Epidurals 101

Who: Epidurals aren’t just for laboring ladies—they may also be used to kill pain during C-sections and other medical procedures. You are likely eligible for an epidural unless you have certain rare blood, neurologic or back-related medical conditions. Talk to your doctor to determine if it’s a good choice for you.
What: An epidural, or epidural block, is an effective way of easing labor pains (or even making them completely unnoticeable) without negatively affecting mom’s energy or awareness. The medication is a mix of local anesthetics and narcotics that typically leaves your lower body pain-free. Depending upon how much medication you receive, you may have more or less sensitivity below the belt.
When: As you go into active labor—and the pains become tough to manage—you may decide to request an epidural (whether you were planning on it or not). Your nurse or doctor can confirm that the timing is right and call in an anesthesiologist or nurse anesthetist to make the injection. It may take up to 20 minutes to have the epidural inserted, medication started and catheter secured. Another 20 minutes max, and you’ll be feeling the relief.
Where: The needle is inserted in the lower back, into the epidural space beside the spinal membrane. This area is numbed beforehand, so while you will feel some pressure, you shouldn’t experience intense pain. A small catheter is passed through the needle; the needle is removed, but the catheter is taped to your back to remain in place. You’ll receive medication through this tube throughout labor. Because the flow of medication is continuous, the dosage can be increased or decreased as needed.
Ups and downs
Epidurals have become standard hospital procedure because they’re a quick and easy pain relief option with relatively few side effects. The baby is normally unaffected, and mom is typically able to advance through labor and push successfully while suffering much less.
However, some moms opt for as few interventions as possible, bringing on medical assistance only when it’s absolutely necessary. Having an epidural often requires mom to stay in bed throughout labor and delivery; strong doses of local anesthetic can weaken the leg muscles and dull the nerves so that standing really isn’t an option.
Epidural medication can also cause your blood pressure to drop, affecting baby’s heartbeat. Because of this possibility, fluids are usually delivered to mom intravenously, and baby is monitored occasionally or continuously.
In some cases, an epidural may slow labor and necessitate the use of Pitocin to speed up the process, and it can make pushing more difficult if the downward pressure and natural muscular urges are subdued. “However,” says Camann, “this is less likely nowadays with the lower-dose epidurals in common use.”
Very rarely, a laboring mom with an epidural will have trouble breathing or develop a painful “spinal headache” which lasts for days.
Good to know …
“Many hospitals today use ‘patient-controlled’ epidural techniques, which means that you, the patient, control the exact amount of medication you receive by using a button attached to the epidural infusion pump. This is very safe and allows you to give yourself just the right amount. And since no two labors, nor women, are alike, this allows a great deal of individuality in how much medication is administered,” says William Camann, MD, Director of Obstetric Anesthesiology at Brigham & Women’s Hospital and co-author of Easy Labor.