Epidurals have been around for almost a century, but they exploded in popularity in the '70s. Today, they're the most common choice for pain relief during labor. It's important to do your research, but sometimes experience is the best teacher. So in the interest of helping a sister out, I'm sharing the things I didn't know to expect about an epidural.
Briefly, epidural anesthesia is pain blocking medication continuously delivered through a tiny tube inserted into your lower back — and it's an option available to most women in labor. There are certainly pros and cons to be considered. Initially, I fully intended to get the epidural because I don't handle pain well. I was going to be all French about it (87 percent of French moms have medicated births and there's no stigma around it). I had a change of heart after I learned from my birth class that I might not be able to labor in different positions once the epidural was in. My midwives didn't pressure me either way. In the end, my birth plan stated that I wanted to go as long as possible but leave epidural anesthesia on the table. I did awesome during early labor, but the pain became too great for me later on. I requested an epidural and received it after 20 hours of labor.
What's important about the decision to have a medicated or unmedicated birth is that said decision is yours to make. If you are considering it, just make sure you know what you're getting yourself into, or you may be in for a few surprises.
It Will Take A Hot Minute
Turns out you can't just immediately get relief when the pain gets to be too much. That's why it's important to anticipate when you're about to lose it (if you can), so you can allow for a window between asking for and receiving your epidural. There are certain procedures that have to be done first (see below), and then you have to wait for the anesthesiologist (and in a hospital, they are busy people).
You'll Need An IV...
I knew that I would need IV fluids (to prevent a drop in blood pressure) before I got my epidural, but I was unprepared for how cold it would make me. I was freaking freezing, Mr. Bigglesworth. My husband convinced me to stand up during this process since I'd have to spend the rest of my labor lying down. I remember my sister holding me up from behind with her arms around my poor, shivering (from cold or contractions, I'm still not sure) body.
...And A Catheter
OK, it's not pleasant, but it's not that bad. Because the epidural can suppress your urge to pee and you've just been pumped full of a liter of IV fluids, you may need a catheter inserted into your bladder to drain your urine. It's not a big deal. My nurse just came every few hours to empty it. I couldn't even feel it (and by that time, modesty was out the window).
You Need To Be In A Certain Position
I guess I was thinking I'd have to be restrained or something. I mean, that's a big needle. Some anesthesiologists will have you lie on your side or lean over a table. Mine had me sit on the edge of the bed and curl over my belly in a C shape. My husband supported me from the front, holding my hands.
You May Have To Wait For Contractions To Pass
Staying still is an essential part of successful epidural insertion. You know when it's really hard to stay still? When you're having contractions. Mine were relatively close together, so it took awhile to get the timing right. The anesthesiologist would be ready to go, and I would whimper, "Not yet," and breathe through another doozy of a contraction.
It Can Take Several Tries
Your anesthesiologist is aiming for the epidural space between your vertebrae. It's an art as much as a science. I braced myself for the pain, because I knew pain was going to happen.What I wasn't ready for was the three attempts it actually took to get that bad boy in there.
It F*cking Hurts...
If you were expecting a single needle, you're going to be disappointed. After the antiseptic solution is applied to prevent infection, you'll get a an injection of local anesthetic to numb you. It stings. Then comes the giant needle you've heard about. It felt like a shooting pain for me. Once that thing is in there, the anesthesiologist will thread a catheter into it to get the meds into you and remove the needle. It's not so bad for everyone, but it definitely sucked for me.
...But Then It Feels Amazing
Seriously though, what do they put in there? I'm convinced it's a magical concoction of unicorn farts, fairy dust, and the whispers of angels. Or maybe it's a Horcrux. Whatever. All I know is that little piece of Voldemort's soul spelled absolute relief for me.
Full disclosure: you're actually getting a dose of local anesthetics, often combined with opioids or narcotics.
You Can Have A Bad Reaction
Some women experience a drop in blood pressure as a side effect of the epidural, and I was no exception. I almost immediately had ringing in my ears and black spaces around my field of vision. Basically, I felt like I do right before I'm going to pass out. It was scary and it happened twice. My provider ended up lowering my dose, and I was good to go.
Low blood pressure can reduce blood flow to your baby, so hospital staff will continuously monitor his or her heart rate from the moment you have an epidural to the moment your baby enters the world.
It Might Slow You Down
There's some evidence that suggests epidurals can slow down labor. You're not up and moving to help labor progress, and the IV fluids you just got can temporarily dilute the hormones that cause contractions. Be prepared for your provider to do as my midwife did and give you some Pitocin (a synthetic version of oxytocin) to speed things up. I got my epidural at midnight and was able to rest for awhile. By morning, the Pitocin had worked its magic and I was fully dilated and ready to push.
You May Still Feel It
Epidural anesthesia numbs the nerves in the lower half of your body. You're probably going to lose some sensation, but you'll still be able to feel something. Many women can't feel their contractions, but I still knew when mine were coming because I would feel pressure. When my baby crowned, I also felt a burning sensation. The pain may have been dulled, but it still hurt, especially to push her that last little bit out.
You Still Have Work To Do
You may be experiencing relief from the pain of contractions, but you're not on Easy Street just yet. You still have to do the work of pushing. The epidural can help you be alert and an active participant in your own labor, so that's a plus. You'll still need all the focus and strength you can muster, especially since the epidural can inhibit your bearing-down reflex. You might need an assist via forceps or, like me, the vacuum extractor and an episiotomy (these are more common in medicated births). But however you get there, the end result is the same: a beautiful baby. It's a pretty good deal, if you ask me.