Epidurals

What is an Epidural?

An epidural is a form of regional anesthesia. The goal is to give effective pain relief and numbness below the waist. There are two main types: epidural blocks and intrathecals.

Epidural Block

This is the most common type of regional anesthesia for childbirth. Placement is done by placing a catheter in the epidural space between vertebrae in the lower back. The medicine is usually a combination of a ‘caine’ (bupivacaine, lidocaine, ropivacaine and mepivacaine) and a narcotic. You will be asked to sit up and curl forward, often over a pillow. You will have to hold very still for the placement of the catheter, often through several contractions. The medicine is given by continuous drip or by repeat injections. Ask your care provider to find out which way your hospital delivers the medicine. Depending on the amount of medicine and your reaction to it, you should get pretty good pain relief. Good epidurals allow some movement of your legs; although, your legs will feel very heavy and be difficult to move. You should also feel the pressure of the contractions but no pain.

Intrathecal

An intrathecal is sometimes called a ‘walking’ epidural. This term is a misnomer. Women with an intrathecal are usually not allowed to walk the halls or even get out of bed. The main difference between the two types is where the medicine is placed. In an intrathecal, the medicine goes into the intrathecal space. The pain relief of an intrathecal is not as good; although, it will get you over a hump and give you enough pain relief to help you sleep. The big pluses to an intrathecal are that you have a huge range of movement in the bed, you will feel the urge to push and you will have control of your pushing muscles.

Benefits

Epidurals give effective pain relief for the majority of women. Additionally, they do not make you sleepy or groggy or affect your mental facilities as many pain relief medicines can.

Drawbacks

• They are not administered instantly. You must have lab work done, an IV has to be in place and fluids have to be given.
• You may not get the pain relief you want. You may only have pain relief down one half of your body, may still feel pockets of pain or experience break-through pain.
• They are not designed to work as well during 8 or 9 centimeters.
• They are designed so you feel pressure and not pain. Some women find the pressure of labor as uncomfortable as the pain.
• You cannot get out of bed once an epidural is in place.
• You will not have much feeling below your waist. This can make it difficult to get into a comfortable position.
• You will probably require a foliate to help you urinate.
• You may develop a fever, bringing concern for you and the baby’s health.
• You may experience a drop in blood pressure, again raising concern for the health of you and your baby.
• Your labor pattern often slows down; although, some women relax enough for labor to quickly advance.
• You will not be able to push as effectively.
  • Without control of your pushing muscles, you may need forceps or a vacuum procedure.
  • If you cannot push your baby out, you will need a cesarean.
  • You may need to push for a long time.
• You may get a spinal headache if the epidural needle punctures the dura space.
• You may get a postpartum backache.
• Your hips and back may be sore postpartum from pushing in uncomfortable positions.
• You will have to have your blood pressure taken every 5-15 minutes depending on hospital policy.
• You may experience itching, nausea and vomiting.
• You cannot have a home birth and an epidural.
• You cannot have a water birth and an epidural.

How do I Decrease the Risks of Side-Effects?

You need to learn comfort techniques such as breathing styles to help you go as far in labor as you can without pain relief medicine. You should also have a birthing coach—either your partner, a family member—or a doula to help with other comfort techniques such as massage, aromatherapy, visualizations, and different positions. Finally, remember that aquatherapy (shower/bath) will often provide the same pain relief as an epidural without any of the side effects. Depending on your care provider, you may even be able to have a water birth. If you know you want pain relief, try to wait until you absolutely need it. A good guideline is to go until you think you need pain relief and then go one contraction further.

In Conclusion

The decision to have an epidural is a personal one. Although there are many side-effects and personal risks, the pain relief is effective for laboring women. You can decrease the risk of side-effects by waiting to get your epidural until you absolutely need it.

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