Epidural anesthesia takes away about 80% of labor pains. This will tell you why you should plan on still having some pain and feeling contractions, allowing you to push during a normal vaginal delivery. Why shouldn’t labor be painless?
Why Does Labor Hurt?
Just like when you’re carrying 12 bags of groceries up 3 flights of stairs — your bicep hurts, so does your uterus.
How do I know all of this? I’ve been an L&D RN since 2001, and have been in more epidural procedures than I can even count in those almost 20 years!
What does labor feel like?
Contractions (or labor pains) start as cramps, and then progress into more painful contractions. They feel very similar to horrible stomach pains that never let up. They are manageable — but many women get an epidural.
BTW, if you’re wondering about the ins and outs of labor and birth I totally recommend this class. I mostly love how it SIMPLIFIES the labor process for you. The reviews are awesome, and you can even save 10% with code PC10!
How Does the Epidural Help with Labor Pain?
Modern epidurals place a tube (we call tubes catheters in the hospital) into the “epidural” space in your back. That’s a very technical spot between the “duras” which protect your central nervous system (brain & spinal cord/nerves). The dura are membranes. That’s all it means. One of our doctors said it’s like placing the tube between the banana fruit and peel of a banana. That’s a pretty good picture of it all.
When they inject medication in that area, it helps to numb those nerves and take away pain. Epidurals are used in many procedures including:
- Surgery, especially orthopedic
- Pain relief, you can get an epidural injection for back, leg or hip pains.
We now frequently use the epidural for pain relief in labor.
History Lesson: Your mom might have had several injections wit her epidural, but we now use a pump and the medication is fairly steady. Gotta love advancements in medicine!
How is the epidural placed?
I have a whole post on epidural placement that details the entire process.
One of the most important things to know is that an epidural is placed by an anesthesiologist (or CRNA, which is like a nurse practitioner of anesthesiology) — not your OB.
Does labor still hurt with an epidural?
The epidural is pure magic. At least, that’s what it seems like to me — on the other side of the patient.
Yes, there is a lot of effort and schooling that have gone into your anesthesiologist to put it in, but once it’s in it should make you fairly numb from about your bra line to your knees.
This post is mostly going talk about how pain-free you should expect to be with an epidural.
How much pain does the epidural take away?
Notice above, I said “fairly”.
Yes, you’re still going to feel pressure, some sensation and, when done correctly — it will not make you entirely numb.
You read that right — it will NOT make you totally numb.
Yes, you’re paying thousands of dollars for that epidural, but…
It is likely that the epidural will cover about 80 percent of your pain when done right.
Why we don’t want the epidural to entirely numb you:
- We still need you to move around a little bit. It’s still important to move from side to side and be able to assist in positioning yourself.
- You need to feel pressure feel when the contractions are happening — that helps you know it’s time to push.
- That pressure helps you push better, and can help decrease your pushing time. If you’re ENTIRELY numb, you can’t push well.
Of course, pressure can very much feel like pain. I can guarantee that the pain you’re feeling is much less than it would be if you didn’t have the epidural, even if you find it very painful.
Most women don’t feel the final “ring of fire” thanks to the epidural — so that is certainly awesome. 🙂 Most women also don’t feel cervical exams much after the epidural (btw this post has tips for painful vaginal exams).
Note to remember: You can not plan on the epidural to make you entirely numb. Plan on some pain as your labor progresses as we have found that to be the best plan for laboring mothers. Painless labor isn’t what we want, and you shouldn’t want it either for the reasons mentioned above.
How does it feel to push with the epidural?
It initially feels quite odd. It’s hard to do anything when half of your body is numb. However, pushing out a baby is exactly the same as being very constipated on the toilet (with admittedly much cuter results). Your body quickly realizes that and gets to work.
Do I have any control over how numb I am?
Yes! Most hospitals allow patients to have a PCA machine for their epidural administration, which means you can push a button to get more epidural medication.
However, I don’t give my patients that button. 🙁
Hahah — it makes it sound like I am mean, but I want to know if my patients are in pain so I can properly assess them (and then help them push the button).
Sometimes you’re in pain because the baby has descended and we need further interventions, etc. As a labor nurse I use pain to help me assess how things are going, and if you just keep pushing your button, I never know that.
The other good thing about the PCA machine is we can turn up or down your “base dose” (the machine pumps in a certain amount just like an IV — when you push the button it gives an extra dosage) to make sure that you can move/feel like we need you to. We can really tailor the experience to what your body needs!
Sometimes we need to turn it up as labor progresses or turn it down if you can’t feel your contractions at all during the pushing phase.
Does an epidural slow labor?
