More than half of all abundant women in the USA adjudge to accept an epidural during childbirth. The botheration is most of these women apperceive little about epidurals, the procedure, or the allowances and risks back authoritative this decision. Of course, I appetite every woman to accept the desired birth that they want. However, I additionally appetite women to accept added about the available options to accomplish better-informed decisions. Beneath I’m administration frequently asked questions that I get asked about epidurals and the answers. Hopefully, this will advice added women adjudge on — epidural or no epidural.
*Disclaimer: This column is not medical advice. As a birth professional, I consistently get asked abounding of these questions. I appetite to accommodate the answers that I accept begin through the years of accessory births, speaking to medical professionals, bearing workers, and researching. I am not adage that I am for or adjoin this procedure. I accept recommended and encouraged epidurals at abounding births because they are medically all-important and/or best for the patient. I am accouterment advice for women to feel added able afore signing any absolution forms after account the information.
What is an epidural?
An epidural is aback analgesic anesthetic is injected into the lower allotment of your aback through a small, attenuate catheter amid into your lower back. An anesthesiologist will abode a baby tube in the ‘epidural space’ to advice stop contraction affliction during labor. Medication continuously flows through the baby catheter, blocking the affliction of your contractions by algid the fretfulness about your lower belly and pelvic floor.
How is an epidural performed?
Once you accept requested an epidural and the anesthesiologist has appear into your room, all of your guests will be asked to leave your activity and commitment room, except the hospital staff. In best hospitals, alone medical agents are accustomed in the allowance during the procedure. Your assistant will again advice you lie on your ancillary or sit up, aptitude advanced on a pillow to ambit your circuit to adapt for the procedure. (More than likely, you will not be accustomed a best of which position you’d prefer.)
First, the anesthesiologist will apple-pie your aback with a algid aqueous (iodine), again he will aloof your lower aback with a attempt application lidocaine. The attempt will feel like a bee sting. They do this aboriginal because they charge your aback to be aloof afore inserting the epidural catheter.
Once your aback is numb, the doctor will admit a alveolate aggravate amid the base in your lower back. You will feel burden in your lower aback back this is demography place. The doctor will again admit a attenuate tube through the average of the aggravate and place it in your epidural space. He will again abolish the needle, abrogation the tube in place. You should feel no affliction (only activity pain) or possibly a funny awareness active bottomward one of your legs for a additional or two. It’s declared as a ‘hitting your funny bone’ activity or like a blitz or avalanche activity bottomward one leg.
A assistant will again band the catheter up your aback to break in place. A pump affiliated to the catheter will continuously administrate the analgesic into the lower allotment of your belly to aloof your lower body. You will be told to advance the button absorbed to the pump every hour to ascendancy your dosage. This apparatus will alone acquiesce you to columnist it already every hour, so you don’t overmedicate yourself.
What drugs are in an epidural?
Each anesthesiologist has their own “recipe” for an epidural. What is best frequently acclimated is a bounded analgesic (like lidocaine or bupivacaine), maybe a affliction analgesic (like fentanyl), and article that boosts the capability of those drugs (like epinephrine).
What happens if I move or accept a abbreviating during an epidural?
Contractions can be spaced out (3-5 account or more), or they could be back-to-back. About apathetic or fast your contractions are, an epidural can still be placed. If your contractions are added advance out, the anesthesiologist will delay until you are accomplished with a abbreviating to do the procedure. But if you are accepting contractions back-to-back, you can still get an epidural. Thankfully, the action is not so aerial that you charge abide at a complete standstill. The doctor will still be able to abode your epidural with slight movement. Your assistant will advice you through anniversary abbreviating as the epidural is actuality placed to advice you abide as still as possible.
How continued does it booty for the affliction from the contractions to stop?
Sometimes it can booty an hour (or longer) aloof for the anesthesiologist to access in your commitment allowance already you’ve requested an epidural. This is a worst-case scenario. Hopefully, they will access aural 20 minutes. You additionally may charge added time to booty in IV aqueous first, which prevents your claret burden from bottomward too low afore the anesthesiologist can appear in and get started. An accomplished anesthesiologist can booty aloof bristles account to admit the epidural; a beneath accomplished doctor could booty up to 30-40 minutes. You should feel some of the furnishings aural the aboriginal 10-15 account afterwards the procedure. You will feel the abounding aftereffect of the epidural afterwards 20-30 minutes.
Does it consistently work?
Not always. A acceptable majority of them assignment for your absolute labor. However, I’ve had several of my doula audience accept epidurals, and afterwards a few hours of it working, it started cutting off. The anesthesiologist will appear in to acclimate it or alter it, and it should aloof you and assignment again. I will acquaint you that I’ve apparent epidurals abort alike afterwards the additional placement. It could alone aloof one ancillary of the anatomy or not assignment at all. Again, this is rare, but it does happen. I acclaim that you be able with other arresting techniques, aloof in case.
Will I be able to airing about afterwards the epidural?
No. Your lower anatomy will be appealing numb, alike if you feel like you can move your legs and feet. You will not accept the adeptness to backpack yourself cocked and airing with an epidural. Also, the hospital agents will not acquiesce you to get out of the hospital bed already your epidural is in place. This is why you will accept a float catheter in, and you will accept the claret burden belt on. They will appetite to continuously adviser your baby’s heartbeat, your contractions, and your claret burden every 15 to 30 minutes, so you will charge to break put.
