What Is an Epidural?

In a nutshell local anesthetic is injected into to the space around the spinal nerves in your lower spine to block pain signals traveling to your brain. 

Epidural medications fall into a class of drugs called local anesthetics, such as bupivacaine. They are often combined with an opioid or narcotics such as fentanyl and sufentanil (it’s the opioids that can give moms an annoyingly itchy nose).  

Why Have an Epidural?

An epidural is one of the most popular and effective pain management options in labor. It can make a very difficult experience a much more positive one. The epidural is one of the many tools in your toolkit and in GentleBirth we recommend keeping everything on the table and experiment with all of the tools in your labor toolkit on the day.  The epidural can be the best thing since sliced bread if you’re having a long difficult birth or simply because you want one! You don’t have to explain your decision to anyone.  An anesthetist or anesthetist nurse will facilitate the epidural set up. In most hospitals there is little delay in getting the epidural once requested but in some cases there may be a short delay so it makes sense to have other coping strategies available. Even if you are planning on getting the epidural as soon as possible when you arrive at the hospital you have to get to the hospital first so for those few minutes getting to your place of birth and waiting on your epidural you will be experiencing natural labor even if it wasn’t your intention to.  (So have some strategies in your back pocket for this time).

What’s Involved

In some areas moms are given extra IV fluids to avoid a drop in blood pressure however this practice is being reconsidered in some hospitals as the extra fluids can pass to your baby - making your baby juicier (heavier) which may impact breastfeeding in the first few days.

You will be asked to sit at the edge of the bed and hug a pillow so there is a curve in your spine to make insertion easier. In some cases mom is asked to lie on her side with knees pulled up as far as you can.  Your partner can stand or sit in front of you and support you so he/she doesn’t see the epidural insertion.  You will be asked to remain still (don’t worry the anesthetist will wait until you are between contractions before inserting the needle).  This is the perfect time for using your GentleBirth Breathing Techniques or your GentleBirth Epidural session to keep you calm and focused.

Your lower back will be washed with cold antiseptic. A numbing solution will be injected into the skin of your lower back. Interestingly - studies show that mom’s pain increases when she’s told to expect this part of the procedure to feel like ‘bee sting’. (A good reason to have something else to focus on at this point). A needle will be inserted between the bones of your spine into the space around your spinal nerves.  Some moms report feeling tingly shocks in their legs when getting the epidural but it usually passes.

A small soft plastic catheter tube will be inserted and the needle will be removed. That tube delivers a continuous does of anesthetic medication that will hopefully provide you with relief within about 20 mins. It’s connected to a pump to deliver a continuous dose (some moms have patient controlled epidurals so you’ll be given a little button to give yourself more medication – don’t worry you can’t overdose on it.   A spinal is slightly different to an epidural as it’s one injection with a higher dosage of pain relieving drugs injected into a different area of the spine.  This is generally used you need a cesarean but don’t have an epidural in place already.

Talk to your careprovider about their policies around when you can and cannot get an epidural as it differs depending on the hospital.

Some Advantages and Disadvantages of an Epidural

The main advantages of an epidural are:

• For most moms they will be free from pain.

• It is considered safe for mom and baby.

• It can make a challenging birth into a more positive one mentally and physically.

• You and your partner may enjoy the birth process more.

Some of the disadvantages of an epidural are:

• You are confined to bed and cannot use gravity and movement for labor (ask for a peanut ball to help your baby move through the pelvis easier and shorten the time spent pushing).

• It may only work on one side (in this case the epidural can usually be re-sited) or you may have pain in one ‘window’ throughout. (A TENS machine can help here).

• Some moms develop itchiness from the opioids in the epidural.

• Some moms have severe shakes after the epidural is inserted (use your GentleBirth After Epidural Mp3s to reduce shaking and keep you connected with your baby).

• You will have a catheter placed to drain your bladder.

• A small percentage of moms will develop a fever in labor which may result in additional testing for your newborn to rule out infection.

• Some moms don’t have a strong urge to push so there is an increase in the use of instruments to assist (asking for more time is also an option if you and baby are well).

• There is an increased risk of perineal injury when you are coached to push with no feeling especially if your baby is still high (you can always ask for more time to labor down). I suggest waiting until baby’s head reaches a point called +2 station (very low in the pelvis).

• There can be WAY too much vaginal stretching when your bits are numb.

• It can make labor longer for some moms as it impacts birth hormones so you may need to have Pitocin/Syntocinon to keep your labor progressing.

• You may have a severe headache for a day or two after the epidural is removed necessitating lying flat and additional pain medication and a procedure to stop the pain.

• Medication may pass to your baby and negatively impact feeding behaviors (be sure to ask for extra support).

• If you plan to breastfeed be aware that your baby’s weight may be inflated at birth due to the additional IV fluids causing concerns to staff and encouraging top ups of formula.

• Write epidural birth preferences - they can make a big difference in optimizing the epidural and reducing some of the potential tradeoffs.

Ditch the Guilt

According to Hamlet “there is nothing either good or bad, but thinking makes it so” and we can apply the same sentiment to birth choices.

Epidurals are neither good nor bad but the meaning that so many people are quick attach to epidurals (and other birth choices) can influence whether we perceive our birth experiences to be positive or negative.  Once we add judgment to birth options we can set ourselves up for unnecessary emotional pain and stress . This applies equally for the people dishing out the judgment as well as those on the receiving end - and our own inner mean girl voice.  For some moms having an epidural was a no brainer and they had qualms about having one and can’t understand why anyone would find the decision difficult.  For other moms having an epidural can be associated with feelings of failure. When we can see events as they are without adding any ‘stories/judgment’ (considering the epidural as just one more tool in your toolkit) more moms will have more positive birth experiences and a lot less guilt.  

Can I get an AMEN to less guilt!!

Did you have an epidural? Do you plan to have one again?