Epidurals. How do you know you don't want one?
Let’s talk about epidurals…
Do you want one during your labour? Do you want to avoid one at all costs? Have you even thought about it?
A good starting point for this conversation to have with yourself is: What do I know about epidurals? This can help you have a good think about what you may or may not want. However, It is important to have the facts. I would never want a woman to chose to have or not to have any medical treatment without first empowering herself with knowledge to support her decision.
It’s also a good idea to learn about epidurals even if you really don’t want one! Things can change rapidly in childbirth and there are sometimes reasons that your Dr. or Midwife even may suggest an epidural. The last thing anyone would ever want was to be forced to make a last minute decision without all the facts.
What is an epidural?
Without getting too medical, an epidural is a form a pain relief called regional anaesthesia. What that means is it works to dull the pain sensations in a cluster of nerves in one part of your body, not your whole body. In childbirth this part of your body is normally from the bottom of your rib cage down to your toes.
The big advantage to an epidural is most times it provides 100% pain relief! When they work great mom to be can rest and likely sleep through labour.
Two medications are used, an anesthetic and a narcotic. The combination of medications is used because together they make for better and longer relief from pain. Also using less anesthetic lets you still have the ability to move your legs and lower body. Although you can still move your legs they are often very weak, so you generally aren’t allowed to stand and are therefore confined to bed.
The medication is infused into a tube in your lower back. A needle is inserted in your lower back and this thin tube is then threaded through the needle, then the needle is removed. The tiny tube is taped in place so it holds tight and doesn’t budge. This tube is then hooked up to some sort of pump that either continually infuses medication or allows you to “dose yourself” when you feel like you need it, or both. The decision as to how that works is up to the Anesthetist, the doctor who inserts the epidural and manages your pain relief.
This whole procedure happens while you are either sitting up or lying on your side. Once inserted, you will usually be required to flip flop back and forth from side to side periodically to distribute the medication evenly. You can still technically lay on your back, but pregnancy makes that very uncomfortable and this has to potential to drop your blood pressure and make you feel pretty crummy. So usually you lay on one side or the other.
The medication doesn’t work right away! It can take 15-20 minutes to take full effect. It also lingers in the system for a bit. After your baby is born, the medication is stopped and the tube is removed from your back when any stitching that needs to be done is finished. The medication takes 1-3 hours to wear off fully.
In order to get an epidural, you need an IV to already be inserted. Some hospitals require that you have blood work drawn to check your blood clotting levels to prevent any possible complications with removal. While you have an epidural infusing you will have your vitals signs (blood pressure, pulse and temperature) taken very regularly. You will also have to have continuous monitoring of your baby’s heart rate and your contraction pattern. You will need to have a urinary catheter placed to drain your bladder since the nerves that tell you when you need to pee will be affected by the medication. A full bladder can also get in the way of baby’s head coming down.
Risks and Complications
There are several rare but documented risks to having an epidural. I don’t include these to scare any one. They are simply for informative purposes. Some of the risks include:
- A decrease in blood pressure, this can potentially decrease the amount of blood that perfuses the placenta (this can often be remedied with increasing mom’s IV fluids and re-positioning her body)
- 1:100,000 risk of paralysis, respiratory arrest, cardiac arrest, brain damage or death
- 1:50,000 risk of bleeding or infection around the spine
- 1:100 risk of headache (this is called an epidural headache and resolves after a few days with rest and sometimes medical out patient treatment)
- There’s also a risk that for whatever reason it may not work. Epidurals can be “patchy” or work better on one side or the other, sometimes this can be fixed and sometimes for unknown reasons it can’t. - Commonly epidural medications cause itchiness, dizziness, nausea and fever during labour.
- Epidurals can slow down or stall your labour. Since you are now confined to bed, you can no longer use gravity and upright positioning to continue to push your babies head firmly against your cervix.
- Epidurals can increase the use of medical intervention for birth (oxytocin augmentation to restart a stalled or speed up a labour that slowed down after the epidural).
- Anecdotally epidurals increase the rate of cesarean birth, however, I can not find any studies that confirm this scientifically.
- The amount of time it takes to “push your baby out” may be longer due to decreased sensations of the “urge to push”.
So knowing those risks (which are actually quite small) would anyone want one? Well the promise of 100% pain relief in labour is pretty enticing. There are actually some situations where a Dr. or Midwife might recommend you get an epidural! Yes, that’s right I said Midwife! In cases of really long labours, I mean really long (which doesn’t happen often) sometimes an epidural is suggested to help mom relax, get some relief form exhaustion and sleep. If a baby is not in the optimal position and that is making labour extra long or extra painful, sometimes an epidural is recommended for the same reasons. If mom has really high blood pressure it might be recommended or in the case of twin delivery it is often recommended in case there is a need to urgently deliver one or both babies.
So are you still undecided? If so that’s ok. If you’ve made up your mind now that’s ok too! Here are just a few more pieces of food for thought. Keep an open mind! Don’t set your decision in stone either way.
Prepare yourself for labour. Learn coping techniques to get you through early labour and active labour if you plan on avoiding pain medication so that you have lots of practice when they time comes. Take a natural pain management class to learn different techniques and methods.
If you decide you definitely absolutely must have an epidural, wait until you are 4cm dilated or more. This ensures that labour is well established and on it way and decreases the chance that having an epidural will prolong your labour and increase the need for medical interventions such as oxytocin augmentation and caesarean birth.
Lastly never feel guilty for your decision. When you are in the throws of labour your body produces an amazing amount of hormones and endorphins that make your mind a bit muddled. Some writers actually refer to it as “your mind going to labour land”. If an epidural is started, those hormones and endorphins aren’t needed, so it can sometimes feel like a cloud has been lifted. This clarity can sometimes make people misjudge their decision to choose medical pain relief. If you empower yourself with knowledge you can make a decision during your labour without trying to fight through the clouds and without that sense of guilt.
There you have it! The truth about epidurals. Now you can start to think about what may or may not be right for you.
Maggie Hilton RN
References used for this post include:
Liefer, G. (2007). Introductory to Maternity and Pediatric Nursing. Elsevier
Simpson, C. & Creehan, C. (2008) AWHONN’s Guide to Perinatal Nursing. Elsevier
American Society of Regional Anaesthesia & Pain Medicine (2016). Regional anaesthesia for surgery. Retrieved from https://www.asra.com/page/41/regional-anesthesia-for-surgery
Grand River Hospital (2011). Epidural information sheet.
Maggie Hilton RN, BScN, is a Registered Nurse with 6 years of experience in Childbirth Nursing and 4 years of experience as a Childbirth Educator in the Kitchener-Waterloo area. Maggie is a part time instructor at Conestoga College where she teaches maternity nursing courses to Nurses looking to further their careers in the maternal-child field. She has a great passion for childbirth education, especially in regards to pain management during labour. Maggie is the mother of two young children, one of whom was born at home and one of whom was born in hospital.