Epidural Block For Labor
Getting an epidural block certainly isn’t your only option for getting through the pain of labor. Even so, the majority of women opt for epidurals because they are usually really effective at eliminating pain. I think it’s always helpful to review all your options so you can make educated decisions. Here, you’ll find all the information you need to know about epidural anesthesia- how an epidural is given, what it does, and the pros and cons of getting one.
What is an Epidural Block?
An epidural block is a regional anesthetic that blocks pain from the abdominal area down.
How is an Epidural Administered?
You will get your epidural from an anesthesiologist or a nurse anesthetist. First, you will be given IV fluids. Then he or she will clean the proper area in your lower back and inject a local anesthetic to numb the area where they will place the epidural. A large needle is inserted into the epidural space, which is a space between two vertebrae in the lower back. Then a catheter is put through the needle into the epidural space. After the catheter is placed, the needle is removed and the catheter is taped in place on the back. The anesthesia will be delivered through this catheter. When the epidural is being given, you have to hold very still, usually curled up either sitting on the edge of the bed or lying on your side. This can be tough because contractions don’t stop while you’re getting the needle placed.
What Can I Expect With an Epidural?
Most hospitals only allow one person to be in the room with you when you get an epidural, in addition to the medical staff, of course. So if you’re planning on getting one, it’s not a bad idea to decide who you want to be with you ahead of time.
An epidural can cause a drop in the baby’s heart rate, so you will need to be attached to an electronic fetal monitor continuously. Your blood pressure will also be continually monitored, and you may need a catheter to keep your bladder empty. Obviously, when you are attached to all these things, you aren’t able to move around much. However, limited mobility might not matter to you if you don’t have to deal with pain on top of it.
Epidural blocks can be very effective at taking the pain away, but note that it takes 20 min or so for the pain relief to kick in. After that, you shouldn’t feel much of anything. The lower part of your body will be completely numb. You won’t feel the pain from the contractions and when it comes time to push you might not feel that either. How much feeling you have with an epidural block depends on how high you have your dose of medication. Some women still feel the pressure of the contractions, but not the pain.
So, if you don’t feel it, how do you know when to push? Your care providers will let you know when you are fully dilated and it’s time to push. Your legs will be numbed also, so after you have your baby, it might take a while before you’re able to get up and around.
Advantages of Having an Epidural
• Epidural blocks provide the most effective pain relief.
• Epidurals can give you much needed rest during an especially long labor.
• In some cases, women get so tense during labor that it causes labor to stall or slow down. Sometimes, getting an epidural block allows the mom to relax enough for labor to progress.
• If you have high blood pressure, an epidural can help lower it.
• If you have a C-Section, an epidural allows you the anesthesia you’ll need, while still being awake and alert.
Epidural Side Effects and Risks
• Epidurals usually slow labor down, which increases the likelihood of getting Pitocin to speed up your labor. Many times, this is the beginning of what’s often called the “cascade of intervention.” Pitocin is given to induce or speed up labor, which leads to more painful contractions, which leads to an epidural for pain relief, which leads to a slower labor and more Pitocin… ultimately increasing the risk of C-Section. Many studies have shown that labors with epidurals are longer than those without.
• Sometimes epidurals don’t work. This is rare- only about 3% of women get no pain relief. About 12% of women still have some pain, for example, it may only work on one side. 85% of women have complete pain relief.
• Epidurals can lower blood pressure dramatically, which can cause fetal distress. This is why IV fluid is also given. Although the IV fluid counteracts the blood pressure problem, it causes the legs, feet and breasts to swell. This swelling in the breasts flattens the nipples, which can make it hard for the baby to latch on to breastfeed.
• Rarely, the anesthetist puts the needle in too far and punctures the space just around the spinal cord. This causes a severe spinal headache afterward that can last days or weeks.
• Getting an epidural can result in up to 3 times the likelihood of needing vacuum or forceps to help deliver the baby. This is because the epidural relaxes the pelvic floor muscles, making it hard for the baby to rotate properly for delivery. This makes the second stage of labor longer, and increases the likelihood of using vacuum or forceps.
• Epidurals can cause the baby to have breathing difficulties.
• Some women experience uncontrollable shivering after an epidural.
• Epidurals can cause a fever in the mother. Since there is no way to know whether the fever is from the epidural, or from an infection in the uterus, this leads to tests and medication for the baby after birth. Usually, this means there will be more separation between mom and baby after birth.
• Epidurals can result in a poor sucking reflex in the baby, which can lead to difficulties with breastfeeding.
• Epidurals limit mobility.
• Having an epidural increases the chance of urinary incontinence after birth.
• The procedures that tend to go along with epidurals, such as electronic fetal monitoring, bladder catheters, forceps/vacuum, episiotomy and Pitocin can have other side effects.
• Very rarely an epidural can cause permanent paralysis or death.
• Epidurals can increase the likelihood of having a C-Section, especially in first time moms.
• Having an epidural increases the likelihood of getting an episiotomy at delivery.
• Epidural anesthesia does cross the placenta, and can have negative effects on the baby. These include reduced muscle tone, trembling, irritability and an increased risk of jaundice.
• Some women experience long term back pain following an epidural.