A painless birth? Could it be? It's possible with the help of an epidural. But is it really all it's cracked up to be?
For some moms, the answer is, without question, YES! The epidural has a strong fan base. I had a friend greet the security guard in the emergency room when she first entered the hospital, begging him for an epidural. It's good stuff!
Epidural anesthesia is medication placed, via a catheter, directly into the epidural space of the spine. The small tube (catheter) remains in place throughout the labor and delivery, continuously administering medication to keep the pain at a comfortable level. In general, it numbs the mom-to-be from the waist down to her toes.
They aren't a one-size-fits-all situation, however. Epidurals come in many shades of numbness. The more anesthesia used, the less it's felt in the lower half of the body. Lower dosages can greatly reduce pain, but maintain some feeling, which many moms find helpful, especially when it's time to push. How much medication depends on many factors, including how sensitive a person is to the medication. But don't sign up just yet.
While a pain-free labor sounds like a no-brainer, there are risk factors to be aware of before signing up during the first prenatal appointment. These aren't meant to scare anyone, but rather to arm readers with questions for them to discuss with their healthcare provider. The more we know, the more informed of a decision we can make when it's close to push time!
14 The Numbness Can Get More Intense
Often, when an epidural is administered early in labor, an anesthesiologist will use as little anesthesia as possible to keep you comfortable. Theoretically your pain isn't as intense as it will become, so there's no need to hit it hard yet.
As your labor and delivery, your pain will grow, requiring more medication to keep you as comfortable as possible. Once the doctor ups the dose, you may go from being able to move your legs to having numb tree trunks, totally out of your control.
For some, this sounds blissful. I've literally read stories of women almost sleeping through their birth because their epidural worked THAT well. No pain, total relaxation, voila, a baby!
For others, this feeling of immobility isn't pleasant. If you experience total numbness, you won't be permitted to leave the bed because you won't be able to walk. If the thought of that makes you feel panicky, talk to your doctor about it.
13 It Can Lose Effectiveness During Birth
There are a few contributing factors when it comes to diminishing pain relief. First, there's a limit to the amount of medication you can have. If your pain exceeds that dosage, you're stuck with the leftover.
We often hear stories of moms trying to wait as long as possible to get their epidural. "Why wouldn't you get one the minute you feel that first real contraction?" is a common question. Because if your labor lasts longer than your epidural options, you're out of luck. If you've had all the medication your body can tolerate in a given amount of time, they shut it off, even if it's the very end.
Second, there's a matter of placement. Sometimes, during the course of your labor, the catheter delivering the medication can shift and affect the amount of the drug hitting the pain. That can lead to one-sided relief where one literal side of your body will be numb while the other feels no relief.
Last, tolerance levels, in general, are different. Bluntly put, it just may not work for you.
12 Epidural Can Cause A Wicked Headache
Have you ever heard the term, "spinal headache?" While it is a rare complication, puncturing the epidural space can cause a small amount of spinal fluid drain out, which causes a severe headache. The pain is caused by a fluid pressure change in your brain and spinal cord.
While I've never had one, I've heard these headaches described as a migraine multiplied by a million and their worse while sitting upright. A friend experienced this complication and she said the pain in her head distracted her from what was happening with the rest of her body. Yikes!
Oddly, there can be a delay in symptoms for up to five days, leaving you with this pain while trying to care for a newborn. Fortunately, a spinal headache can be treated with hydration to restore the lost fluid and a second procedure called a blood patch, which seals the puncture with your own blood.
11 Can Cause A Dramatic Drop In Blood Pressure
Like the spinal headache, a dramatic drop in blood pressure this is a rare complication, though very serious. In fact, it's life-threatening.
A consistent blood pressure keeps the necessary blood flowing to throughout your body to keep the whole system going. When you're in labor and your body is stressed, this blood flow is even more important because it's supporting your wee one.
When there's a sudden and severe drop in blood pressure, immediate medical attention is critical. That's one reason close and frequent monitoring is necessary while you've got an epidural in. Should your blood pressure tank, you can be treated very quickly.
Symptoms of a sudden and severe blood pressure drop in nausea, dizziness, fainting, and blurred vision. While nausea can be a common symptom during labor and delivery, it's best to know your medical care provider so he or she can decide if it's a medical emergency.
