Should I Get an Epidural?
One of the most common concerns women ask about during labour is pain. As a labour & delivery nurse, I routinely get asked about how long the pain will last, whether my patient’s contractions are going to get worse, and if so, how will they be able to handle the pain. These conversations often transition to the topic of pain relief, and at some point, I get asked about getting an epidural. For many women, the fear of pain in labour is exacerbated when they think about the epidural procedure, how it’s performed, and the perceived risks associated with it. For women who have not had the chance to understand the procedure, this can be a very stressful time.
These feelings and concerns are totally understandable. In fact, If I didn’t know what an epidural procedure entailed, I’d be afraid too. The aim of this post is to educate women about epidurals so that when they are presented with the choice about whether to get one, they are informed about what they are getting into.
Disclaimer: This post is meant for informational purposes only and should not replace information or medical advice provided by your primary health provider or healthcare team in hospital.
What is an epidural?
The epidural is a medical procedure performed by the anesthesiologist (a medical doctor specializing in administering medication in order to reduce sensation and pain) and assisted by a nurse. It involves inserting a small flexible tube (similar to an IV) into the epidural space in your lower back which will deliver medication to you for the remainder of your labour and delivery.
The picture shows how a woman is positioned for her epidural insertion
A step-by-step of the epidural procedure:
The anesthesiologist will arrive in your labour room and discuss the risks and benefits prior to the procedure. You will need to provide verbal consent to proceed.
If you decide to go ahead with the procedure, you and anyone in the room will be required to wear a special hat and mask to help maintain a sterile environment
You will be placed in a sitting position for the duration of the procedure which typically takes 15 – 30 minutes. Your nurse and anesthesiologist will coach you throughout and instruct you on when you will need to remain still.
The anesthesiologist will use a small needle to administer local anesthetic to freeze the skin on your back prior to starting, and then another needle to find the epidural space. They will then remove the needle – so nothing sharp is left in your back, leaving only a small plastic tube behind where the medication travels through. The “freezing” medication is often the part many women say hurts; however, it generally pales in comparison to contraction pain
After the epidural has been inserted the nurses will instruct you on how the epidural pump works and frequently check if the epidural is working
What does the epidural feel like?
After the epidural is in, it is normal to experience reduced sensation of pain and temperature from you belly button down to your toes. Some women describe it as pins & needles in their legs. You will still be able to feel touch and experience sensation of pressure, or tightening during contractions. Many women lose some level of control to the muscles of their lower body. You will likely have reduced ability to get up and move around due to numbness in your legs, and you will likely be in bed for the rest of your labour.
Some common side effects women experience are itching, lightheadedness (due to drop in blood pressure), nausea/vomiting, shaky/shivering, fever and tired/sleepy. It’s important to note that some of these side effects also occur in labour regardless. So, it’s difficult to determine whether the epidural is the cause. If you experience any of these side effects, the nurses and anesthesiologists may give you medication for relief. Epidural aren’t perfect so if you find yourself still in pain after the procedure then the nurses and anesthesiologist will troubleshoot the situation. This may involve, adjusting the dosage of the medication or providing additional medication to achieve a higher level of comfort.
What are the benefits of getting an epidural?
With an epidural you have the possibility of complete contraction pain relief. You will feel more relaxed and you may have the ability to sleep and rest for a portion of your labour. Most women will still feel the urge to push when it’s time to deliver the baby, and are coached on how to do so with an epidural (Blog: Push It Real Good; how to push with an epidural). In case there’s vaginal tearing during the birth, the epidural continues to provide pain relief while the doctors perform suturing (stitching).
What are the risks in getting an epidural?
The most common risks discussed are bleeding, infection, headache and nerve damage. Many women are concerned about the risk of paralysis associated with an epidural. This risk is extremely low and after witnessing over a thousand epidurals, I personally have never seen it. There is the possibility of nerve damage but this is not permanent and also uncommon. Another concern is back pain from the epidural. This is a myth; epidurals do not cause back pain. There can be some bruising and swelling at the skin where the epidural is inserted but this heals in a few days. Any long-term back pain has more to do with the weight of being pregnant and the need to strengthen back muscles postpartum. The risks of injury will be covered with your anesthesiologist at the time of epidural request.
One important thing to consider is that when you are requesting an epidural you will likely be having painful contractions. Often women are in so much pain that they are not in the right mental space to fully process the implications of the procedure. This is why educating yourself before labour is extremely important. You may not have a clear mind to think about this with painful contractions occurring frequently.
When is the right time to get an epidural?
On one hand, you don’t want it too early because you will be in bed for many hours without the ability to walk or move much. However, you also don’t want to wait too long where you aren’t sure if you’ll be able to sit for the procedure. Don’t wait until you can’t handle another contraction as you need to sit still for the epidural procedure and the medication takes time to work. In some cases, you may need to wait until an anesthesiologist is available.
Unfortunately, there is no “right answer”. You’ll need to decide if it is the right time for you. Your ability to cope during your labour experience so far should help guide your decision-making process. You can also get the advice of your nurse and healthcare team to guide your decision.
What if I have a contraction during the procedure?
Most women will have at least one contraction during the epidural procedure. Your nurse and anesthesiologist will coach you on breathing and assist you in staying still so that the procedure can carry on safely.
Is an epidural safe for baby?
One of its biggest advantages with respect to safety is that very little medication crosses the placental barrier. This means that compared to other methods of pain relief, very little epidural medication is getting into your baby’s bloodstream. This is why the epidural is the gold standard for pain relief during labour compared to other medicated options for pain relief in hospital.
When will I start feeling pain after birth?
The epidural pump administering the medication will be turned off after delivery by your nurse. You can expect to regain sensation and strength in your legs 1-2 hours after the pump is turned off. The sensation of pain during postpartum varies from women to women. You will be offered other medications to help with this pain.
Here are a few other things to keep in mind when you are considering an epidural:
Communicate openly with your nurse and doctors about your needs. Your nurse will be the one to organize this procedure with an anesthesiologist.
Prior to the start of the epidural procedure you will receive an IV to keep you hydrated.
With an epidural woman often lose the ability to safely get up to pee. Your nurse will offer you a small tube called a catheter to drain your bladder when it gets full. This can seem scary and painful but the epidural numbs that area so that you don’t feel pain with the tube being inserted.
In summary, the epidural is the most common and arguably the most effective way to relieve pain in labour. However, please remember that like everything in pregnancy, epidurals work differently for everyone, and can be different from pregnancy to pregnancy.