What Is an Epidural?

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What Is an Epidural?

An epidural (or epidural block) is a safe and effective method of delivering pain medication often used during childbirth. This popular pain relief option was first used for childbirth in the 1940s. It can be used for regular labor and delivery, induced labors (induction), forceps or vacuum delivery, as well as cesarean section.

Many women choose to have an epidural while giving birth. In fact, studies show that 60% to 70% of women in the United States get epidurals for pain relief in labor.

Uses for an Epidural

While labor and delivery is a natural process, it is extremely painful for most pregnant women. Many laboring women want pain medication to help them cope with this discomfort. Epidurals can be delivered at any time during childbirth but are most often administered after the cervix has opened several centimeters and before full dilation. Epidurals have no or minimal adverse effects for most women and babies—and no known long-term disadvantages.

How It's Given

An epidural is administered by an anesthesiologist along the spine in the lower back. The procedure delivers numbing medication (a local anesthetic, such as bupivacaine, chloroprocaine, or lidocaine) into the epidural space of the spine (the fluid-filled area surrounding the spinal cord) to block pain signals, numbing the body to varying degrees from the belly on down.

The amount of medication can be adjusted so that the laboring woman can still feel contractions—but without the intense pain. The medication can be delivered in a variety of ways, including continuously, intermittently (called bolus-dosing), and/or patient-controlled. Research is ongoing on the relative benefits and drawbacks of these delivery methods, but all have been shown to effectively manage pain in childbirth with limited drawbacks.

How It Works

An epidural is usually done with the pregnant woman on their side or sitting up. In these positions, you curl your back to give the anesthesiologist the best view of your spine. The area of the back where the injection will be given is then washed with a cleansing solution.

You are then numbed with a local anesthetic to minimize the pain you feel from the actual epidural needle going in. Once the epidural is placed, a test dose of the medication is delivered to be sure that the medication is going into the right space. The needle is removed and a thin, plastic catheter is left in your back and taped down for security.

How an Epidural Blocks Pain

Epidural medication works by blocking nerve pain signals at the level of the spinal cord, so that they're not transmitted to the brain.

Once the test dose is working well, then you are hooked up to a bag of medication that will flow continuously or intermittently into the catheter until it is removed from your back. This medication can be changed depending on your needs.

Pain relief should be felt soon after the medication is administered. The epidural doesn't alter your consciousness; you will remain alert the entire time. Once the catheter is removed from the back, the numbing effects will wear off over the course of a few hours.

Timing

Contrary to popular opinion, an epidural can be given at a variety of points during labor. Some hospitals, doctors, or midwives may have a policy (or inclination) to only provide epidural anesthesia after a certain stage of labor. This is meant to help ensure that your labor does not slow down or stop because of the epidural.

Research shows that receiving an epidural may slow down labor slightly, particularly when administered earlier in labor. Getting an epidural a bit later in your delivery is thought to decrease your risks of certain complications.

In the past, there were concerns that using an epidural earlier in labor could increase the risk of c-section. However, research indicates that modern protocols for epidurals do not usually increase c-section risk, and it's now generally accepted that fears of an increased risk of adverse events with epidural use are unfounded.

There is no shame in asking for pain medication earlier in labor. Your requests should be honored if medically appropriate. Still, it's a good idea to ask ahead of time about your practitioner's and hospital's policies and/or recommendations for when you can get an epidural. Prior to getting an epidural, you can also use other forms of pain relief like comfort measures and IV narcotic or opioid pain medications to help you cope with the discomforts of early labor.

When Can You Get an Epidural?

In most cases, the only time it's too late for an epidural is when it's time to push. At that point, you'd need to forgo this pain management option, as the baby is ready to come out—and waiting to push is usually not safe.

How Does It Feel?

What does an epidural feel like? Below, we explain how it feels to have the procedure done and how labor feels once it's in.

The Procedure

The actual procedure is described as anywhere from uncomfortable to moderately painful. It can be hard to hold still while leaning over your pregnant belly during contractions—and a bit stressful. Holding still helps the doctor correctly place the needle.

Luckily, the procedure only takes a few minutes, and doctors will aim to work around your contractions. Plus, many women are highly motivated to bear the prick of a needle and a minute or so of stillness for the reward of pain relief the epidural offers.

What the Procedure Feels Like

Getting an epidural can be a bit scary—a needle is going into your spinal column—but the procedure is very quick, usually not very painful, and provides fast, effective pain relief.

The local anesthesia usually hurts more than the epidural needle, because once the epidural needle goes in you are already numb at the injection site. Many women describe the epidural needle going in as feeling more like pressure than pain. Occasionally, the needle will touch a nerve causing your leg to jump, or you may feel a shooting pain. This is normal and does not cause permanent harm or mean you are paralyzed.

During Labor

What you feel will depend on the combination of medications, how far along you are in labor, your personal experience, and various other factors. Some women feel the contractions but not painfully, while others hardly notice the contractions at all. In the past, many women reported that they felt little or nothing from the waist down, but that is not usually the case today, as the modern approach uses less medication. Be sure to talk to your anesthesiologist about what you want to feel.

