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Epidurals are the most popular form of pain relief requested by mothers during the labor process. It also the most easily recognized style of pain relief, as most people do not realize there are other types of pain relief.
They will ask for the epidural by name and as a result, more than half of all labors that occur in the United States feature epidural use. As you begin your preparations for delivery, it is important that you inform yourself about what an epidural is, how it works, and the misconceptions that exist about this method, as well as the benefits and risks.
So what is an epidural and how does it work?
An epidural is actually a term that refers to a type of anesthesia. This anesthesia is regional, meaning it helps to block the pain in the area it is felt. Typical anesthesia will lead to total lack of feeling, so the aim with an epidural is simply to ease the pain in a specific area, also known as analgesia.
The epidural is then inserted into your back, and helps block the pain signals from your lower body. This is similar to lidocaine or other local anesthetics that you might be familiar with, as lidocaine is what is used during dental procedures. The epidural is normally combined with other pain medications such as fentanyl. This combination helps lower the dosage for the epidural itself, and can help soothe the nerves of an anxious mother.
How is it administered?
Receiving an epidural is actually a multi-step process. As the medicine needs to be injected in the space in-between your spinal fluid and your vertebrae, hydration is key! Without hydration, it becomes more difficult to insert the medication. Because of this, the medical team will start you on intravenous (IV) fluids as your labor is starting. Afterwards, an anesthesiologist, a nurse-anesthetist, or your obstetrician will visit you. This is who can administer your epidural. In order to increase the effectiveness of your epidural and decrease any complications, your epidural provider will ask you to arch your back as far as you can, while either lying on your left side or sitting up. This position presents the best positioning of your spine to receive the epidural.
After wiping your back with an antiseptic solution to minimize infection, they will then administer a small amount of local anesthesia to numb the area of your back where the epidural is needed. After that, they will then insert a larger needle into the space between your spinal cord and your spinal column and a thin catheter tube will be slid into the epidural space through the needle so when the needle is removed, the catheter remains. This is where the medicine will be injected, and can be periodic as needed, or a continuous stream of medicine. To ensure that the catheter will not slip, it is then taped to your back and you are done! The epidural typically takes around 15 minutes to kick in, but can last for hours after that, especially when the medicine is continuous.
Misconceptions about Epidurals
All epidurals are the same: Many misconceptions surround the use of an epidural during labor. Part of this comes from the fact that in popular culture “epidural” has come to stand for all pain relief given during pregnancy. Even some doctors are guilty of using it as a general term for labor pain relief. Therefore, many people do not actually understand that an epidural is a specific procedure done with specific results in mind. “Epidural” refers to the procedure mentioned above, with the catheter placed in between the spinal column and the spinal cord. The other type of pain relief that is often used under the “epidural” name is in fact referred to as the CSE, or Combination Spinal Epidural. This is also known as a “walking epidural”. This method is inserted directly into your spinal cord and includes the anesthetic and the narcotic medication combined. With this other style, you can ask for more pain relief if needed, and allows for greater mobility than a typical epidural. However, this method can decrease muscle strength and reaction time.
You can move with a CSE: Another misconception that exists is that the “walking epidural” allows the ability to actually walk while receiving the medication. However, this is not true, as once the epidural is administered, you will be attached to fetal monitors and other pieces of equipment. In addition, you will experience muscle weakness from the narcotic that is mixed in, and most doctors will tell you to be less active.
Receiving an epidural is painful: Many people fear receiving an epidural as they have heard that the needle used for it is huge and creates a lot of pain. However, the needle is actually relatively small, and often time cannot be felt once the local anesthetic has been administered. The most pain felt by the majority of patients is pressure along their spine.
An epidural makes pushing more difficult: While this can be true for the higher dosage typical epidural, it is not true for the CSE. The higher dose epidural can cause numbness in the lower half of the body which can make it difficult for your body to know when it needs to push and how hard you are pushing. With the CSE, because it is a lower dosage, pushing is not hindered too much, other than by the muscle weakness caused by the combination narcotic.
The benefits for an epidural are as follows:
-If receiving a C-Section, an epidural will allow you to stay awake and alert during the delivery, which will enable you to be more “present” for the birth.
-By reducing the pain many women can experience a more positive birth, and it can help lower the anxiety of the mother.
-If labor is prolonged, the epidural can allow the mother to relax for a little bit.
Just as there are several benefits to using an epidural there are also a few concerns as well.
-Because it is hard to test, it is not entirely clear how much of the epidural medication reaches your child. The child will receive some of the medication, but the dosage is unclear.
-Epidurals can lead to lower blood pressure in some women, cause fevers or nausea.
-As mentioned a higher dose epidural might make pushing difficult.
-In rare cases, you can develop a “spinal headache” which is caused by leaking spinal fluid. This can be dangerous.
Epidurals are becoming synonymous with “birth”. As more than half of all women in the United States choose an epidural to help manage their labor pain, it is important to educate yourself on the different types of epidural, and the benefits and risks of the procedure.