10 Some Women Experience Intense Itching Or Other Allergic Reactions
Just like any other drug, the anesthesia used can cause an allergic reaction. One common reaction is intense itching, often on your face.
If you're one of the lucky ones who experiences these unpleasant symptom, you're in luck. It's often temporary and occurs just after the epidural is administered and it can be treated if it doesn't subside quickly. .
To best prepare, make sure to bring a list of medication you know you're allergic to when visiting your OB/GYN or midwife before giving birth, note those drugs on your hospital admission forms, share the list with the admitting nurse, and tell everyone who is on your medical care team.
That way, by the time your anesthesiologist gets to you, he or she can make informed decisions about whether or not you're a good candidate, and which and how much of the drug to use.
Even if you have no known allergies but feel "off " after receiving an epidural, tell your healthcare provider, no matter how small you think the symptoms are. They're trained to recognize a true allergic reaction versus a side effect.
9 Some Women Get The Chills
While the cause is unknown, moms sometimes experience a fever after the administration of an epidural. Some theories suggest that labor, itself, puts such strain on your body that you sweat less, thus making it more difficult to maintain a normal body temperature.
Another cause of a fever is, of course, an infection. An infection during labor and delivery is serious as it could impact your overall health and the well-being of your baby. So should your teeth start chattering, it's important to let your medical care provider know immediately.
Here's to hoping it's nothing a gloriously warmed blanket can't solve. They keep hospitals the temperature of a produce room at Costco, basically a refrigerator!
If you are running a fever, your medical care team will decide how best to determine the cause and a course of treatment. Sometimes it's as simple as upping your hydration. Other times more intervention is necessary.
8 It Can Cause Labor To Stall Or Stop
As I mentioned before, there are different levels of numbness when it comes to epidurals. If your anesthesiologist gives you a light or "walking" epidural, you may be able to get up, out of bed, and give gravity a chance to get your labor moving along. The weight of the baby coupled with the force of contractions bearing down on your cervix and do wonders for dilation and effacement.
If you receive an epidural that provides a substantial amount of numbing, you'll be a bit stuck. Not just in bed, but in a limited number of positions.
The loss of control of your legs might be a bigger deal than you're imagining. If you can't proficiently use a bedpan, you'll have a catheter. Your vitals will be monitored frequently and you might spend quite a bit of time on your back. While you'll likely be quite comfortable, this position doesn't encourage progress.
On one hand, an epidural can help your muscles relax and get a baby to move down. On the other, it sometimes causes contractions can get less intense or stall altogether.
7 Induction Is Likely With An Epidural
If you're trying to avoid pitocin, be vocal about it. Otherwise, you're likely to be exposed to this labor-inducing drug.
Sometimes it's necessary. If the baby is showing signs of distress, your water has been ruptured for a prolonged period of time, or your labor is stalling are a few examples of why administering pitocin is used.
Sometimes pitocin is a choice made to speed up labor. And, let's be honest, if you're not feeling any pain, why not crank it up and get it over with? However, if you were hoping to have as few interventions as possible, then make sure you're vocal about it.
An epidural comes with a requirement to have an IV in at all times. If you're drowsy or otherwise less attentive than usual you may not remember a nurse asking about it or a doctor giving an order for it. That's why it's important to discuss your birth plan with your medical provider and anyone caring for you during your hospital stay.
6 Some Women Vomit From The Medicines
Vomiting is seriously unpleasant, but it's part of the game for many moms. You shouldn't freak out over this one. I'm mentioning it just because the more you know, the better you'll be able to prepare.
An epidural can cause nausea and vomiting. Newsflash, so does labor, in general. What am I saying? You might puke either way. The difference is your ability to handle the upchuck should you have little warning that the system is reversing.
If you're able to move around, you'll, at least be able to vomit in a receptacle, whether that be a toilet, trash can, or other container. If you're in bed because you can't walk, or worse, you're laying down, you might end up with a mess. If you do get an epidural, consider keeping a puke bucket within arm's reach.
If you're feeling exceptionally nauseated, let your nurse, doctor, or midwife know. They may have remedies to offer you to ease your queasy symptoms.
