Medical Pain Management Series: Epidurals

February 20, 2022
by Alex Barr
Medical Pain Management Series: Epidurals

Epidurals

CW: description of medical procedure.

In this series we are talking about the different types of medical pain management that are available in birth.

What is it:

This is when a catheter is placed in your lower back in an area right beneath where the spinal cord ends. An epidural can cause some loss of feeling and numbness in the lower part of your body, but the person who’s in labor remains fully awake and alert.

Benefits: 

An epidural can bring down labor pain an average of 3 1/2 points. (0 to 10 scale)
Epidurals are safer for babies than IV pain medication.
If a birthing person is exhausted or needs to rest an epidural can help accomplish that.
The most common form of medical pain management.
An epidural can allow you to be awake during an emergency cesarean

Risks: 

Epidurals increase the risk of vacuum and forceps delivery.
They increase the likelihood of perineal tears.
You’re more likely to experience low blood pressure, which can make you feel lightheaded or nauseous, and may require additional IV fluids or medications to manage.
Low blood pressure can also compromise the baby’s oxygen.
Less common side effects: infection, spinal headaches, nerve damage.

Steps

IV placed, and typically IV fluids are administered

They will confirm you are in labor

Meet with the anesthesiologist

Blood pressure cuff will be placed on your arm and go off periodically

Heart rate monitor for baby 

Monitor for your contractions

The anesthesiologist will go over the risks and have you sign a consent form

They will get you in position for placement (sitting, slouched, rounded shoulders)

Disinfect the area on your back 

A numbing agent will be administered through a syringe

(they may have to work through your contractions, ask for help from your support person or nurse so you have someone to steady yourself on)

It’s important to stay still!

The anesthesiologist will insert a needle and a tiny tube, called a catheter, in the lower part of your back. 

The needle is removed and the catheter left in place for delivery of the medication through the tube as needed

5-10 minutes for warm and heavy legs

15-20 minutes for less painful contractions

Sometimes it will be up to an hour to feel relief

Sometimes epidurals don’t work the first time! (But typically can be redone/fixed!) 

You won’t be able to eat after an epidural only ice, water, clear liquids

You’ll receive a bladder catheter since you aren’t able to get out of bed

If your provider wants to monitor your baby or contractions more closely they may ask to switch to internal monitors


Tips and tricks

Wait until active labor if possible (5-6cm). 

Rest as much as possible while you have it. 

Get help to move positions every 30 minutes. 

A peanut ball can help you achieve different positions to help move baby down.

You can ask for your epidural to be turned off or lowered. (whenever you feel like it or when you're close to pushing)