Everything You Need to Know About Epidural Anesthesia

Epidural Anesthesia

Epidural anesthesia is the most popular method of pain relief during labor. More than 50% of women who give birth at hospital request it. Let’s review what an epidural is, how and when you can receive one, and their pros and cons.

What is an epidural?

An epidural (sometimes called an epidural block or epidural anesthesia) is a method that blocks pain in the lower half of your body while allowing you to remain fully conscious. The medications used in an epidural are local anesthetics. They are often delivered in combination with opioids or narcotics in order to decrease the required dose of local anesthetic.

Before an epidural, and even before active labor begins, you may receive intravenous fluids. You will be asked to arch your back and remain still while lying on your left side or sitting up. This position is vital for preventing problems and increasing the epidural effectiveness.

An antiseptic solution will be used to wipe the waistline area of your mid-back to minimize the chance of infection. A small area in your back will be injected with a local anesthetic to numb it. A needle is then inserted into the numbed area surrounding the spinal cord in the lower back. Some women describe it as feeling some discomfort in the numbed area and pressure as the small tube or catheter was placed.

Then, your anesthesiologist (specialist in administering anesthesia) or nurse-anesthetist will inject the drugs around the nerves that carry pain signals from your womb (uterus) and cervix to your brain during labor. A catheter – a very thin, flexible, hollow tube – is used to deliver the medication either through periodic injections or by continuous infusion.

A low-dose epidural should allow you to retain some sensation in your legs and feet. You should have enough strength in your legs to move around in bed and change position when you want.

Are epidurals only available in hospitals?

Yes. You can only have an epidural in a hospital’s obstetrician-led maternity unit. In general, you can’t have an epidural at a birth center, or if you have a home birth. However, there may be exceptions and you should consult with your health care provider.

At what stage of labor should I have an epidural?

You can usually have an epidural at any point, even if you are not yet in labor. If you arrive at the hospital before you’re in active labor and you know you’re going to want an epidural, you can ask the anesthesiologist to place the catheter as soon as you’re settled in your bed. Then you can wait to start the medication when your labor becomes active.

Most women want an epidural when their contractions are getting strong, often when their cervix has dilated to about 4 to 5 centimeters. Your obstetrician or midwife may advise against an epidural once you’ve reached the pushing stage, but it will depend on how your labor is progressing.

You may be offered an epidural if your labor is sped up with an oxytocin drip. Oxytocin makes your cervix dilate and your contractions intensify. You may need extra pain relief because oxytocin can make your contractions harder to cope with.

Once your epidural is in place, it can stay in until after your baby is born and your placenta is delivered. An epidural may be especially welcome in the unlikely event that the placenta is retained and your doctor needs to remove it by hand.

An epidural can also provide pain relief after the birth if you need stitches.

What are the advantages of having an epidural?

The website americanpregnancy.org summarizes the benefits of epidural anesthesia as follows:

  • Allows you to rest if your labor is prolonged.
  • By reducing the discomfort of childbirth, some women have a more positive birth experience.
  • Normally, an epidural will allow you to remain alert and be an active participant in your birth.
  • If you deliver by cesarean, an epidural anesthesia will allow you to stay awake and also provide effective pain relief during recovery.
  • When other types of coping mechanisms are no longer helping, an epidural can help you deal with exhaustion, irritability, and fatigue. An epidural can allow you to rest, relax, get focused, and give you the strength to move forward as an active participant in your birth experience.
  • The use of epidural anesthesia during childbirth is continually being refined, and much of its success depends on the skill with which it is administered.

What are the disadvantages of having an epidural?

  • For about one woman in eight, an epidural doesn’t work properly and only numbs parts of her tummy. In this case, you will need extra pain relief. If you’re not pain-free within half an hour of the epidural starting, ask for the health care provider to come back to adjust it or try again.
  • Although an epidural delivers pain relief quickly once it’s working, the whole process can take up to about 40 minutes to take full effect. This is longer than most other types of pain relief.
  • You may experience shivering, ringing of the ears, backache, soreness where the needle is inserted, nausea, or difficulty urinating.
  • You may feel a bit itchy, particularly if you have a combined spinal epidural.
  • After your epidural is placed, you will need to alternate sides while lying in bed and have continuous monitoring for changes in fetal heart rate. Lying in one position can sometimes cause labor to slow down or stop.
  • Epidurals may cause your blood pressure to suddenly drop. For this reason your blood pressure will be routinely checked to help ensure an adequate blood flow to your baby. If there is a sudden drop in blood pressure, you may need to be treated with IV fluids, medications, and oxygen.
  • You’re more likely to find pushing more difficult. Therefore, you may need your labor sped up with additional medications. There’s more chance of your baby needing to be born with the aid of forceps.
  • There is a small risk you may experience a severe headache, which can be treated relatively easily.
  • There’s a very small risk of nerve damage, leaving you with a numb patch on your leg or foot, pins and needles, or a weak leg. But this rarely happens. The risk is between one in 1,000 and one in 2,000 for temporary nerve damage and one in 24,000 for permanent damage.

How can an epidural affect my baby?

The most recent studies suggest that an epidural does not have a negative effect on a newborn (as measured by his Apgar score, an evaluation routinely done immediately following birth). In fact, some studies show that babies whose moms had epidurals had better Apgar scores than babies whose moms had prolonged labors without the relief of an epidural.

Whether or not an epidural affects a baby’s ability to breastfeed immediately following birth remains controversial. Some experts suggest that the baby may have trouble latching on if the mother had an epidural. Others believe there are no good studies on which to base this conclusion.

In what cases I should NOT use an epidural?

Epidurals should not be used if:

  • You use blood thinners
  • Have low platelet counts
  • Are hemorrhaging or in shock
  • Have an infection in the back
  • Have a blood infection
  • If you are less than 4 centimeters dilated
  • Epidural space cannot be located by your doctor
  • If labor is moving too fast and there is not enough time to administer the drug
Diego Wyszynski
Dr. Diego Wyszynski is the Founder and CEO of Pregistry. He is an expert on the effects of medications and vaccines in pregnancy and lactation and an accomplished writer, having published 3 books with Oxford University Press and more than 70 articles in medical journals. In 2017, he was selected a TEDMED Research Scholar. Diego attended the University of Buenos Aires School of Medicine and Johns Hopkins School of Public Health.

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