What You Need to Know About Epidurals in Labour
*Disclaimer: As a doula I am a non-medical professional. The words written here are my own views, and based on research that I have done myself. This is not to be taken as medical advice. Please speak with your health care provider and do your own research.*
Epidural anesthesia is the most common type of pain relief used in labour, with over 50% of women receiving them. I believe that it’s a wonderful procedure that exists for certain births, but that it is definitely utilized too often without all the facts being known.
I say it time and time again, but knowledge is power! Use the BRAIN acronym to educate yourself on everything you think you might want to happen at your birth. Because it’s exactly that, YOUR birth. You get to call the shots. You need to be armed with your knowledge and choose what feels best for YOU.
With so much information available at our fingertips it can be hard to distinguish what is what, and so I put a lot of work in to create this post for all of you (#birthnerd)! I’m presenting this info to you in an unbiased way; just the facts. I definitely suggest doing your own research as well, and I totally recommend the book “The Thinking Woman’s Guide to a Better Birth” by Henci Goer.
Let’s jump in, shall we?
What is an epidural?
Epidurals are a regional anesthesia to block pain in part of your body. Their main goal is to provide pain relief, analgesia, instead of anesthesia, which provides lack of feeling. Epidurals block nerve impulses from the lower spinal segments resulting in decreased feeling in the lower half of the body.
How is it done?
First, an IV is started and about a quart of fluid is run to prevent a fall in blood pressure. Electronic fetal monitor belts will be attached to pick up on baby’s heart rate throughout your labour. A blood pressure cuff will be placed on your arm which will inflate periodically to assess your BP.
You will then sit on the edge of the bed, or lie on your side, while your back is washed with antiseptic and sterile dressing is placed around you. Once ready, you’ll be asked to arch your back and the anesthesiologist will inject one needle filled with local anesthetic to numb the area. After that, a large needle will be inserted between 2 of the spinal vertebrae a little above your waist area.
You must hold absolutely still during this part of the procedure, even though you most likely will be experiencing contractions.
The anesthesiologist guides the needle in slowly until they reach the epidural space (outward of the two membranes that cover the spinal cord). They perform a check to make sure it’s in the right spot, either by aspirating the needle to see if blood comes out (which means they are in a blood vessel), or they inject a small amount of the dose to see if you have a bitter taste in your mouth. If all is well, they will thread a tiny plastic catheter through the needle, and then remove the needle. The catheter stays in place throughout your labour, and this is where the dose enters your body.
The full dose is injected and the anesthesiologist checks that it’s working by using icepacks to see if you are losing sensation in the proper areas.
Ideally you will feel no pain but will have control over your legs so that you will have sensation to push when the time comes. It takes about 15 minutes for the epidural to take full effect. This whole procedure can take up to one hour to complete.
The best time to receive an epidural is once you are already in active labour, which is about 4-5cm dilated with regular contractions. This is to prevent the epidural from slowing labour down.
What are the benefits?
-Epidurals are the most effective pain relief available, almost always eliminating pain while leaving you alert and awake.
-They allow you to rest or sleep, which can be exactly what your body needs to dilate the rest of the way.
-Can transform very long difficult labours into positive experiences.
-Promote progress of labour when you’ve gotten “stuck”.
What are the risks?
-They can slow labour resulting in increased use of pitocin to stimulate stronger contractions, usually leading to higher episiotomy rates, forceps or vacuum extraction, and cesarean births, especially in first time moms.
-Require electronic fetal monitoring (EFM) & precautionary IV, which can lead to higher c-birth rates
-IV can cause fluid overload, leading to fluid in in mom’s and baby’s lungs, maternal anemia, and blood chemistry disturbances in mom and baby.
-Body temperature rises over time which can lead to fever (because epidurals interfere with certain functions of the autonomic nervous system like sweating).
-You may need a bladder catheter, which can lead to a urinary tract infection
-Insertion of the epidural needle can injure blood vessels & nerves. If it pierces a blood vessel (which is easy since pregnancy enlarges them), or goes deeper than the epidural space, or the catheter migrates inwards, convulsions, respiratory paralysis, and/or cardiac arrest can occur. The latter two as commonly as 1/3,000 births. Drugs causing serious adverse reactions in this range have been taken off the market or forced into restricted use. (Info from “The Thinking Woman’s Guide to a Better Birth”)
-Can cause drop in blood pressure.
-Even though it’s injected into the cerebrospinal fluid, it passes into maternal blood vessels & crosses through the placenta into baby’s circulation where it can slow heart rate.
-Can cause fetal distress.
-Can result in lower APGAR scores
-Decrease chance of spontaneous vaginal delivery
-Potential postpartum complications include temporary incontinence, nerve injury causing temporary muscle weakness or abnormal sensation, blood filled swelling (hematoma), excruciating spinal headaches which can last a couple of days.
-May cause adverse physical and behavioural effects in baby, like problems breastfeeding.
-Allergic shock is a possibility.
-Labour becomes high-tech and medicalized which can cause negative emotional feelings.
There are alternatives to epidurals such as narcotics. Usually a nurse can inject it into your hip muscle or into a port on the IV tube which delivers it to your vein. Narcotics dull but don’t abolish pain. They can make you feel drowsy or drunk. Chemically they are similar to endorphins, our body’s own natural pain relievers. They take effect almost instantly when injected into a vein (not as long if injected into muscle).
A study between Stadol and Fentanyl (two common narcotics used in labour) found that Stadol provides better relief.
They last only an hour or 2 which is good because baby won’t metabolize the drugs.
Some pros include, no back needle, no bladder catheter, don’t have to wait as long like you might for an epidural (if the hospital only has one anesthesiologist it can take a while for them to arrive), they don’t slow labour or interfere with pushing.
Some cons are that they depress breathing which can be bad for baby if there already is some fetal distress, and they can adversely effect fetal heart rate.
Sterile water injections are an option if you are having very bad back labour, but they don’t do much for regular labour pain.
As you can see there is a LOT of information to gleam on epidurals. There is so much more out there but these are the basics. My suggestion is to go with your gut!
They provide wonderful pain relief, while having a lot of possible risks. It’s an individual choice that no one can make for you. I believe that it’s best to try out other options of pain relief first, and work with your body through your labour. Your body knows what it’s doing, it was designed perfectly.
In some cases, epidurals are awesome! I’ve seen it work magic on a client who was in tremendous pain for hours and wasn’t progressing very much. Epidural happened, she slept for a couple hours and then BOOM, she woke up at 10cm ready to push! This is the ideal situation, I think, for epidurals to be used. But again, you get to make that choice for yourself!
Did you have an epidural? Let me know in the comments below!