to keep it all clean (that area is now considered sterile, so you want to be sure to not move too much or touch it) and place a drape over the area
4. The doctor numbs the skin area
5. He inserts the needle
6. He moves the needle with very tiny movements to find the right space
7. He injects a little fluid
8. He injects a test dose to make sure he’s not in a blood vessel
9. He inserts the catheter (In the hospital tubes are called cathers, this one goes into that space and is about as wide as a piece of thin spaghetti) so the medicine can continue to go in
10. He gives you a “bolus dose” (a large amount of medicine that will help to get you numb faster)
11. He secures it with tape.

This usually all takes 20-30 minutes, and most patients are finding comfort within 20-30 minutes of the bolus dose.

Epidural Drug

It can be given in a variety of ways, each doctor has their own mixture they use.

In my hospital, we currently use bupivacaine and fentanyl.

But again, each hospital and doctor are different.

The epidural medication is most often pumped in until you have your baby.  It is like a small IV pump that continually replaces it.

So, the epidural should not wear off before you have your baby.  However, in rare cases, the catheter migrates and it no longer works.

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A few final thoughts about the epidural

• Anesthesiologists can often be tied up doing other things, so if you are considering it, let your nurse know.  That way she can get you “in line” or between c-sections.
• Most often, only one other person can be in the room during an epidural placement, and most practitioners prefer they sit in front of mom.
• If you feel like it’s not working, the only one who can truly fix it is the anesthesiologist.  Ask to see him/her.  Remember that often the only fix is to put it in again.
• The epidural is secured with a large amount of tape, so you can still move in bed, but be thoughtful of dragging your back across the bed if possible.
• Before a cesarean section, patients are given a spinal.  The difference is the area where they put the medicine.

Epidurals are great and can take away a lot of the pain of labor, but I recommend having some pain coping skills to utilize before an epidural (if that is your plan).

If you have more questions before it is placed, you can always talk to an anesthesiologist before you are admitted, or your OB doctor might be able to answer the simpler questions as well.

Want to know more information about epidurals and other labor and delivery things — be sure to check out my Online Childbirth class, with a full chapter on pain management.

If you liked this post, I highly recommend checking out my printable birth plan worksheet (comes with a special bonus after you get it).  It will help you get educated on your birth choices and be more informed!

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