An epidural is a form of regional anesthesia meant to help you manage the pain of childbirth. It is the most commonly used form of labor pain management in the United States.
How is an epidural administered?
You can get an epidural at any point in labor if you’re able to sit up and you’re not actively giving birth. Commonly, it is recommended during active labor, when contractions are regular and your cervix is changing.
It is placed by anesthesia providers while you are either sitting up or lying down on one side. Your lower back is cleaned with antiseptic solution and allowed to dry. Then numbing medication is injected with a small needle to get the skin very numb. This is similar to the feeling when you have local anesthetic at the dentist. Then your provider will use an epidural needle to find just the right space to place the epidural medication. Because local anesthetic is placed first, you will feel pressure, but shouldn’t feel pain. After the needle is in the right place, a catheter (tiny tube) is threaded through this needle and into your epidural space. After this, the needle is removed, and the soft, flexible catheter stays in place and is taped down very thoroughly, allowing you to move comfortably and rest against your back even with the epidural in place. Medication is delivered through the epidural tubing via a special pump that carefully meters out the dosage. You will probably have a button that you can use to give yourself additional medication for breakthrough pain.
How quickly does it work?
Generally, the effects of the epidural can start to take place within moments, but full relief from contraction pain is expected within about 15-30 minutes of placement. You can expect that the sharp and cramping pain from the contractions will greatly improve. If you’re using a pain scale of 0-10, the hope is to get you down to a manageable 1-3. Epidurals do not remove the sensation of pressure, so you may still feel certain parts of your labor and birth with some intensity.
Are there any risks involved?
Epidurals are a very safe option for pain relief in labor. However, as with any medical procedure, there are some risks. Perhaps the most common risk is that it won’t work on one side of your body, or be as effective as you’d hoped. Sometimes epidurals have to be replaced if this is the case. There is a chance of low blood pressure after receiving epidural medication. This can be treated, but needs to be identified quickly and can make you feel nauseated, dizzy, and sleepy. There is a chance of infection at the placement site. And there is the chance of a severe headache for a few days after the epidural placement isn’t perfect.. These headaches are very specific because you’ll feel fine lying down and in severe pain when sitting or standing. This can be treated, and needs to be reported to your provider and anesthesia professional right away.
Research hasn’t shown that epidurals increase the chance of having a cesarean section birth, and they can be adjusted during the pushing phase of labor to ensure you can feel to push effectively.
The medication used gets to Baby in very small amounts, which hasn’t been shown to cause negative effects. Epidural medication varies from hospital to hospital, so you can ask what’s standard at your location.
There are a few conditions that could mean you are not a candidate for epidural anesthesia. One is having very low platelets. This is a blood condition that makes it more difficult for your blood to clot and increases the risks of the epidural. Another limitation could be history of certain surgical procedures on your spine which would not allow for placement of the epidural, though this is very rare.
The bottom line
The labor epidural is a fabulous tool that is commonly used to improve the birthing experience for millions of people every year. It is a safe option for most and can be adjusted as needed so you get the individualized pain relief you need. Talking with your provider about epidurals before you’re in labor is helpful so you have the presence of mind to ask all the questions you want!
Reviewed by the Ovia Health Clinical Team
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Sources
- https://www.acog.org/womens-health/faqs/medications-for-pain-relief-during-labor-and-delivery
- https://madeforthismoment.asahq.org/pain-management/techniques/epidural/
