The bag is packed, Mom has her birth plan typed up and laminated and she's ready to meet the little human she's been growing inside of her for nine months. But what if things don’t go according to plan once you go into labor? Whether you and your doctor have planned for an epidural, spinal tap or medication, or you decide on it in the moment, it is important to be educated and prepared. I had to receive an epidural and spinal for both of my pregnancies out of medical necessity. I had had an emergency c-section with my first born. This wasn’t planned and not at all what I had in mind. Looking back, I realize that educating myself on what to expect should the occasion arise may have made for a better birth experience the first time around.
The most valuable lesson I learned when I was in the delivery room is something a nurse told me. She said the most important thing is not your birth plan. The most important thing is to have a healthy baby and healthy mama. After 12 hours of labor, my doctor and I decided throw out my birth plan to proceed with the epidural. Epidurals are quite popular. In fact, over 50% of women have used this method of pain relief while giving birth. Regardless of whether you choose and epidural or natural childbirth, it is a personal choice that should be made by you and you alone. After all, it’s your body! Don’t succumb to pressure to do it someone else’s way. It is, however, important to educate yourself on the options. Understandably, you may not know what questions to ask if it’s your first time. Here are 15 things you may not know about receiving an epidural, spinal tap and medication.
15 What's The Difference?
There is a difference between the epidural anesthesia and the spinal anesthesia procedure. According to WebMD, “Epidural anesthesia involves the insertion of a hollow needle and a small, flexible catheter into the space between the spinal column and outer membrane of the spinal cord (epidural space) in the middle or lower back.” Then the needle is inserted and removed after the catheter has passed through it. The catheter remains in place. The anesthesia goes into the catheter to numb the body above and below the point of injection as needed. The catheter stays in so it can be used again if more medicine is needed. “Spinal anesthesia is done in a similar way. But the anesthetic medicine is injected using a much smaller needle, directly into the cerebrospinal fluid that surrounds the spinal cord.” The anesthesia goes into the spinal canal without a catheter. You may not be able to move your legs until the anesthetic wears off.
14 Common Side Effects
A headache is the most common side effect of spinal anesthesia. Make sure you speak up and tell your doctor if you have a headache so you don’t suffer needlessly. Doctors should be able to treat it easily. Headaches are less common with epidural anesthesia than with the spinal. Nausea and vomiting can also be a side effect. The doctor should be able to give you something for the nausea as well. It is typically a very safe procedure, but the nurse and doctor will monitor you closely while you are receiving the anesthesia, as it can effect your vital functions, such as heartbeat, blood pressure and breathing. The most common side effect of epidural anesthesia is lowered blood pressure in the mother. You may also experience difficulty urinating or walking after delivery. Other side effects include shivering, itching, a ringing in the ears and soreness at the needle injection site.
13 It Can Help With Dilation
An epidural may allow your body to relax and help your cervix to dilate faster. I learned this first-hand from my doctor. My body was under so much tension and stress due to 12 hours of contractions, my cervix was not letting go and opening. For the natural birth mothers out there, it is so wonderful to be able to give birth naturally. For some of us, that is not what is best for the baby and the mother. When the mother is under stress, the baby is too. With such amazing advancements in medicine, mothers now have more options available. This means lower infant/mother mortality rates and fewer infections. While it may not be ideal for some, like myself, it can be life saving. Not to mention the pain factor! It was such a relief to be able to sleep after 12 hour of contractions. My doctor was right. After just one hour of having my epidural, my cervix began to dilate much faster.
12 Light Epidurals
You may have the option of getting a “light epidural,” or “walking epidural” (though they will probably not be letting you walk around). This is a procedure in which the anesthesiologist uses less medication, allowing for you to be more active during labor and feel enough to know when and how hard you are pushing. It will allow for you push more effectively, which is ideal during labor. This can also allow you to remain more alert and maintain a degree of comfort while experiencing contractions. One important thing to remember with a light epidural is that since the amount of medicine given is so small, the anesthesia will wear off during active labor if additional medicine is not given. This problem can be solved with an infusion pump, in which the medicine can be given continuously throughout the delivery. Using the infusion pump can also give you more control over your tummy and leg muscles and lessen the amount of potential side effects.
