More than 50 percent of all women will receive an epidural to control their pain during labor and delivery, according to the American Pregnancy Association. Ideally, the epidural should be administered before the baby’s head crowns.
It takes approximately 15 minutes for an anesthesiologist to place the catheter and start administering the anesthesia. Once the anesthesia has been administered then it can take up to 20 minutes before you start to experience any pain relief. If labor is moving at an accelerated rate and the baby is crowning then it may be too late to get an epidural.
What is an Epidural?
An epidural is a form of regional pain relief that is used during childbirth to block out lower body discomfort. It significantly lessens the misery of contractions and childbirth. You can still push during active labor but the pain is dramatically reduced. It blocks the nerve impulses in the spine.
It is often used in a combination with epinephrine, fentanyl, morphine, or clonidine. You will need to ask your doctor to determine which drug combinations he will be using to bring you relief. On rare occasions, an epidural may also be used to stabilize your blood pressure during delivery.
How is an Epidural Administered?
You will be asked to sit up with your back arched or lay on your left side. Your lower back will be cleaned and disinfected with an antiseptic. An area of your back will be numbed using a local anesthetics.
A large needle is then inserted into the area around your spinal cord. A catheter is threaded through the needle into your back. The catheter is used to administer the medications periodically during your labor as needed. After labor, the catheter is removed.
When Can You Receive an Epidural?
Most anesthesiologists ask their patients to wait until they are at least five centimeters dilated to receive an epidural. They typically suggest waiting because the epidural can slow down labor. However, other doctors allow their patients to obtain an epidural upon request.
A spinal epidural is called a Combined Spinal-Epidural (CSE) or “Walking Epidural”. When the epidural is placed, a narcotic is injected in combination with the anesthetic. The placement of the catheter allows you to move. If the discomfort becomes too severe, you can request additional medication to control the pain level.
There are several benefits to an epidural/spinal combination.
- Pain relief is achieved within 10 minutes of administration.
- The epidural remains if the labor lasts longer than a few hours and the spinal wears off then additional medication can be administered.
- The epidural is in place if an emergency C-section is required.
Is an Epidural Safe?
Many women worry about the procedure’s safety. Overall, it is a safe pain control method with numerous benefits.
- A very reliable pain control method
- Alleviates tension
- It allows the mother to remain awake if a c-section is required
- By removing the pain and tension the cervix relaxes which can hasten delivery
- Helps the entire labor and delivery process be a positive, relatively pain-free experience for the mother.
Disadvantages of an Epidural
Although an epidural is a blessing for many mothers. There are a few disadvantages.
- In about 5 percent of women, an epidural is not effective or they may experience only one-sided pain relief. If such a reaction should occur the anesthesiologist can usually adjust the medications to gain full pain reduction.
- Although it relaxes the cervix to accelerate dilation it lessens the effectiveness of contractions.
- The mother’s body temperature can increase which also increases the baby’s temperature.
- Some women are less effective at pushing so may require a forceps or vacuum delivery.
- Bladder emptying becomes difficult
- The mother may experience a severe headache if the procedure is not done correctly.
- The relaxed vaginal muscles may not effectively turn the baby’s head as needed for delivery.
- There may be back pain that persists for weeks after delivery if the anesthesiologist is inexperienced.
What the Experts Say
“Each patient has the choice,” says Ferne Braveman, MD, director of obstetrics and gynecological anesthesiology at Yale Medicine, and professor of anesthesiology and of obstetrics, gynecology, and reproductive services at Yale School of Medicine. “The epidural is the best pain relief in terms of quality, but not all patients need that level of pain relief and not all patients want it.”
“When epidural is used, it may be normal for labor to take two hours longer, and physicians don’t necessarily have to intervene, as long as women are progressing and the baby is OK,” said Dr. Yvonne Cheng, one of the researchers on the study and an obstetrician at University of California, San Francisco.
“The complication rate associated with epidurals is very small, and there is absolutely no risk of spinal-cord injury,” says Marjorie Meyer, M.D., a maternal-fetal medicine specialist at the University of Vermont College of Medicine, in Burlington.
“Combined spinal-epidural anesthesia offers significantly better and faster relief for patients in labor, [and] there was no increase in side effects or cesarean sections, either,” said Dr. Jennifer Wu, an Ob/Gyn at Lenox Hill Hospital in New York City. “For patients who desire pain relief in labor, this is good information.”
“I think there are still providers that were trained in the earlier era when they preferred their patients to receive an epidural in the later stages of labor,” said Dr. Neil Seligman a maternal and fetal medicine expert at University of Rochester Medical Center in New York. “The literature has been fairly consistent that epidurals do not meaningfully prolong labor.”
There is little doubt that an epidural is highly effective at pain relief during labor and delivery. It also poses very few risks. As soon as a woman starts to experience discomfort the epidural can be administered. It only becomes too late to get an epidural if labor is progressing at a rapid pace and the baby’s head has started to crown.