E is for Epidural
Epidural Anesthesia is commonly used in birth these days, with 50% to 80% of all laboring women in hospitals receiving this method of pain relief.* I'm writing this guide so that parents have the tools and information available to make an educated decision on their birth plans. I have personally seen epidurals be very effectively used to continue a VBAC birth, to reduce panic, or to let a mother sleep when she needed to rest.
What Does An Epidural Do?
It's important to note that while they may refer to "pain relief," Anesthesia by definition is the lack of sensation or feeling.* Technically, what an epidural does is relieve you of the sensations of contractions, but also creates a general lack of feeling in your lower extremities. While an Epidural can be absolutely wonderful pain relief, there are some serious implications and risks some expectant parents aren't aware of. Let's take a look at the benefits and risks involved.
Benefits of Epidurals
Sleep or rest is possible during prolonged labor
Pain relief without drowsiness or mental fog
Quick procedure, with relief in 10-20 minutes of administering the medicine
Your provider has active control over amount, type, strength of pain relief through the spinal IV and can adjust as needed
Smaller amount of medication reaches the baby than with narcotics or other systemic medications.
May result in more positive labor experience or more energy during pushing
Can be effectively used during Cesarean Birth so the mother may remain awake and alert with no pain
Can be removed immediately after birth
Risks of Epidurals
Ineffective pain relief- occasionally pain is only relieved on one side or to a certain degree of comfort
Reduced positioning- it is necessary to stay in bed and alternate sides, as well as have continuous monitoring for changes in fetal heart rate. Lying in one position can sometimes cause labor to slow down or stop.
Epidurals may cause your blood pressure to drop suddenly. Your vitals will be checked frequently and if there is a sudden drop in blood pressure, you may need to be treated with IV fluids, medications, and oxygen. They will also be observing you for a maternal fever which can indicate infection.
You may experience a severe headache caused by leakage of spinal fluid. Less than 1% of women experience this side effect. If symptoms persist, a procedure called a “blood patch”, which is an injection of your blood into the epidural space can be performed to relieve a headache.
You might experience the following side effects: shivering, a ringing of the ears, backache, soreness where the needle is inserted, nausea, or difficulty urinating.
Pushing can become ineffective, and forceps or other methods of assisting delivery may be used, such as episiotomy or vacuum delivery. Some doctors may agree to "turning off" the epidural or lowering the dosage for more effective sensations during the pushing stage.
Other Helpful Information
After the epidural is administered, you may be restricted to a clear liquids diet. Ask your care provider about their policies and what your options are.
"Walking Epidurals" are not very common. Ask your provider if you were interested in this as an option. Most women who receive epidural anesthesia are routinely restricted to bed for their safety.
You will need a catheter to be inserted due to being restricted to bed, and after the birth you will still feel numb and need assistance to use the restroom immediately.
In rare instances, permanent nerve damage may result in the area where the spinal catheter was inserted.
Though research is somewhat ambiguous, most studies suggest that some babies will have trouble “latching on” causing breastfeeding difficulties.
Other studies suggest that a baby might experience respiratory depression, fetal malpositioning, and an increase in fetal heart rate variability, thus increasing the need for forceps, vacuum, cesarean deliveries, and episiotomies.*
When Can An Epidural Not Be Used?
According to the American Pregnancy Association*, an epidural may not be an option to relieve pain during labor if any of the following apply:
You use blood thinners
Have low platelet counts
Are hemorrhaging or in shock
Have an infection on or in your back
Have a blood infection
If you are not at least 4 cm dilated
Epidural space can not be located by the physician
If labor is moving too fast and there is not enough time to administer the drug
Should You Get An Epidural?
A Doula's job isn't to inform you of what to do, we provide options and ask which seems best. There becomes a point in labor where your mind and your body may be fighting, or as I like to say, there is a difference between pain and suffering.
Natural Pain Relief Methods
and much more
Labor hurts, but you shouldn't ever be suffering. There are many comfort measures we use to greatly reduce a laboring woman's discomfort, but sometimes we need to have an honest look at our options if these things aren't working for you. A Doula will still support you, offer you options, and encourage you after the epidural has been administered.