Usually, the aim is to give you just enough medication so that it takes the edge off the pain but you still feel the pressure of the contractions and the urge to push. Being able to still sense the contractions aids in timing and maximizing your pushes. Your doctor and/or doula can also tell you when to push, whether or not you can feel this urge.

Post-Childbirth

After you have given birth, the epidural catheter is removed by taking off the tape holding it in place and pulling the catheter out. You may still experience numbness in your legs for several hours, which will decrease gradually until you regain full sensation. Occasionally, mothers will feel weak in the legs or even numb for a longer period of time. Back pain may also occur at the site of the epidural.

Risks

Like all medical procedures, there are risks involved with getting an epidural. However, the rate of serious adverse events is extremely low. The most common complications for the mother include the following:

  • Back pain
  • Difficulty urinating, which impacts about 15% of women (in these cases a catheter is used to empty the bladder during labor as needed)
  • Headache
  • Itching
  • Low blood pressure, which can usually be quickly treated with medications and position changes
  • Nausea and vomiting
  • Nerve damage
  • Numbness after delivery, which usually resolves within 24 hours
  • Soreness at the injection site

Other risks include fetal distress, fetal malpositioning, and a slightly slower progression of labor. There are safety measures put in place to prevent or, when needed, minimize these issues. Babies are exposed to the medication, as well, but generally experience limited side effects. Maternal paralysis, numbness, nerve injury, and infection are possible, but the occurrence is extremely rare.

Contraindications

Not everyone can have an epidural. There are some reasons why an epidural may not be right for you. These may include your medical history, conditions you may have, hospital staffing, or availability.

For example, if your labor progresses rapidly and/or you wait a long time while in labor to request an epidural, you may need to push before an anesthesiologist can get to your hospital room to put in the epidural. If you have a concern or questions about getting an epidural prior to labor, it is usually possible to schedule an appointment for a consultation with an anesthesiologist.

Other Options

If an epidural is not right for you due to contraindications or personal preference, you do not have to have one—nor do you need to forgo pain relief measures. There are multiple other options for pain management, including other types of pain medications that do not cause numbing, such as narcotics and opioids.

Other options that can help manage pain include breathing techniques, soaking in water, hypnosis, biofeedback, distraction, aromatherapy, massage, and acupressure. These techniques can be used to get through labor with or without using any medications. Using a doula to help manage your discomfort is also known to increase the likelihood that you can cope with the pain without an epidural.

Most Women Are Happy With Their Pain Relief

The good news is that, according to a survey conducted by the American Society of Anesthesiologists, 90% of women felt the pain management options they used (epidural or not) effectively controlled their discomfort.

Who Chooses an Epidural

Women make pain medication choices for a variety of reasons. Research shows that multiple factors influence whether a person gets an epidural. The higher the maternal age and education level, the more likely the person is to choose an epidural. Studies also show that early access to consistent prenatal care makes pregnant women more likely to opt for this pain relief method.

Other women are motivated to experience all the sensations of birth and specifically choose not to have an epidural regardless of their pain level. This is often referred to as "natural childbirth." Sometimes, women feel pressure to either have an epidural or not to have one—and can feel guilt, judgment, and/or disappointment about their choice.

Letting Go of Preconceptions

Having a baby is a monumental life experience with or without an epidural. There's nothing weak or "unnatural" about wanting pain medication and also nothing wrong with (or better about) choosing not to have an epidural.

It can help to remember that the point of childbirth is the baby. The way they are born is ultimately a means to an end. It's also key to emphasize that there is great variation in how each labor progresses in terms of speed, interventions needed, pain experienced, and complications. So, each woman simply needs to decide what works best for them in the labor and delivery experience they are having.

Tips

Taking a childbirth class, researching the process of labor and delivery, and asking lots of questions of your doctor and friends and family who've had children can help you formulate your optimal birth plan. Having thought through your options and making a plan can help you feel more comfortable and less apprehensive about giving birth—and reduce the need to do as much decision-making about pain relief options while in the throes of labor.

However, be aware that childbirth does not always go as planned. It may be faster, slower, or more or less painful than expected. Unexpected complications, such as fetal distress or labor that doesn't progress, sometimes happen, which may necessitate altering your birth plan. However, even if your birth plan takes a detour, with or without an epidural, the end goal is the same—ending up with a bundle of joy.

You're Free to Change Your Mind

Sometimes, women who think they won't want an epidural change their minds once they're in the throes of active labor. Conversely, others who are sure they'll need the pain relief an epidural provides end up foregoing it when the time comes. These decisions are good ones—all that matters is what is right for you.

A Word From Verywell

Rates of epidural use (and a woman's reasons for choosing one or opting not to) vary significantly from state to state, person to person, and year to year. The key is not to worry about what other women are doing. Instead, follow your own instincts about what you need. Most importantly, let go of any feelings of guilt or disappointment if you choose to go with pain relief (or not). Simply focus on what feels right to you—and the baby you that will soon be in your arms.

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Article Sources
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