When it comes to pain management and labor and delivery, every woman’s labor and level of pain is different. Talk with your doctor about your options. Ultimately, the choice is yours.
Types of medications used for pain relief during childbirth
Analgesics: Pain medications (opioid and non-opioid) can be administered through an IV or injected into a muscle. They act on the whole body rather than on a specific area. They are not given right before delivery because they may slow the baby’s reflexes and breathing at birth.
Local Anesthesia: An injection that can provide numbness or loss of sensation in a small area, but does not lessen the pain of contractions. It does not require involvement of an anesthesia provider. For example, your OB provider may inject local anesthesia prior to an episiotomy.
An epidural is a procedure performed in your lower back by an anesthesia provider. You will be asked to sit up or lie on your side with your back curved outward until the procedure is completed. A small tube (catheter) is inserted through a needle and the needle withdrawn. In some cases, the catheter may touch a nerve and cause a brief tingling sensation in a hip or down a leg. The catheter is connected to a pump that continuously provides medication specifically to the nerves that sense pain in the area of labor contractions and delivery. Pain relief will begin within 5-20 minutes after the medication has been injected. Although an epidural block will make you more comfortable, you still may be aware of your contractions, or exams and the epidural can be adjusted, as needed. You also may notice numbness, heaviness or weakness in your legs, which is why you can move around in your bed after the epidural, but are usually not allowed to walk around. A catheter is inserted into your bladder after epidural placement, and is removed after delivery.
Who is eligible to receive an epidural?
Most women are able to receive an epidural as soon as they are in active labor. There are instances where it may not be safe to place an epidural, such as: women with excessive bleeding, significant preeclampsia, use of taking blood thinners, those with an inherited bleeding disorder and those with an infection of the lower back. If you’ve had lower (lumbar) back surgery, try to find out the exact procedure that was performed, as some types of back surgery can make an epidural placement challenging or not possible.
What are the benefits of the epidural?
The primary benefit of the epidural is excellent pain relief during labor and delivery. This is achieved by delivering small doses of medicine directly to the nerve roots that transmit the feeling of pain, with minimal drug exposure to the baby. The epidural catheter can also be used to deliver additional medicine for use during a cesarean delivery, or if vaginal birth requires an episiotomy or the use of forceps or vacuum.
A spinal is different than an epidural in that a spinal is a single injection, while the epidural has a catheter that stays in place until after the delivery. A spinal block is performed by an anesthesia provider. A small amount of medicine is inserted in the lower back into the spinal fluid. This can be used alone to provide a very significant and dense block, as is the case for a cesarean delivery, or in combination with an epidural for labor. Although it can be used alone for labor, it is usually not ideal because it can wear off before the delivery.
Are Epidurals Safe?
Many women chose to manage their pain during labor with an epidural. Although considered a very safe procedure, it is not without potential side effects. Epidurals may be associated with temporary soreness where the needle was inserted. The medication can lower your blood pressure, so you will be given extra fluids through an IV prior to epidural placement. Some women may get a headache after the procedure that is referred to as a postdural puncture or spinal headache. Although it will go away without treatment, it can be debilitating and commonly lasts several days up to a week or two. Please notify your health care team if you are experiencing a severe headache, so we can assess if it is associated with the epidural, and can discuss various treatment options with you. Serious complications such as bleeding, infection or nerve damage are extraordinarily rare. If the drug enters a blood vessel or the catheter is in the spinal fluid, it can have serious effects on your heart or breathing. There are various steps taken to ensure the proper placement of the catheter.
Women sometimes ask if an epidural can slow labor or lead to a cesarean section. There is no evidence that it does. If you are having difficulty sensing your contractions and your ability to push your baby through the birth canal is affected, the epidural can always be adjusted.