11 A Little Electric Shock
You might feel a little electric shock down one of your legs as the epidural is going in. This happens when the catheter touches nerves in the spine as it goes in. It feels a little weird but doesn’t last long. Since you are in the seated position and have to stay still during the procedure, it is important not to panic when you feel this little shock. I had a nurse holding my hands and talking me through the whole process. She explained that I may feel the shock and told me it was nothing to be alarmed over. When the shock came, I was still surprised even though I had been warned it could happen. It only lasted for a second and I started to feel the medication a few moments after the epidural was in. Once the contractions subsided, I relaxed and forgot all about the little shock.
10 It Can Slow Down Labor
In some cases, the epidural may slow down the labor process. It’s not really the epidural that slows it down, but the IV fluids they pump you full of to prep you for the procedure. Those fluids may dilute the hormones that cause contractions. This is why some women experience a slowing of contractions after the epidural is in. After a couple of hours, your body will have eliminated those extra IV fluids and the contractions pace should speed up. In some cases, the process is interrupted and the contractions don’t pick back up. If that happens, your doctor may prescribe the synthetic hormone Pitocin to pick up the pace. Pitocin is used to induce labor or strengthen contractions when the labor is not proceeding as it should. Another reason epidurals can slow labor is if they are given too early. If the mother is not in active labor and has an epidural, she won’t have the opportunity to use movement and gravity to her advantage in progressing the labor since you can’t walk or stand with an epidural.
9 The Medication Does Not Reach The Baby
Since the medication goes into your spinal cord and not your bloodstream. This is an obvious benefit over intravenous medications like morphine or Fentanyl. Those medications, though diluted in the mother’s system, do reach the baby. Intravenous medications can cause complications with the baby. Even though the baby doesn’t get the full dose, he or she can have difficulty breathing. This is why most doctors won’t give the mother these medications if she is within an hour or two of delivery. There is the risk that the baby will be too sleepy to want to breathe on her own. Doctors can counter that effect with a narcotic antagonist medication like the ones they use for drug overdoses, but who wants to go risk having their baby go through that? Especially if an epidural is an option. There is still a slight risk of the baby’s blood pressure dropping with the epidural since mom’s blood pressure may drop. That’s why mama and baby are closely monitored during the whole process.
8 Epidural Meds Can Make You Loopy
Many women have hilarious stories about things they said after getting the meds in their epidural. Who doesn’t love a good embarrassing labor story? When your body is under that much stress, etiquette and manners are the first things to go. Especially if medication is involved. One mother asked her doctor to marry her. Another mama asked her husband, “why can’t we just lay eggs?” Some of the women get a bit sassy under the influence of these medications. One woman grabbed her nurse and told her to switch places with her and then tell her how easy it is to push. Another mama-to-be shouted “bring me a man in here to kill! Any man I don’t care who!” If women were held accountable for everything they said in the delivery room, moms all over the world would be in big trouble. It does make for a few funny stories to tell the kids later!
7 Walking Is Not An Option
Since the lower half of your body is going to be numb, it’s not really possible for you to get up and walk to the bathroom. This means, if the labor is longer than four hours, you’re going to need a catheter in your bladder. Thankfully, they usually wait until after you’ve had the epidural so you don’t feel a thing. They will also ask you to lie on your side because lying on your back could constrict blood vessels and cause complications with the labor process. Since the numbing goes all the way up to your torso, you may need to have someone help you roll over onto your left side. That’s the best side for you be on to ensure all the hormones and blood flow remain unrestricted. The effects of the epidural meds wear off in about 1 to 2 hours. If you’re still in labor, they can give you more medicine. If you have delivered, you won’t be walking around until your catheter is out.
