An Expert Guide on an Epidural for Pregnancy

This post has everything you need to know about getting an epidural for pregnancy. Learn about what to expect, how an anesthesiologist administers it and the benefits and risks to you and baby. This guide has everything you need to know about epidurals so you can decide if it’s right for you and your birth plan.

Epidural During Pregnancy

An epidural for pregnancy is one of the most common anesthesias used during labor and delivery. It numbs the sensation in the lower abdomen, back and perineum, while allowing you to remain awake.

Whether or not you get an epidural is personal preference and your own birth plan. But before you make this decision, it’s important to understand the benefits and disadvantages of having and epidural during pregnancy and the different types of epidurals. It’s easier to understand and fully comprehended these benefits and risks now, when preparing for labor, as opposed to in the heat of contractions when you aren’t thinking as clearly.

This post will teach you everything you need to know about getting an epidural so you can make the best decision for you, your baby and your birth plan.

What’s an Epidural and How is It Given?

What’s an Epidural?

An anesthesiologist injects an epidural for pregnancy in the lower back near your nerve roots in the spinal column. The medication affects the lower region of your body. This includes an area as small as your abdomen and lower back or as large as from your chest to your toes. The severity and strength depends on a number of things, like the combination of anesthetic medication, affected nerves and nerve branches and the strength of the medication.

The medication that makes up an epidural is typically a narcotic-like analgesic, such as fetanyl.

Options for Epidurals

The types of epidurals offered differ among hospitals. Typically, you don’t have a say in which type you’ll get. This is something you can discuss with your health care provider ahead of time or when choosing your birthplace.

Epidural with Combination Anesthetic & Narcotic

This is the most common type of epidural because combining medications proves to have better benefits with fewer side effects. Doses of medication typically run though a continuous drip or a patient-controlled analgesia.

Patient-Controlled Epidural Analgesia (PCEA)

PCEA contains the same medication combination as the above. Instead of a continuous drip, a button and epidural pump that allows you to give yourself more medication when needed. This option allows the patient to control how much or little medication she’s receiving. The device includes a timer to limit the number of dosages given in a time period to prevent overdose.

Combined spinal-epidural (CSE)

A spinal analgesia, also known as a spinal black, is an injection that takes effect quickly, lasting for an hour or two. Used in early labor, it may allow more mobility and movement to further labor progression. Later, an administered epidural provides more pain relief.

Procedure for Epidurals and Spinals

1. An anesthesiologist typically administers the epidural for pregnancy or spinal. Although, it depends on the hospital. A nurse anesthetist or resident (physician-in-training) can administer epidurals and spinals, too. If you have a preference, ask about this on your hospital tour or when choosing your birthplace.
2. Before medication, typically at least one bag of of fluid is given. The extra fluids help to reduce a drop in blood pressure.
3. Hospital staff will present you with a consent form and explain the potential side effects and risks associated with the chosen medication and procedure.
4. To receive medication, you will lay either on your side to curve your back or lean forward to curve your back.
5. To find the correct spot to inject medication, the anesthesiologist pushes on the lower back to find the correct spot. The lower back is cleaned with antiseptic and numbs your skin with a local anesthetic.
6. The preparations and administration takes about ten minutes. You must remain still, so extra support helps to relax during contractions, while the procedure takes place. The anesthesiologist can also pause until the contraction lessens.

The procedure varies from here depending on the type of block.

Epidural Catheter

• A larger, hollow needle is inserted into the epidural space.
• A catheter, a thin plastic tube, is threaded through the needle. The needle is removed. The catheter stays put for the continuous flow of medication. So the catheter doesn’t move, it’s taped to your back.
• The catheter, attached to a pump, releases medication according to the type of epidural.
• Within 15 minutes, you’ll likely feel the effects of the epidural and feel tingly or numb from your chest or belly to your toes or pelvis.

Spinal Analgesia (Block)

• A needle injection of anesthetic or narcotic is given and inserted through the dura – the tough membrane that surrounds your spinal cord, and into the intrathecal space, which is filled with spinal fluid.
• A spinal block takes effect in just minutes and lasts a few hours.

7. After the procedure(s) takes place, a nurse monitors your blood pressure, pulse, fetal movement and contractions, and temperature frequently, if not continuously. You may also have an EKG (electrocardiogram) to monitor heart function.

Benefits of Epidural Medication

An epidural for pregnancy is one of the most common choices for pain relief. That’s because it has a lot of benefits. It’s the most effective for removing pain while allowing women to stay alert for labor and delivery.

Epidural for Pregnancy Benefits

• It removes all if not most of the pain of labor and birth and contractions,
• You won’t be drowsy like other pain relief options.
• It provides continuous relief.
• Women remain awake and alert if a cesarean takes place, as opposed to general anesthesia.
• A tense mother who is struggling through contractions can relax in order to further labor progress.
• Pitocin can be administered without increased pain.
• No further medication is needed if repairs or stitching needs to be made to the uterus or perineum.
• It typically lowers blood pressure in women who have pre-eclampsia or high blood pressure.
• Women are able to rest during labor.
• Some mobility may be possible (limited to your bed).

