Pain Management

Epidural shot. Nurse comforting pregnant woman, doctor gives Epidural.
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Everything You Need to Know About Getting An Epidural

OBs explain the truth behind the pain management medication.

Pain management is a very personal decision when it comes to labor. That might explain why if you’re thinking about ways in which to minimize the discomfort during delivery, you’re obviously going to think of an epidural. But like all things that pertain to pregnancy, it’s better to be informed so that you can make an educated decision about how to handle the hurting. So if you’re wondering what is an epidural, how it works, (and most importantly, how it could affect Baby), read on.

What Is An Epidural?

What can freak some folks out is that unlike any other needle you’ve probably been poked with, an epidural needle goes into your spine. Even more unnerving is the fact that you’re often warned by your labor and delivery team (the anesthesiologist, your , an OB/GYN and the labor and delivery nurse) to remain completely still while said needle is being inserted into your back. No easy feat, particularly if you feel an eye-crossing contraction coming on. “An epidural is an anesthetic procedure that introduces a tiny catheter into the area surrounding the spinal cord that is covered with dura and bathed in fluid known as cerebrospinal fluid,” Dr. Kim Langdon, MD, an OB/GYN tells Romper. “A drug, or anesthetic, is infused into the epidural space outside of the dura.”

Does Getting An Epidural Hurt?

Sure, getting a needle stuck into your spine sounds like it would be pretty painful, but the actual injection of the epidural needle won’t hurt as much as you anticipate — it should probably pinch at best. “Typically, anesthesiologists will numb the area with a benzocaine or some sort of lidocaine derivatives,” Dr. Vonne Jones, MD, OB/GYN, board-certified physician, providing care to women at Total Women's Care, in Houston, TX tells Romper. “But it usually doesn't hurt when the catheter is placed.” She says that sometimes when the epidural is being put in, the anesthesiologist may ask if you’re feeling any pain on the left or right side, just to ensure proper placement. But if anything, Dr. Langdon says, “Pressure is the usual symptom”, as the catheter is inserted.

When Is An Epidural Given?

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When you actually get the epidural can vary, but it can depend on how far along you are in labor and your pain threshold. “Usually an epidural is given when the patient can no longer bear the contractions,” says Dr. Langdon. “An epidural is also given during a Cesarean section and other procedures that need numbing below the abdomen.” But also keep in mind that if you are delivering vaginally and close to pushing, your doctor might make the call that you’re too close to childbirth to get an epidural, so give some thought before you have Baby whether or not you want the option of an epidural included in your birth plan.

Can You Walk With An Epidural?

After your epidural is inserted and starts kicking in, you’re probably going to start feeling pretty fine. So fine, in fact, that you might just want to get up and take a walk around the hall. But not so fast there, momma. Once you get an epidural, you’re pretty much bound to your bed, says Dr. Kecia Gaither, MD, MPH, FACOG, a double board-certified in OB/GYN and Maternal Fetal Medicine, and Director of Perinatal Services at NYC Health + Hospitals/Lincoln. “With an epidural, you will not be able to walk during labor,” says Dr. Gaither. But once you’ve delivered, you’ll be able to walk around again, trusting that you’re steady on your feet. “Upon delivery, the epidural is removed and you’ll have the ability to feel and resume walking within a short period of time,” she says.

How Long Does An Epidural Last?

Once your epidural is in place and working, “there is a continuous infusion of the drug until the catheter is removed,” explains Dr. Langdon. You might even a control to give yourself a boost of the medication as needed, though it will be regulated so that you cannot overdose on the pain medication. and it’ll be set so that you can’t give yourself too much. "Once the epidural is removed, the medication will most likely wear off in about two hours," per University of Michigan Medicine.

That said, there might be a time when you have to put a pause on the pain meds. “If we’re concerned and we want to get the baby out sooner rather than later or the baby’s vitals start to change, then we can turn down the epidural and allow for some of that sensation to come back in order for us to get the baby out,” says Dr. Jones.

What Are The Risks?

Although an epidural can alleviate a lot of pain when it’s time to push, the procedure is not without its own set of risks. “You might experience fetal bradycardia, which is a low fetal heart rate, to pruritus, which is when your skin itches,” says Dr. Gaither, who adds that you could also get a fever or suffer a potential injury to nerves. But that's not all. “An epidural can lead to a spinal headache if there is inadvertent leakage of the spinal fluid from the spinal canal,” says Dr. Langdon. And in the study, Epidural versus non-epidural or no analgesia for pain management in labour, researchers found that women who opted for an epidural had “more hypotension, motor blockade, fever, and urinary retention.” If you’re worried about the potential risks, you can always discuss non-medical pain relief options during delivery, such as hypnobirthing and massage.

Is An Epidural Timed?

Once you get a taste of the good stuff, you probably won’t want your epidural to end — like, ever. Don’t worry, there’s no time limit when it comes to how long you can have it for. “An epidural is placed on a pump to give doses of anesthetic, so time really isn't an issue,” says Dr. Gaither. You’ll probably be given a button to press each time you feel that your epidural is starting to wear off, and that button will become your BFF during labor and delivery. “Once fully dilated, [the] pump is generally discontinued such that the mother can feel to push,” Gaither explains.

Can An Epidural Slow Down Labor?

It’s a complete Catch-22. Once you’re in active labor, you’ll mostly likely want your epidural to last as long as possible. But by having an epidural in place, it can actually slow down the progress of your labor, as the study Influence of combined spinal-epidural analgesia and epidural analgesia on the progress of labor found. In addition to making active labor longer than it may have been without an epidural, it can make a person’s ability to push ineffective, says Dr. Gaither, which is why the epidural pump is turned off during delivery.

Does An Epidural Affect The Baby?

This might be one of the biggest worries of a mama-to-be: Will the epidural adversely affect Baby? “The epidural is not going to harm the baby,” says Dr. Jones. “The epidural medication is going into the spinal cord of the mom, and if the blood pressure goes down drastically after an epidural, then that can sometimes affect the blood flow going to Baby.” That’s why you and your baby are constantly being monitored during labor and delivery to ensure that it doesn’t happen, Dr. Jones says. “But if that event happens, and we give the mom fluids and there's a medication that the anesthesiologist would administer.”

Will You Feel Pain During Labor If You Have An Epidural?

Here’s the thing about an epidural. While it can take away the serious sting from contractions, it might not completely render you pain-free either. While you might watch the tocodynamometer (the machine that monitors your contractions) and see them coming and going and feel nary a thing, at some point you might feel pain. Most likely with a good epidural, though, “The mother can feel pressure during labor,” says Dr. Gaither. And hopefully, nothing else.

It’s a deeply personal decision whether to get an epidural or not during labor and delivery. Ultimately, you have to listen to your body and, without the influence or judgment of anyone else, determine what makes the most sense for you and your baby.

Studies referenced:

Anim-Somuah, M., Smyth, R., Cyna, A., Cuthbert, A. “Epidural versus non-epidural or no analgesia for pain management in labour” 2018.

Zhang, M., Yang, H., L, H., Shi, H., Qu, Y. “Influence of combined spinal-epidural analgesia and epidural analgesia on the progress of labor” 2005.

Experts:

Dr. Kim Langdon, MD, an OB/GYN with Medzino

Dr. Vonne Jones, MD, OB/GYN, board-certified physician, providing care to women at Total Women's Care, in Houston, TX

Dr. Kecia Gaither, MD, MPH, FACOG, a double board-certified in OB/GYN and Maternal Fetal Medicine, and Director of Perinatal Services at NYC Health + Hospitals/Lincoln