Epidural – Pain relief during labor or delivery

Labor pain feels different for every woman. Some women may feel a lot of pain and others may not. The size and position of your baby and the strength of your contractions can affect the amount of pain you feel. Some women are helped manage their pain by using breathing and relaxation techniques.

An epidural delivers continuous pain relief to the lower part of your body while allowing you to remain fully conscious. It decreases sensation, but doesn’t result in a total lack of feeling.

The medication is delivered through a catheter – a very thin, flexible, hollow tube – that’s inserted into the epidural space just outside the membrane that surrounds your spinal cord and spinal fluid. An epidural is the most commonly used methods of pain relief for labor.

First, you’re given a small “test dose” of medicine to be sure the epidural was placed correctly, followed by a full dose if there are no problems. Your baby’s heart rate is monitored continuously, and your blood pressure is taken every five minutes or so for a while after the epidural is in to make sure it isn’t having any negative effects.

The medication delivered by the epidural is usually a combination of a local anesthetic and a narcotic. Local anesthetics block sensations of pain, touch, movement, and temperature, and narcotics blunt pain without affecting your ability to move your legs. Used together, they provide better pain relief with less loss of sensation in your legs and at a lower total dose than you’d need with just one or the other.

You’ll start to notice the numbing effect about ten to 20 minutes after the first dose of medication, though the nerves in your uterus will begin numbing within a few minutes. You’ll receive continuous doses of medication through the catheter for the rest of your labor.

You may also have the option of patient-controlled analgesia, which means that you can control when you get more medication via a pump that’s connected to the catheter.

After you deliver your baby, the catheter will be removed. Having the catheter removed doesn’t hurt at all beyond the sting of having the tape pulled off.

Best time to get an epidural

Many practitioners wanted a woman to be in active labor before starting an epidural due to a concern that it might slow down her contractions. These days, most caregivers will allow you to start an epidural whenever you ask for it.

If you arrive at the hospital before you’re in active labor and you know you’re going to want an epidural, you can ask the anesthesiologist to place the catheter as soon as you’re settled in your bed. Then you can wait to start the medication when your labor becomes active.

Or you can wait and see how you feel. It’s never too late to get an epidural unless the baby’s head is crowning. The only risk of waiting is that the anesthesiologist may be busy and you may have to wait a bit longer for her to arrive once you decide you want the pain medication.

Advantages to have an epidural

  • An epidural provides a route for very effective pain relief that can be used throughout your labor.
  • You may still be aware of your contractions, and have a clear mind, but you’ll feel no pain.
  • Unlike with systemic narcotics, only a tiny amount of medication reaches your baby.
  • Once the epidural’s in place, it can be used to provide anesthesia if you need a c-section or if you’re having your tubes tied after delivery.
  • If you have high blood pressure, it can help to lower it.
  • It can be topped up with stronger local anaesthetic if you need an unplanned caesarean.

Disadvantages to have an epidural

  • It may make you feel shivery.
  • It may cause itching, particularly if you have a CSE, but it’s not usually severe.
  • You may develop a fever.
  • You will need to stay in bed, as your legs are likely to feel weak or heavy. Even if you are able to shuffle around on the bed, you won’t be able to walk around. Not many hospitals offer true mobile epidurals.