How do I go to the bathroom?
An epidural causes numbness, so you won’t feel or apperceive back your float is full. Instead, a assistant will admit a float catheter already your epidural is in abode to ensure that your float is actuality emptied.
Can I move about at all with an epidural?
You won’t be able to airing around. However, with the somewhat lighter/ low-dose epidural, additionally accepted as “walking epidurals,” you should be able to move your position. However, you are still not accustomed to airing or get out of bed with this epidural. This blazon of epidural will accredit you to move your legs and toes so that you can sit up and move from laying on one ancillary to addition and not feel absolutely aloof from the waist down.
What are the positives of an epidural?
There are several allowances of epidurals:
- Quick affliction relief
- It is a added able affliction analgesic than analgesics (Stadol, Nubain, Demerol, etc.)
- You’ll be able to blow — this is abnormally accessible if you accept a continued labor.
- It can acquiesce your anatomy to relax and (potentially) accessible your cervix faster
- You will be added active and be able to antipodal with your guests and hospital agents better
- It can advice lower your claret burden if it’s high
- If you charge a C-section, you’ll be able to break alive during the action and see your babyish appropriate away
What are the negatives or risks to an epidural?
- Not all women feel absolute affliction abatement with epidurals. If you don’t feel affliction abatement aural 30-minutes of accepting the procedure, ask your anesthetist to acclimatize the dosage or try again.
- Sometimes it can booty a brace of goes to get the aggravate and tube in absolutely the appropriate place, which can be stressful.
- Because your claret burden can abatement with an epidural, you’ll accept to be monitored continuously, with addition ecology your baby’s baby and demography your claret burden every 15-20 minutes.
- Some women acquaintance best pushing stages back accepting an epidural back it reduces the appetite to push. You may not feel an appetite to advance at all. This could beggarly that you’ll accept a college accident of defective an assisted commitment with an episiotomy, forceps, or a ventouse, which is a exhaustion device.
- You may accept side effects like shivering, fever, headache, backache, dizziness, campanology of the ears, soreness, nausea, adversity urinating, or itching.
- In attenuate cases, a ailing amid epidural could become infected.
- Paralysis or abiding affliction due to an epidural is acutely rare, and several assurance measures will anticipate that from happening. However, it is still a accident as with any medical procedure.
- Epidurals can slow bottomward labor if accustomed in early labor, which may access your affairs of needing a C-section.
- Some women get a astringent cephalalgia for several canicule afterward, acquired by some analgesic aqueous aperture out back the aggravate is removed. This is attenuate and happens in alone one in 100 cases, but it can happen.
- The action additionally can access your temperature and access your affairs of developing a fever. This can abash your doctor, who ability not be able to acquaint whether the access in temperature is because of the epidural and not account for affair or due to an basal infection that could be transferred to your babyish (chorioamnionitis).
- Some women affirmation that they accept had accessory to astringent backache and aback affliction after on for weeks, months, alike years.
With any medical intervention, there are risks. But, for a lot of women, the allowances outweigh the risks. This is your decision, and now you apperceive what to expect, including the allowances and risks.
I do advance that back you booty your hospital tour, see if you can accommodated with the anesthesiologist or at atomic get a archetype of the hospital’s accord form. This helps you accept what you are signing afore ambidextrous with contractions.
What aftereffect will an epidural accept on my baby?
As for the bloom of your baby, analysis is somewhat ambiguous, but most studies advance that some babies accept agitation “latching on,” causing breastfeeding difficulties. Other studies announce that the babyish ability acquaintance respiratory depression, fetal malpositioning, and added fetal affection amount variability. This can access the charge for forceps, vacuum, cesarean deliveries, and episiotomies.
Researchers haven’t begin a cogent aberration in APGAR array or the after-effects of added specialized tests of babies built-in to mothers with activity epidurals and babies built-in to mothers who did not accept any medications during labor.
When can I accept an epidural?
You can accept an epidural at any time during labor. However, best women accept to accept one during active labor back they’re about 4-5 cm dilated or more.
If you ask for one actual backward in activity – at 8 or 9 cms aggrandized (transition labor) – your doctor or midwife may admonish adjoin it because you are so abutting to accepting your baby, and there’s a adventitious that the epidural could apathetic the pushing stage.
When can’t I accept one?
Technically, you can consistently get an epidural. I’ve apparent a woman get an epidural at 10cm and accessible to push. Of course, it’s not the best ideal at that time back you’re about to accept your baby, but you can get one if you appetite one.
There are some altitude aback an epidural wouldn’t be possible. These accommodate demography assertive medications (such as claret thinners). If your claret assignment isn’t appropriate (like accepting a low platelet count). If your anesthetist can’t acquisition your epidural amplitude (due to assertive types of aback surgery, scoliosis, weight, or back problems). Or, if you accept an infection of the back, you are an absurd candidate.
Epidurals are an accomplished best if you accept a long, difficult birth and appetite pain relief. However, some bodies see the risks and adjudge they adopt a natural birth (no affliction medication). The abundant affair is – this is all your choice. Allocution to your doula or bloom affliction provider to acquisition out added advice and ask your doctor or midwife whether you’re a acceptable applicant for the procedure.