It’s always good to know lots of comfort techniques for labor, like I teach in my Bradley Method classes. Using positions, relaxation techniques, resting, using the bath or shower, and continuing to eat and drink will help your body progress during labor. Even if you have not chosen to have a natural unmedicated birth and plan to get an epidural, you will need to know how to cope with your labor contractions until it’s time to have the epidural administered. As with any medical procedure, it is very important to know the risks as well as the benefits of having an epidural during labor. Below are the most commonly asked questions and answers regarding using an epidural during labor.
1. WHAT IS AN EPIDURAL?
An epidural is a procedure during which an anesthetic (a medication that provides pain relief) is provided through a catheter (a flexible tube) and injected into the Dura (the dense connective tissue surrounding the spinal cord and the brain). The epidural is provided during labor and birth to provide pain relief from contractions and allows the laboring mother to rest. The epidural medication blocks nerve impulses.
2. ARE EPIDURALS SAFE?
- Studies have shown that epidurals are generally safe for both mother and baby. But as with any medical procedure, there are risks and benefits. Epidural medications used are local anesthetics.
- The medication in an epidural may be bupivacaine, chloroprocaine, or lidocaine. They are used together with opioids or narcotics.
- The type of opioids used are fentanyl and sufentanil. The narcotics help to decrease the required dose of the local anesthetic.
Side effects of narcotics for the mother are:
- Decreased gastric motility
- Loss of protective airway reflexes
- Hypoxia due to respiratory depression
Side effects for the baby are:
- Central nervous system depression
- Respiratory depression
- Impaired early breastfeeding
- Altered neurological behavior
- Decreased ability to regulate body temperature
- In order to prolong the epidural’s effect or to stabilize the mother’s blood pressure, epinephrine, fentanyl, morphine, or clonidine may also be used by the anesthesiologist.
3. WHAT ARE THE SIDE EFFECTS OF EPIDURALS?
- Pain relief
- Allows mother to rest
- Continuous fetal monitoring
- Low blood pressure
- Shivering or Shakiness
- Problems urinating ( urinary catheter is placed)
- Numbness or tingling in the legs
- Severe headaches
- Back pain long term
- The need for instrumental delivery – vacuum or forceps
4. WHEN CAN I GET AN EPIDURAL?
Studies have shown that it is best to wait until you are 5-6 cm dilated.
Getting an epidural at 2 cm-4cm can increase your risks of an unplanned Cesarean.
5. HOW IS AN EPIDURAL GIVEN?
- You will sit on the edge of the bed and curl forward, around your baby, with a rounded back. It may help to hug a pillow.
- You will feel a cold and wet substance on your back as it is cleaned and disinfected.
You’ll feel a pinching sensation and a slight burning sensation as the doctor applies a local anesthetic to numb the area where the needle and catheter will be placed.
- As the needle is placed into the numbed area on your back you will feel a slight pressure. It is important that you stay very still and DO NOT MOVE.
- A thin catheter (or flexible tube) is place through the needle into your back.
- The needle is removed and the catheter is taped on to your back to keep it in place.
6. HOW LONG DOES IT TAKE FOR THE EPIDURAL TO START WORKING?
- In about 10-20 minutes, the epidural should take effect.
- In a small percentage (15%) of women, the epidural may be ineffective. It may numb the legs but you’ll have full sensation of the contractions. Some women get “spotting” which is numbness in part of the abdomen and full feeling in spots in the abdomen.
- You should begin to feel numb from your navel down to your toes.
- You will probably feel pressure from the contractions and the baby descending but most women feel pain relief.
7. HOW LONG DOES THE EPIDURAL LAST AFTER DELIVERY?
It can take up to a couple of hours for the medication to wear off.
But with help from the nursing staff you will be able to breastfeed your baby within an hour after the birth.