6 Epidurals Are Not For Every Mama
This type of pain intervention might not be an option for you under special circumstances. Women are not eligible candidates for epidurals and spinals if they use blood thinners, have low platelet counts, are hemorrhaging or in shock, have a blood infection, are in early labor – meaning less than 4 cm dilated, if doctor is having difficulty locating the epidural space, if labor is proceeding too fast and there is simply not enough time to get the injection done and the medication into the body before the baby comes. It is important to have a conversation with your doctor about the right pain management plan for you. There are important questions you can ask when talking with your doctor, such as, what combination of drugs will you be using? How active will I be able to be during labor? Will I be able to eat or drink anything? This important dialogue will help you and your doctor make the right decision and keep you on the right track to a positive birth experience.
5 Baby Might Have Trouble Breastfeeding
This is a controversial subject, because experts tend to disagree on whether or not the baby is affected by the epidural. After the baby is born, the doctor assesses the health of the baby with something called an Apgar Score. It’s a quick test to see if your baby is ready to be out in the world without medical assistance. Practitioners usually evaluate the baby within 5 minutes of being born. Apgar is an acronym for Activity, Pulse, Grimace, Appearance and Respiration. Here’s where it gets tricky. Having an epidural does not have a guaranteed impact on your baby’s ability to breastfeed or thrive after delivery. In fact, some studies show that babies whose moms had epidurals had higher Apgar scores than babies born after a prolonged labor in which the mother refused the epidural. It is harder to sit up and nurse in the proper position with a catheter in your bladder, so that could also be part of the cause of poor latching.
4 Spotty Pain Relief
Sometimes women experience spotty pain relief from their epidurals. Women’s bodies are different and what works for one mama might not work as well for another. In some instances, the medication may not reach all the nerves in the spine, leaving you with some pain. In other cases, the epidural catheter can drift a bit out of place, making it so the medication is not aimed at the specific nerves in the spine that target the belly and pelvic area. If the pain relief from the epidural was working fine in the beginning, but you are starting to experience pain after a while, that is a good time to notify your doctor. She may be able to adjust the medication or re-insert the catheter so it can do its job more effectively. Your doctor can monitor your pain level and decide if it’s a dosage issue or a catheter issue.
3 Ways To Avoid Epidurals
If you have read all the information and decided on a non-medicated birth, there are some things you can do to help you achieve that goal. Many women prefer a more active and natural pain relieving laboring process, such as hypnobirthing, acupuncture, the Bradley Method, or a water birth. Some mothers hire a doula and choose to give birth in the comfort of their own home, without the temptation of medications just a nurse page away. Breathing and meditation can help to get your mind in the right state for dealing with contractions. Getting your partner involved as your coach can bring you closer and make the delivery a team effort. Strengthening your pelvic floor muscles during your pregnancy with prenatal yoga can assist you in efficient dilation and pushing once you are in labor. As long as you and your baby are healthy and strong, you can choose to go the natural, non-medicated route and skip the epidural altogether.
2 Do Epidurals Increase C-Section Risk?
Some experts have argued that epidurals increase C-section risk. Experts observed that women who opt for epidurals are more likely to have C-sections that women who don’t. But the women who requested epidurals in these studies had other risk factors involved. For example, they had difficult births from having large babies, or babies in abnormal positions. When labor is induced, it can sometimes make for a painful and difficult birth. In one study it was reported that women who request pain relief had smaller pelvises than women who don’t. This characteristic makes for a hard and painful labor and is a risk factor on its own for C-sections. So just because epidurals are often given prior to C-sections, it’s not proven that they cause them. In fact, the American Congress of Obstetricians and Gynecologists published a statement saying, “the fear of unnecessary cesarean delivery should not influence the method of pain relief that women can choose during labor.”
1 Forceps May Be Required
Some research suggests that epidurals increase chances that doctors will have to use forceps of a vacuum extractor to pull the baby out of the birth canal. The use of forceps or a vacuum can cause complications during the delivery process, such as bruising and jaundice in the baby, and lacerations in the mother. Since the mother is not able to feel the full sensation when she is pushing, it may be hard for her muscles to work together and push hard enough to get the baby down the birth canal and out on her own. While there are risks associated with this, it’s important to know that the doctor is not forcibly pulling on the baby, but more guiding the head down the canal as the mother pushes. The vacuum works the same way, they put a suction cup on the baby’s head (not on the soft spots) and assist the mother as she pushes, guiding the baby to the light.