There are lots of things in modern medicine for which many of us are truly grateful, and close to the top of that list is the heaven blessed magic of the epidural. Having experienced labor both with and without it, I will tell you that I would sooner walk through broken glass in a pool of salt water before having another child without an epidural. But how does the process of pain management work if you don't choose to get it right away? When is it too late for an epidural?
When I had my first child 10 years ago, the popular research at the time suggested that if I were to get an epidural, I was up to twelve times more likely to end up getting a C-section than if I remained unmedicated. Desperately trying to avoid that fate, I chose to labor without it. After giving birth to my son, I reasoned that I would rather swallow a bag of darts dripping in hot sauce than do that again. A few years later, obstetricians were no longer advising their patients of this enhanced risk, and the women of the world sighed happily. The American College of Obstetricians and Gynecologists reported that the majority of women will receive some form of pain relief during labor with the most common being the combined spinal-epidural block (CSE). This can be given even in the very late stages of labor, according to Pregnancy, Childbirth, and the Newborn, at the anesthesiologist's discretion, up until the point wherein the baby is coming out.
Often, if delivery appears to be imminent within the hour, rather than an epidural your anesthesiologist may opt to give you an intrathecal injection of medication rather than an epidural.
When I went into labor with my daughter, the contractions were strange, and not painful in the beginning. There was a time when I worried that somehow my early, weird contractions were going to mean that I was not going to progress properly, and that I should hold off on the epidural. Then, I remembered the whole "I'd rather jump barefoot onto a pile of LEGOs first thing in the morning everyday for the rest of my life" than have an unmedicated birth, and called for an epidural. I was only 3 centimeters dilated, and I wasn't too proud to admit that I'd rather feel none of my labor than anything like the hell that happened to my uterus last time.
I think I proposed to the anesthesiologist by the time I watched the contractions surge moments later, because I felt nothing. Unlike the first time, when I decided to go wholly unmedicated and by the time I realized that I wanted one, I was already crowning. But would I have had a cut-off time this second birth? I contacted anesthesiologist Dr. Leif Dahleen to find out. He tells Romper, "A labor epidural does take a little time to set up and give optimal pain relief. If your cervix is fully dilated and you feel ready to start pushing, you've missed that window for an epidural."
However, all may not be lost. "If you're close to that point and the anesthesiologist is immediately available, there may still be time if you can remain relatively still for a few minutes between contractions," he adds.
Dahleen does say that there are options doctors have. "Often, if delivery appears to be imminent within the hour, rather than an epidural your anesthesiologist may opt to give you an intrathecal injection of medication rather than an epidural. The intrathecal is essentially a spinal anesthetic at a low dose that will take away much of the pain with those final contractions without making you completely numb." As someone who eventually did receive one of these after my son proved to be a compound presentation, I will tell you, it's way better than nothing.
However if you go into labor like I did and are planning to go unmedicated, there is a window when it's safe to get an epidural, so make sure you are comfortable with your decision and plan to ask yourself frequently during the process how you're feeling. If you don't want an epidural, that's completely up to you and completely OK, just know that when you're pushing, you're not going to be able to stop to get that medicated relief.
Dr. Leif Dahleen, anesthesiologist
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