- What is an epidural?
- Drugs in an epidural medication
- Benefits of epidurals
- How is an epidural administered?
- Epidural impact on labor hormones
- Side effects of epidural
Childbirth can be a painful experience for most women, and epidural analgesia offers relief from that pain. This is why several women ask for it during delivery.
What Is An Epidural?
Epidural analgesia is local anesthetic injected into the epidural space of the spine, to numb the spinal nerves and offer relief from the pain during labor (1). The drug travels through the epidural space to the nerves and works by stopping the pain signals from reaching the brain.
Since it is injected into the lumbar region of the spine, pregnant women do not feel any sensation in the lower half of the body. For women who do not want to experience natural labor pain and do not want to take medications, epidural analgesia has become the choice of labor pain relief.
Note that an epidural is not the medicine itself, but a procedure of administering anesthetics for pain management.
Drugs In An Epidural
Epidural medications are a combination of local anesthetics (bupivacaine, levobupivacaine, or ropivacaine) and opioids (fentanyl, diamorphine, morphine, and sufentanil). The opioid dosage used in epidural is (2):
Local anesthetics lidocaine and chloroprocaine are not used nowadays because the action time for chloroprocaine is too short and repeated doses of lidocaine are found to cause tachyphylaxis.
When administered the right way, these epidural combinations can be highly effective and beneficial for managing pain during delivery.
What Are The Benefits Of Epidurals?
- Are more effective than other pain-relief options during labor.
- Make movement easy and give you the strength to push out your baby.
- Can be administered at any stage of labor.
- Are very safe in experts’ hands.
- Help you stay awake and alert during delivery (4).
- Can be used to numb only the lower part of the body in case of a C-section.
- Help you get rest and stay focused, especially if you feel exhausted.
Besides the benefits, you should also know about the exact procedure of epidural analgesia before opting for it.
[ Read: How To Speed Up Labour ]
How Is An Epidural Administered?
An anesthetist administers the epidural. The procedure is explained next, in detailed steps (5):
- Before giving you the anesthesia, the doctor will insert a drip into your arm.
- You will be asked to sit upright straight or lie on your side with the back curving towards the anesthetist. A nurse can help you to get into the desired position.
- The specialist will apply a cold, antiseptic solution to the area of the skin where he injects the local anesthetic.
- You have to stay still and not move when the doctor puts the epidural in. The doctor may ask you to report any contractions at this time.
- A needle with a catheter containing the epidural medication will be inserted into the epidural space of the spine. The needle will be removed, and the catheter stays put in that place, secured with a bandage, until after delivery.
- 15 minutes after epidural administration, you will feel the pain subside.
- You will be able to move around or on the bed comfortably, with the catheter attached at the back. However, you should not slide or drag the lower back as it can pull off the catheter.
- If the initial dose does not work well, then the midwife can give you more medication.
Once the epidural is given, the doctor will monitor the fetal heart rate continuously during the labor. A CTG machine is used to measure the fetal heart rate and your contractions.
Doctors may give you synthetic oxytocin (Pitocin) to induce contractions.
Though epidural analgesia reduces pain during delivery, it can have some side-effects.
[ Read: Best Position To Induce Labor ]
Side-effects Of Epidural
Epidurals are generally safe, but there some side-effects (6).
- Epidurals can lengthen the second stage of labor.
- They can cause a drop in the blood pressure, making you dizzy and nauseated. In the case of a sudden blood pressure drop, IV fluids, oxygen, and medication may be given to you.
- Around 23 out of 100 women get a fever due to the epidural (7).
- Loss of excess spinal fluid, if the needle is inserted accidentally in the subarachnoid space, can result in a headache.
- You can feel weakness in the leg muscles.
- Numbness in the lower body makes it difficult for you to sense the urge for urination. Thus a urinary catheter needs to be inserted. 15 out of 100 women face this problem.
- The chances of vaginal delivery reduce to some extent.
- Reduced muscle strength and the inability to push effectively during labor can lead to assisted or instrumental delivery using forceps and vacuum extraction. Around 14 out of 100 women who have an epidural have an assisted delivery (7).
- An assisted delivery requires episiotomy (a cut in the back of vagina) that needs stitches.
- Stopping the epidural in the later stage of labor can result in more pain and doesn’t make birthing easier.
- Epidurals can cause itching, which can be treated with antihistaminics.
- You may experience pain or tenderness in the injected area.
- Slow breathing or drowsiness can be a side effect.
- The epidural catheter can cause temporary damage to the nerve.
- Permanent nerve damage that can cause loss of movement or sensation in one or both legs, although rare, can be a major side-effect (8).
- A bruised feeling and possible infection around the skin where the catheter is inserted.
If the epidural analgesia fails to block the pain entirely, the procedure might be repeated, or you will be offered an alternative method of pain relief (9).
Very rare complications of an epidural include:
- fits (convulsions)
- severe breathing difficulties
If you are considering an epidural but still have doubts about it, keep reading to get the answers.
Frequently Asked Questions
1. Do epidurals increase the chances of a C-section?
There is no proof that epidurals increase the likelihood of a C-section. If you have doubts, talk to your doctor about it (5).
[ Read: Enema During Labor ]
2. Who should not get an epidural?
Avoid epidurals in case of:
- Blood clotting disorders
- Use of medications for blood thinning
- Neurologic disorders
- Heavy vaginal bleeding
Epidurals are also not ideal for women who have had lower back surgery.
3. How long does it take to inject an epidural?
The procedure lasts around ten minutes, and the pain starts to subside five minutes after administration. However, the time taken for the procedure may exceed in case of obese women or women with abnormal spine.
4. When will the epidural be administered?
An epidural is administered during active labor or on the demand of the patient or based on the circumstances, the doctor usually decides the best time to inject an epidural.
5. Do I need an epidural during labor?
If you can cope with labor pain easily, there is no need of taking an epidural injection. It will be given only upon your request.
6. Will the epidural injection hurt?
The doctor will administer local anesthesia before injecting an epidural. So, you will only feel a sting and a little pressure in the back.
7. Does epidural have any effect on the fetus?
Epidural analgesia enters the mother’s bloodstream and reaches the fetus through the umbilical cord and doesn’t have any strong impact on the baby’s health. However, it might prevent the baby from attaining the best position, leading to assisted vaginal delivery. According to a study, 10 out of 100 women need an instrumental delivery without having an epidural and 14 out of 100 women need it with an epidural (7).
8. Does epidural always work?
In the majority of cases, epidural brings adequate relief from labor pain. However, there are cases when the epidural does not work effectively. This could be due to improper insertion of the catheter in the epidural space, owing to the problematic neuraxial anatomy of the patient. This hastens the labor process or can prevent the epidural block from acting on time (10).
[ Read: When & How To Push During Delivery? ]
Considering that the side-effects of epidural are mild, it is the most sought after pain-management method by mommies. However, this option may not suit everyone. As you near your due date, take time to find out more about the different options for labor pain relief and make an informed choice.
What are your thoughts on epidurals for labor pain management? Let us know in the comments section below.