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Childbirth is painful; there is absolutely no denying it. And when you are creating your birth plan – something that is highly recommended – you need to take into account any possible pain management you want to use during labor, including an epidural.
What is an Epidural?
An epidural is a type of injection that works as an anesthetic that provides temporary relief from pain or inflammation. It can be used in various circumstances, but it is commonly used during childbirth.
The injection itself is named for the area that it is administered: the epidural space, the outermost part of the spinal canal. Rather than providing a full anesthetic effect – which completely takes away all feeling – the point of an epidural is to provide pain relief around the lower extremities to make labor a bit easier.
Types of Epidurals
There are two basic types of epidurals that are typically used during labor:
– the regular epidural
– the combined spinal-epidural (CSE).
For either type, you will be asked to arch your back forward while sitting or lying on your left side. The anesthesiologist will wipe the area with antiseptic and inject a local anesthetic to numb the area before placing the actual epidural catheter.
The catheter administers the medication through continuous infusion or by periodic injections via a pump. The difference between these two types of epidurals is the method used to administer the medication.
With a regular epidural, a combination of narcotic and anesthesia is used, administered by periodic injections or by a pump. The morphine of fentanyl is typically used as the narcotic, which helps to counteract any adverse effects of the anesthesia.
A CSE, or “walking epidural”, is a bit different. The narcotic is injected locally to cover the spinal cord and epidural space before the catheter is threaded through the needle. This allows you to move a bit more during labor since the anesthetic isn’t placed right away.
The CSE only provide pain relief for about 4-8 hours with the narcotic alone. However, you can request an epidural at any time since the catheter is already in place.
Pros and Cons
Obviously, the best thing about an epidural is the fact that it greatly reduces your pain during labor. You will still be awake and alert for the delivery, and you will still feel some slight pressure and possible stretching, but it will be next to nothing compared to what you would feel unmedicated.
Reducing pain can also help you relax more, which is a must in order to help your labor progress. If your body is struggling with preparing for delivery, particularly with cervix dilation, an epidural may help you relax enough to move things along.
There are definitely downsides to epidural injections, though. The first being an inadequate or failed epidural. They don’t always work (or only half work) and can be hard to place at times; some mothers have experienced tingling sensations in their leg(s) from nerves being hit or excess blood backing up in the catheter tube.
When administered too late in labor, it can also have adverse effects on your baby. It can potentially lower your blood pressure which may slow your baby’s heart rate.
Possible Long Term Side Effects
Though it is rare, there have been cases that have resulted in temporary or permanent nerve damage. Because you are dealing with the spine and the injection administered in such a small area, it is possible that the needle itself may go in too far and affect the nerves or spinal cord.
Another possible long term side effect – though far less extreme – is a slight backache that never seems to go away. You may only feel it when there is pressure on the area or it may be a bit more persistent.
Can Any Woman Get an Epidural?
While epidurals are safe for the majority, there are some cases that do not allow a woman to receive one.
Certain medications (particularly blood thinners) or other blood conditions, like low platelet count or heavy bleeding, can stop you from receiving an epidural. Because the anesthesia used can cause low blood pressure, any blood conditions can cause excess bleeding which can be life-threatening.
Sometimes the inability to receive an epidural is simply due to the fact that it just doesn’t work out. It could be that the anesthesiologist can’t find the right space due to your anatomy, swelling, or weight gain. Or it could be that an anesthesiologist just isn’t available at the time.
When to Ask and When It’s Administered
It was previously believed that requesting an epidural too early or too late can negatively affect your labor, but more recent research has shown that this may not be the case. This new study suggests that the best time to receive an epidural is whenever you request it.
This simply means that a doctor shouldn’t really deny your request for an epidural at any point during labor. However, there is still an ideal time that is best for an epidural to ensure that labor goes smoothly and as planned.
Because an epidural dulls your ability to feel your lower extremities, it does slightly interfere with your body’s responses to labor. You may not feel the need to push like you would unmedicated or you may end up lying in a position that doesn’t help labor progress properly.
These things aren’t always an issue as many women give birth vaginally just fine with an epidural, but they are definitely things to keep in mind.
Is It Painful?
When done right, you shouldn’t really feel the epidural itself. You may feel a slight pinch from the initial local anesthetic and a slight burning or warm sensation as the medication is administered, but once the area is numbed, you shouldn’t feel the epidural needle itself and the catheter being inserted.
Does an Epidural Increase the Likelihood of a C-Section?
As previously mentioned, professionals used to believe that receiving an epidural too early could increase the likelihood of a C-section. However, more recent research has shown that there isn’t much evidence to back that up.
There is definitely something to be said for a natural (unmedicated) labor though. When you are able to move during labor and respond naturally to your body’s cues (because you can feel it!), labor can progress much more smoothly.
That doesn’t always mean that labor will go according to plan without an epidural. The body will do what it will regardless of whether you receive medicated assistance or not.
How Long Does It Last?
Depending on the type of epidural administered, the effect can last from a couple of hours to the entire duration of your labor and delivery. A CSE starts working much faster than a regular epidural, but it wears off much quicker as it is a localized low dose anesthetic.
With a continuous infusion method, it can last for the entire duration of your labor and the dosage can be adjusted as you go. Some women may opt to have the dosage lowered when it comes time to push so that she has more control over her body during this vital stage.
There is no right or wrong way to do your labor; it is very painful and no one should shame you for getting an epidural. It can be a very effective method of pain relief so you can move forward with your labor, possibly helping it to progress while you relax a bit more.