5 They Require Frequent Flipping And Monitoring
An epidural is flowing medication over the course of several hours. Because of that, you'll require frequent monitoring and constant fetal monitoring. If being hooked up to an IV, fetal straps (for heart rate monitoring), and frequent blood pressure checks, maybe reconsider whether an epidural is a good choice for you.
Let's be real. Some moms have super fast labors, but the rest of us typically take the better part of a day. If you get an epidural, there's a nice chance you can put some earbuds in with soothing music and drift off for a few hours, blissfully unaware of what's happening in the lower half of your body.
Other moms, however, don't like to be tied up. They like to move during labor and not be limited in by an IV pole or straps. If you're that second type of mom, all of the monitoring that comes along with an epidural might get on your nerves.
4 Epidurals Can Cause Ineffective Pushing
Remember that numbness I keep mentioning? If you keep that epidural flowing through pushing and delivery, it might take you longer than if you turn it down or off completely. Why? Because you quite literally can't feel what's going on down there.
Effective pushing can be tricky, even if you can feel everything. In many moms' experiences, you push more like you're having a bowel movement than like you're trying to push something out of your vagina. Weird, I know, but it's true.
Pushing starts at the beginning of a contraction, and remains constant for the duration of that contraction. Typically there's someone there counting for you or reminding you to hold it. It can be annoying, but there's a lot going on and having someone else keep score makes things easier.
Now imagine all of this is going on and you can't feel anything. Not when a contraction begins, if there's pressure, or if you're pushing in the general area or down there. That epidural can cause a prolonged pushing phase simply because you're not typically as effective as if you can feel everything.
3 Additional Interventions May Still Be Necessary
While this isn't the case with everyone, an epidural can cause labor to be longer. Which, let's be honest, is hard on a baby. While they're meant to be squeeze through your nether regions, each contraction probably feels like more than a big bear hug.
Prolonged labors can put stress on the baby. Stressed babies can start showing signs that they need to be born sooner, rather than later. When that happens things kick into high gear and interventions may be necessary. If you're close to delivering, your doctor or midwife might just dial up the motivational speeches. If things are serious, there are other options.
Forceps and a vacuum-assisted delivery are the most common types of intervention to expedite the delivery of the baby. If the baby's condition is serious enough or those methods are not necessary, a Cesarean section surgery will be performed. Women who receive an epidural are more likely to have an assisted birth.
2 Epidurals Can Take Their Time To Wear Off
When you have a baby without medication, there are some things about the process that wear off immediately after the baby has left the building. The same sometimes happens when you have an epidural and it's turned off. Other times, not so much.
While effects from the epidural anesthesia should wear off in a few hours or less, they can stick around longer than anticipated. That could be beneficial as you may require some stitching or other medical procedures after your baby is born. Pain relief during that time might be just what the doctor ordered. Also, your uterus won't stop contracting immediately, causing continued pain. That's especially true if you breastfeed.
If your body takes longer than usual to regain feeling, it might be frustrating. You'll be confined to bed as you won't be able to walk. Even when the feeling starts coming back, you'll require assistance getting around.
1 Some Women Aren't Good Candidates For Epidurals
No matter how much you'd like the sweet and blissful pain relief of an epidural, you may not be a good candidate. There are several medical conditions that prohibit an epidural procedure, or, at very least, require a serious conversation with your doctor and the anesthesiologist or would perform it.
The following types of patients need to take extra caution. Women who:
- are on blood thinners
- have a blood infection
- have a skin infection near or directly on the puncture site
- have low blood pressure
- have bleeding disorders
- have had previous allergic reactions to anesthesia medication
An epidural can make a laboring mom's experience much more comfortable than handling the pain without pain-relieving medication. While we've listed many complications, the majority of moms have none or very minor issues.
Deciding whether or not to receive one is highly personal. It's one you'll want to research and talk over with your healthcare provider. Get as much information as possible, then make the decision that's right for you. I leave you with just one word or caution. Prepare.
When you go to childbirthing class, pay attention during the session when they talk about coping mechanism for pain relief. Usually that includes breathing techniques, stretching, and position options. If for any reason you can not receive an epidural or it's not effective, you'll wished you had prepared.