- 7 years ago
- Wedding: October 2009
I was going to post something like this in response to a thread this week about epidurals but I couldn’t find it. So I will start a new one, and hopefully provide some useful information. I am an anesthesiologist and have put in hundreds of epidurals so that is where I’m coming from. A lot about your epidural will be institution dependent, and will vary by your OB, your hospital, and of course your anesthesiologist. This might be lengthy but I’ll try to answer some of the most common questions I get from laboring women. (I’m 24 weeks pregnant myself and hope this info helps you guys!)
Does it hurt getting the epidural?
Most women say that it hurts less than getting the IV placed. The worst part is the initial poke with the local anesthesia, which burns a bit going in, but that will numb your skin and other tissue so the rest shouldn’t hurt. You will feel pressure as the larger needle goes into your back. Sometimes, unfortunately, the placement is not easy or straightforward and that can start to get a bit more painful when it takes longer. This is a little more common in overweight or obese women but sometimes a thin woman can be equally difficult. You just never know.
Something stays in my back?
This was answered in the other thread, but yes, usually a small tube or catheter will be placed in the epidural space through a needle which will give a continuous infusion to help prevent the pain. You can still lie on your back, the tube is so thin you probably won’t know its there, and if your anesthesiologist is experienced they will probably secure it extremely well (laboring women sweat a lot, I’ve learned!) so you will still be able to move around and shouldn’t worry about it coming out.
What medications are given?
This varies by institution, but generally a local anesthetic, to numb the nerves, and a narcotic (same family as morphine). After several hours of receiving the infusion in the epidural space, these medications will reach a concentration in your blood equivalent to what is being infused in your back, and will also reach a similar concentration in the baby’s blood. The benefit of infusing the medications near where the nerves exit the spinal cord is that very low doses can have a significant effect, much lower than what would have any effect in your blood or in your baby.
Does the epidural slow down labor?
There have been several studies that showed an increase in time in women who had an epidural compared to those who didn’t. The biggest and maybe best of these showed no increase in the first stage of labor, and an increase in the second stage (from the time you’re fully dilated to the time baby comes out) of around 20-30 minutes on average. There are also studies that show no difference. Recently, one study turned conventional wisdom upside down by showing that women who had their epidurals placed early, at around 1cm of dilation, had an average 4 hour shorter labor overall than those who had theirs placed starting at 4cm, which is what OBs are often taught is the “right” time to start an epidural. Essentially, the jury is still out here.
Is there an increased risk of C section?
There have been some studies that showed that there is (again, some more recent studies showing no difference).
How soon will the epidural start to help?
Usually, the first couple of contractions feel the same, and then they will start to get shorter. It takes up to 20-25 minutes to take full effect. Some people also use a small dose of intrathecal medication to give much faster pain relief (intrathecal = space next to spinal cord, separated from epidural space by a layer of tissue called the dura).
What are the risks?
The most common thing is a headache, which happens up to 1% of the time. This is more common if the wrong space is entered during epidural placement. This is not dangerous but can be very uncomfortable. There is a small chance of bleeding that requires further intervention, about 1 in 300,000, which usually happens in women who have preexisting bleeding disorders, so many providers will want to see some lab work before placing the epidural if they suspect such a disorder. Also a small chance of infection, I think about equivalent to the chance of bleeding. There is a chance of permanent nerve damage, which is the most feared complication, that happens about 1 in 2 million epidurals, usually resulting from bleeding or infection which was not caught soon enough.
There is also a chance that the epidural will not work, or will work only on one side. In this case, there are some interventions we can try, but there is also a possibility we will have to replace the epidural.
Many women complain about back pain after their delivery that they attribute to the epidural. In one study, the incidence of back pain following a vaginal delivery was the same in women who had an epidural as it was in women who didn’t. Back pain following pregnancy and delivery is pretty common, unfortunately. Many OBs are eager to blame it on the epidural. I won’t tell you that an epidural will not cause you back pain, but even if you don’t get the epidural, you might get back pain.
I plan to have an epidural for my delivery. I’ve never had one, so I can’t tell you exactly what its like. But what I see is women in labor, who are literally different people when I first interview them, and I cannot even imagine how painful it must be. They are miserable during contractions, their partners are miserable seeing them in such pain, and if they have friends or family visiting, those people are uncomfortable too. Then, when I go back to check on them after placing a successful epidural, they are joking with family, laughing with their husbands, or taking a well-deserved nap. It can be a very rewarding part of my job and I definitely plan to have an epidural for my labor! But every woman has to decide what is right for them, and I have seen some women just beat themselves up after getting the epidural and not enjoy their labor at all, even if it is pain free.
If you have any questions, I’ll try to check back here and answer them. I hope this helps some bees! I have had many questions answered on these boards so I am hoping to contribute too.