Discussing pain management is a huge part of a prenatal class. There are many options to choose from depending on a variety of factors and your stage of labour.
One of the biggest decisions about pain management in labour is an epidural. It’s venturing into the unknown for a lot of mamas and the thought of having a needle put into your spine can be frightening to some.
So let me ease some of your fears and explain epidurals. Even if you are not planning to have an epidural in labour, it’s a good idea to be informed about the procedure in case your labour doesn’t go as you had planned.
Who can get an Epidural?
Pretty much any mama can get an epidural, with a few rare exceptions. Mamas with issues with their spine, or who have a history of bleeding problems or brain trauma, may not be able to receive an epidural. Back tattoos are rarely an issue with epidurals. If you are unsure if an epidural is safe for you, you can request an Anesthetic Consult to discuss your medical history and concerns.
How does an Epidural Work?
The Epidural Space is a tiny space in-between the ligaments that help your spine move and the dura – the thin membrane that keeps your spinal fluid where it is suppose to be. When the epidural is injected, a combination of a local numbing medication and a narcotic (typically Bupivicane and Fentanyl) is used to numb the nerves in the spine providing pain relief.
What can I expect with an epidural?
First off, when you request an epidural, your labour progress will be assessed. Getting an epidural too early in labour can slow the labour process. Whereas getting it too late and when you are close to giving birth, it may not provide you any pain relief. If it is too early or late for an epidural, then other pain control options should be offered to you.
Next you will need Intravenous (IV) access and blood work done. At most birth sites, this is done upon admission to the labour unit. Like mentioned before, certain medical problems can prevent you from getting an epidural, so we want to make sure your blood work is normal. One of the most common side effects of an epidural is lowering of your blood pressure. An IV allows your nurse to provide you with fluids to counteract that potential drop.
Then you will meet the Anesthesiologist. They will come in and explain the procedure and the risks and obtain your consent. Your consent is needed for any procedure in the hospital. Once you consent, they can proceed.
The epidural procedure itself takes anywhere between 5 – 15 minutes to put in place. You’ll need to sit in a hunched over position, but your nurse or midwife will help you with that. Once the epidural is in place it’s secured with tape. You should notice your contractions will feel shorter or easier fairly soon after the epidural is inserted, but it will take up to 30 minutes to reach it’s full effectiveness. Epidurals can also be used to provide pain relief if you require a instrumental vaginal delivery or a cesarean section.
Once you have a epidural you will most likely have to stay in bed. Because of the way the medication works, you legs may not be stable enough to hold your weight for a trip to the bathroom. This means you will also need a catheter to empty your bladder. Typically 2 hours after the epidural is stopped, you are able to get up and walk safely again.
Will my Epidural Wear Off?
This is a common question. Birth is NOT a sensation-free process – you are having a baby come out of your body, and no matter how much pain medication you receive, you will still feel something. Epidurals numb the tiny nerves which take away the sensation of pain and cold. They do not take away sensations like pressure which are larger nerves. The good thing is that with an epidural you will still feel an urge to push, but having an epidural may prolong the pushing process by up to 30 minutes.
Epidurals give you a consistent dose of medication throughout your labour. Imagine a line across a piece of paper. If your pain level is below that line, you will be comfortable. As your labour progresses, especially if you progress quickly, your pain level may rise above that line causing you to feel pain again and is why people believe it wears off. If this happens, your epidural dose can be adjusted to make you comfortable again.
If you are interested in learning more about epidurals and other pain relief methods for labour, contact your local Mama Coach for a private or group prenatal class.