Birth Doula Blog
I'm a straight shooter, so I'll start by saying that there is a time and place for an epidural. Personally, I believe it's overused, rarely necessary, and not fully understood by laboring people. If the immediate and future benefits and risks are truly considered then I see no problem with the use of an epidural. My biggest issue with it is that the promise of quick pain relief overshadows the uncomfortable prep work that is needed prior to administration, the potential risks during its use, and the effects after it's been removed. That being said, there are actual circumstances in which the benefits outweigh the risks.
What's in an epidural?
It's actually a combination of a few drugs: numbing meds ending in -caine such as bupivacaine, and opioids such as fentanyl and morphine. These drugs do not greatly affect the baby as compared to other narcotics but they tend to prolong labor and might have an effect on newborn alertness. The reason both are given is so that less of each is necessary. In simple terms, an anesthetic alone would require a higher dosage and an opioid alone would also require a higher dosage to provide pain relief.
What happens before an epidural and when can you get relief?
When you decide you want an epidural, you will be given consent paperwork to sign (if you didn't already do that during a prenatal appointment or when checking in) and an IV line will be placed into your arm to give you a continuous flow of fluid, vitamins, and electrolytes. This is done to avoid dehydration and reduce your chances of a drop in blood pressure, which is a side effect of epidural. It can take up to 30 minutes for the whole bag to be administered which is what some hospitals require. During this time, your mobility will be somewhat limited as you will have a line attached to your arm. While the IV fluids are being given, the anesthesiologist is paged. They may come soon after the call or you might have to wait. Once they arrive, you will be asked to sit on the edge of the bed and remain perfectly still (easier said than done when you're having contractions) while they insert a fine needle and catheter into your spine. This procedure can take 15-45 minutes depending on the doctor's level of skill. Once inserted, you will begin to feel numb within 5-30 minutes.
So, realistically relief can take at least an hour after you've decided you want one and is rarely as instant as the laboring person would like.
What happens after an epidural is placed?
As soon as the epidural begins to work, you will have a urinary catheter placed in your urethra. Because you cannot walk to the bathroom or even feel the urge to pee, the catheter is needed to empty your bladder. The collection bag will be placed on the side of the bed. You will also be attached to two straps that go on your belly...one to measure your contractions and the other to monitor baby's heartbeat. Blood pressure drops are common so you will have a cuff attached to your arm that will frequently take your blood pressure. The nurses might also want to keep an eye on your oxygen levels and attach a pulse oximeter to your finger. So if you're tracking the number of lines running out of your body, that's SIX! All of these machines require constant checks from the nurses which means frequent interruptions if you happen to fall asleep.
If you've taken a childbirth course then you understand the importance of movement to manage pain and help progress labor. At this point, your mobility is greatly hindered, although a few people are able to retain some sensation and with the help of others can get into a few beneficial positions.
It's also not always possible to predict how much numbing an epidural will provide but some hospitals will allow you to control the drip. A high dose isn't easily undone but a low dose can easily be increased.
What are the possible benefits?
•Effective numbing from the waist down
•Relaxation and sleep become possible
•Anxiety and stress are reduced which can help progress labor
•A low dose will allow you to have some mobility and sensation
•Can quickly transition to anesthesia for a C-section
•Is given to people who are laboring with high blood pressure, as it helps to lower it
What are the possible risks?
•Inability to move if the dose is high
•Blood pressure drop that requires an ephedrine shot
•Prolonged or stalled labor which might require the use of Pitocin
•Spinal headache that can last days
•Lack of oxygen and decreased heart rate in baby
•Possible changes in newborn's reflexes
•Diminished post-birthing high as it interferes with oxytocin and adrenaline
•Decreased pushing sensation which increases chances of forceps/vacuum and possible tearing
•Increased chances of other interventions
•IV fluids can negatively affect baby's birth weight and loss
•Can affect the immediate breastfeeding experience
•Rarely, chronic back pain or hematoma and infection at the site
When does the epidural wear off?
Once the drip is turned off it can take up to two hours for you to regain sensation and be allowed to walk.
Who shouldn't get an epidural?
If the fear of being paralyzed or losing control from the waist down is a concern then an epidural isn't right for you. If movement during labor or feeling connected to the experience are priorities then you should also pass on it. It's definitely contraindicated if you have low blood pressure, a bleeding disorder, or are on blood thinners. Very rarely, it is possible to get ineffective relief if you've had back injuries or surgeries.
Can it be "too late" to get an epidural?
Yes, it's true! When birth is imminent an epidural offers minimal benefits when compared to the risks. Once your cervix has fully dilated many doctors will deny you an epidural as the birth is soon to follow. It's also important to note that pushing contractions feel different than active labor contractions. It actually feels good to push with contractions!
My Personal Experience
I had a pretty heavy dose with my first and was labeled with "failure to progress" so I was given Pitocin to speed things along. I felt nothing and was exhausted after laboring for 24 hours. She was born vaginally and was quickly taken away for 4 hours, but I was too tired to care and fell asleep. I never felt that high that keeps you alert and in love. Bonding and nursing were never easy with her. I had no good coping skills, so it was easy to just get an epidural even though it was never the plan during pregnancy.
My second was also planned to be epidural-free but I got one after feeling the uncontrollable urge to push when I wasn't fully dilated. The epidural helped my body rest and progress. When pushing came around, I was able to feel my contractions and push when my body wanted to. It was just the right dose of relief. I bonded with my baby immediately and felt much better about nursing and being a mom.
Was the mother/baby connection due to heavy epidural vs. light epidural or 1st time vs. 2nd-time mom? I don't really know. I'm definitely the last person to judge someone for getting an epidural, but I cannot ignore the tragic stories most moms describe when talking about their epidural experiences. I also can't tell you how many times I've talked to people who want an epidural, yet have no idea what it entails.
Education is key, my friends! Use your B.R.A.I.N.
Final Thoughts and Recommendations
Do your research and ask yourself whether the risks are worth the benefits. If you are truly suffering during labor, have legitimate mental roadblocks or trauma, or have tried natural methods to help progress labor but they fail, then an epidural is definitely called for. Think past the immediate pain relief and remember that the effect isn't instant and that you will be required to be attached to many lines.
•Ask for the lowest dose possible to retain mobility but also have some pain relief
•Roll over and change positions every 30 minutes so that the epidural can provide even relief
•Have it turned off or greatly reduced when you are 9 centimeters to be an active participant during the pushing phase
•Studies show the best time to get an epidural is after 6 centimeters so that labor has been well established
•Even if you're dead set on one, prepare for an unmedicated birth just in case it can't be administered
If the fear of coping with labor pains has you considering an epidural, remember that these pains have a purpose and bring you closer to baby. There are many ways to cope with contractions and you CAN do it! If an unmedicated birth is your goal, still open yourself up to an epidural. Getting one for whatever reason doesn't mean you've failed. In the end, you will still have a baby in your arms no matter how they were born.