Studies show it does slow the pushing process. This is because most often we allow the patients to rest and let their body bring the baby down vs an extensive pushing time. Not that you push for much longer with an epidural.
Also, as I said before, it usually takes a few pushes for patients to “get the hang of it” when they start pushing with an epidural, which may extend pushing time a bit (but if you still can’t feel we can adjust the base doseage).
What about a walking epidural?
I have heard much about this magical “walking epidural” but I have yet to hear of a doctor who’s ever done one or recommends them.
Epidurals do require extra monitoring of you and your baby, I can’t imagine having a patient walking the halls with them. Also, if you were able to walk, you would likely be also feeling all of your pain (which seems to negate the reason you have an epidural).
Can I have a C-section with an epidural?
If a woman already has an epidural in she can have extra medication through the tube to get numb for c-section.
However, for a normal C-section they use a spinal — which basically changes which membranes the medication is injected under, the medication works faster and is a bit stronger. BTW, if you have a scheduled C-section I have a post that has all the things you’ll want in your c-section bag.
What about a CSE (combined spinal epidural)?
Some doctors give a patient a spinal and then place the tube in the epidural space. This is extra helpful when a woman is in a LOT of pain when she receives the epidural.
It is done at doctor’s discretion. Some seem to like it, some don’t. Personally, you want your doctor to place it the way that he/she is most comfortable — so, I’d stick with that.
Is it possible to have a painless labor?
Yes, it is possible (although not for all women) — but it is not considered the safest or best route for childbirth.
Does it hurt to have an epidural?
I have a whole post to answer the question — does it hurt to get an epidural
But, in short — I think the placement of an epidural is very similar to the pain involved in your IV start. That at least gives you a frame of reference (as you’ll have to have an IV before you have an epidural).
Once the epidural is placed, you don’t notice the placement area until a few days later when the shower hits it — it will likely feel like a bruise at that point.
Problems that can happen with an epidural
Note: Your anesthesiologist should do informed consent during an epidural placement — and should go into ALL of these areas. If they don’t, feel free to stop them and ask the risks and benefits of the procedure they are about to do.
With any time the skin is punctured there are inherent risks (these are VERY rare especially the last two — but doctors are required to talk about them before doing the procedure):
- Pain at the injection site
There are a few other specific things that can go wrong with an epidural:
- The catheter can “migrate” — or sometimes just pull out. The doctor will tape your back a LOT, but as we move you, there’s always the chance it could pull out (or could move internally)
- You might have a “window” where the nerves are bundled and the spinal medication can’t get to.
- Sometimes they don’t get it right on the first try, and it’s just not effective — in which case, the only thing they can do is try again.
- They can push the needle a bit too far and you can get a “spinal headache” — which they can counteract with a blood patch (sounds worse than it is). This is a pretty bad headache, but we are trained to look for and treat them. This is the most common complication of an epidural
Keep in mind that the placement of an epidural has many factors including:
- How you’re positioned (that’s up to you to listen to the doctor and follow orders)
- Your anatomy (and yes, skinny girls are often easier to get it in than larger girls) But, it also has to do with where your fat is located, and how your spine bends.
- Doctor skill
A lot of the epidural is feeling your anatomy, so they can get in the right spot — so that takes cooperation between you and your doctor.
Keep in mind that labor has inherent risks as well, and not having an epidural often puts a lot of stress on moms who aren’t prepared.
What you can do to make an epidural easier?
Things you can do to help your epidural:
- Listen to your nurse/anesthesiologist to position yourself as well as possible (see this post about what labor nurses do)
- Stay still — a moving banana would certainly be extra hard to get it right!
- Be realistic — as I said above — your pain will be 80% taken away.
- Give your nurse as much info as you can. Did you ever get pain free, is it in a specific spot? That helps us know if there’s anything we can do?
And that, my friend, is the real magic (because you’ll need pain management techniques for the next 18-40 years with that child). 🙂
How long does the epidural last?
The short answer, as long as you want (as long as the tube stays in the right place) –but I have a whole post on how long epidurals last.
Labor Pain Management Classes
This online prenatal class, has a great pain management bonus video that will show you:
- Breathing techniques
- Positioning to help with the pain
- Household items you can use to help (like a heating pad)
If you have an epidural does childbirth still hurt?
In short, a bit — but if an epidural is working correctly — it should take away 80% of the pain.
So, that’s the nitty gritty on what you should expect from your epidural. Just a reminder this is part of a series all about labor epidurals. don’t miss the others:
- Does it hurt to get an epidural?
- Epidural during Labor — the procedure & more.
- How long should my epidural last?
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