Epidural for Pregnancy Potential Side Effects

With the benefits sounding so great for an epidural during pregnancy, you might be wondering what benefits there are for a natural and unmedicated delivery. This may due to a woman’s personal preference, women with preexisting conditions or the list of potential side effects associated with epidurals for pregnancy.

• Women must remain in bed.
• Labor may slow or stall, so Pitocin (a synthetic hormone of oxytocin) may be given to speed up contractions.
• Longer second stage of labor.
• Baby is more likely to remain in an unfavorable position for birth.
• Increased risk of episiotomy, forceps and/or vacuum delivery, and c-section.
• IV fluids are required to prevent a drop in blood pressure.
• If blood pressure lowers, the mother may need epinephrine, a hormone drug used to regulate breathing. Epinephrine during pregnancy has its own list of risks associated. If this doesn’t correct the problem or baby becomes to distressed, it’s likely a c-section is needed.
• Sometimes the relief is only partial or women experience periods where the epidural wears off for some time and returns.
• Constant monitoring is required.
• Baby may be born drowsy and tried, thus effecting sucking reflect and negatively impact breastfeeding.
• Edema, or swelling, can occur,
• A catheter must be placed for the bladder to be emptied.
• Women are not allowed to eat or drink or may be limited to ice chips.
• The urge to push is taken away. So women must be told when to push. So the second stage of labor is longer.
• Maternal fever can occur, which results in antibiotics for the mother.
• Some women have allergic reactions to the medication(s) like itching, shaking, or shivering.
• The medication may numb the chest, making it difficult to breath.
• Partial paralysis to the foot or leg is possible.
• Risk that the anesthetic is injected into one of the veins in the epidural space, which causes series and sometimes un-reversible problems. Accidental puncture of the dura, which can lead to spinal fluid leaking and prolonged headaches.
• Slowing or even stopping the labor progress.
• Infection of the injection site.
• Long-term back pain.
• Coma and/or death.
• Nerve injury or respiratory paralysis.
• Cardiac arrest
• Convulsions
• Cost of the epidural, which may range from $2,000 to $5,000 depending on the type of epidural and who administers it.

Other Considerations Epidural for Pregnancy

Late or Light Epidurals

Late Epidural

Reduce some of the potential side effects of epidurals by choosing to get a late or light epidural. The reasons epidurals can lengthen or stall labor is because it relaxes mom too much. In early labor stage epidurals, the possibility of mom and her body relaxing too much increases. Contractions lessen or can stop all together. Labor stalls and doctors are likely to suggest Pitocin or augmentation to keep labor progressing.

When you wait until later into active labor, you let your body do a lot of the hard work. Contractions are strong and work to dilate and efface the cervix. This way when the epidural is administered, labor is close to the third stage, pushing, and the chance of labor stalling or stopping is less likely.

Light Epidural

A light epidural also gives you the option to better work with your body to prevent the potential stalling and stopping of labor.

A light epidural for pregnancy is when a lesser amount is administered. Labor pains lessen while still allowing you to feel and move your legs. It’s possible you’d also still have some labor feeling like the pressure of when a contraction starts or the need to push.

This option allows you to some movement for position changes and helping labor progress and baby descend into the right spot. It also lessens push time. Starting to push at the very beginning of a contraction gives you more time and strength to move baby down and out of the birth canal.

When is it too late to get an epidural?

Rumor says that to receive an epidural early because at certain point in labor, epidurals can’t be given. This rumor is both true and false.

It’s true that if your labor is progressing quickly and birth seems to approaching quickly, your care provider may suggest holding off on the epidural.

However, if labor is progressing slowly, it’s possible to receive an epidural for pregnancy at nearly any point. Some moms get an epidural even into the transition stage.

Food and Drink

Most hospitals only allow ice chips after receiving an epidural. An epidural increases cesarean section potential. Doctors want to prevent choking, vomiting and nausea.

Lower risk mothers may be allowed more flexibility in food and drinks. Talk with your health care provider ahead of time.

Failed Epidurals

Epidurals can pose challenges for some. They might not provide complete relief or more fade over time. It’s possible that the epidural mostly works but leaves one spot having more sensation and feeling than others.

Ill preparation of labor pain and coping mechanisms allows you to slip into the fear-tension-pain cycle. This makes labor pain significantly worse and can cause suffering. The potential of traumatic births increases.

Even if you plan on a epidural, learn some coping techniques to rely on.

Epidural for Pregnancy Conclusion

There are lots of pain management strategies for coping with the intensity of labor. Choosing an epidural is at the top of the list for most expecting mothers.

Although epidurals have lots of appealing benefits, like getting rid of all childbirth feeling, it also comes with a list of risks.

It’s important to thoroughly think through these risks and rewards before deciding what option’s right for your birth plan.