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decision pointShould I use epidural anesthesia during childbirth?

The key to managing labor pain is feeling as in control as possible, both mentally and physically. To ready yourself in advance, arrange to have continuous support during your labor, and research your pain control options, including nonmedication pain management, breathing techniques, and types of pain medication and anesthesia. For more information, see the Labor and Delivery: Your Birthing Options section of the topic Labor, Delivery, and Postpartum Period.

Labor pain is unpredictable. Your labor pain may be manageable without pain medication, or it may become severe and exhausting. Unmanageable labor pain can increase your anxiety and muscle tension, which can prolong labor. Although relieving labor pain can speed labor, numbing all pain and feeling with anesthesia can slow labor. It's best to achieve a balance, so you can walk and change positions as well as push during contractions until your baby is born.

Even if you'd prefer to manage your labor pain without medication, you may want to prepare yourself with a plan for treating labor pain with medication. Consider the following when deciding about using epidural anesthesia, which is most commonly offered for pain during labor and delivery:

  • Epidural anesthesia is considered the most effective and easily adjustable type of pain relief for childbirth.1
  • A light epidural dose doesn't fully numb you below the waist, making it possible for you to move around and to push during contractions.
  • A light epidural reduces the standard-epidural risks of having a slowed or stalled labor and needing an assisted (forceps or vacuum) delivery or cesarean delivery.2
  • Medication given by epidural is unlikely to affect your baby. However, fetal heart monitoring is often used along with epidural anesthesia to make sure that the baby is doing well during the labor.

What is epidural anesthesia?

Epidural anesthesia is considered the most effective and easily adjustable pain medication for childbirth.1 It can be used to partially or fully numb the lower body, either allowing you enough feeling to push with your contractions or blocking all feeling for a cesarean delivery if that becomes necessary. With a low dose of medication (light epidural), you may also be able to walk around, which can make you more comfortable.

Epidural pain medication is given through a very thin tube (epidural catheter) into the area surrounding the spinal cord, within its outer membrane (epidural space ). From the epidural space, medication goes through the membrane directly to the spinal nerves that cause feeling in the lower body. Meanwhile, you remain alert, because the medication doesn't travel through your blood to your brain and central nervous system.

Because epidural pain medication doesn't go directly into your bloodstream, your baby is unlikely to be affected. (Research data aren't yet clear enough to say that there are no effects.)2 By comparison, when medication is given through a vein (intravenous, or IV) or by injection into a muscle (intramuscular), it travels to your baby across the placenta after an hour or so. If your baby is born before the medication wears off, he or she may suffer side effects such as breathing difficulty and grogginess (which are reversed at birth with another medication).

A combination spinal-epidural anesthesia is gaining more use for labor and delivery. Before the epidural line is installed, medication is injected into the spinal fluid around the spinal cord. This spinal injection acts more quickly than the epidural will. Then the epidural line is placed and used for ongoing anesthesia needs.

What are the benefits of epidural pain relief?

  • Once an epidural line is installed, you can quickly receive pain medication if and whenever you need it during labor and delivery.
  • With an epidural, your pain medication dose can be given continuously and adjusted as needed, rather than wearing off during labor. In some hospitals, you can safely give yourself more pain medication when you need it by pushing a button attached to a medication pump.
  • Epidural anesthesia is unlikely to affect (depress) the central nervous system, so you and your newborn can be alert after delivery.
  • If you were to develop a need for a cesarean delivery, the epidural medication could be used to quickly numb the area below your waist for the surgery.

What are the drawbacks and risks of epidural pain relief?

With an epidural, you may not be free to leave your bed to walk or use the bathroom. Talk to your health professional about:

  • Having medication light enough that you can walk or at least stand. Walking and changing positions helps you feel more comfortable during labor.
  • Whether the required fetal heart monitoring and IV line can be adjusted to allow walking.

Epidural anesthesia using standard medication doses increases your risk of:

  • Having a prolonged labor. The average epidural labor takes an extra hour to deliver the baby.2 (Some studies suggest that epidural labors are no longer than average labors when medication is not given until the cervix is at least 4cmdilated.3)
  • Having a drop in blood pressure (hypotension), which can lower your baby's heart rate. This is why you receive fluids through an intravenous (IV) line beforehand and why you're encouraged to lie on your side, which improves blood flow.
  • Being unable to feel your contractions and to push. This increases your risk of needing an assisted (forceps or vacuum) delivery and possibly your chance of needing a cesarean section you wouldn't otherwise have needed.2
  • Having your baby move into the wrong position (malposition) because of slack pelvic muscles and a slack uterus. This increases your risk of needing an assisted (forceps or vacuum) delivery. Some experts question whether malposition may happen first, causing pain that leads a woman to ask for an epidural.2 Talk to your health professional about his or her experience with this problem.
  • Having a seizure related to the medication. This is very rare.

After childbirth with an epidural, you may have:

  • Back soreness at the catheter site during recovery. This is uncommon. Some women fear that an epidural causes chronic back pain-studies have not shown a connection between new back pain and epidural use.2
  • Severe, prolonged headache after delivery, when the spinal cord sheath has accidentally been punctured during the procedure. A puncture occurs in about 3% of women receiving an epidural. About 70% of these women develop the headache after childbirth. The puncture is repaired by an anesthesiologist, using another injection in the puncture area. This usually relieves the headache.

Spinal-epidural anesthesia carries the same types of risks as an epidural alone.3

For more information, see the topic Labor, Delivery, and Postpartum Period.

Before going into labor, learn as much as you can about all pain management options available to you. Because labor pain is unpredictable, include as many choices as you can in your birth plan-you may end up using several. Your choices include managing your labor and delivery pain:

  • Without medication, using such techniques as special breathing patterns, position changes, massage, and distraction.
  • With standard or light epidural anesthesia, possibly combined with a spinal injection.
  • With an injected narcotic (opioid), which gives you short-term anxiety relief and lessens your labor pain.
  • With an injection of numbing medication in your lower pelvis to block delivery pain (pudendal block) for an hour or so. This is one of the safest forms of anesthesia for numbing the area where the baby will come out.

The decision about whether to have an epidural takes into account your personal feelings and the medical facts.

Deciding about an epidural
Reasons to have an epidural Reasons not to have an epidural

An epidural may be a good pain control choice if you:

  • Have the option of a light epidural that allows you some feeling and mobility.
  • Have an increased chance of cesarean delivery after labor has started, such as during a vaginal birth after cesarean (VBAC) or twin delivery. (You can remain awake during the surgery when using epidural anesthesia.)
  • Are in labor and nonmedication measures aren't controlling your pain well enough.
  • Have a low tolerance for pain and worry that you won't be able to control it without medication.
  • Have considered IV or intramuscular injections of an opioid but are concerned about the side effects on you and your baby.

Are there other reasons you might want to have an epidural?

 

 

Consider other pain-control choices if you:

  • Are opposed to using pain medication.
  • Hope to avoid having an intravenous (IV) line.
  • Are concerned about the risks of epidural anesthesia.
  • Are concerned about needing an assisted delivery because of the effects of an epidural. (Pain relief with an opioid is less likely to lead to a forceps or vacuum delivery.4)
  • Have a history of rapid labor and don't expect to have time for an epidural to be placed.
  • Have an infection in the area where the epidural would be placed.
  • Have a bleeding disorder or a low platelet count. This would make bleeding into the epidural space more likely.
  • Have a spinal deformity that would make it difficult to place the epidural.

Are there other reasons you might not want to have an epidural?

 

 

 

These personal stories may help you make your decision.

Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about epidural anesthesia and other pain control measures. Discuss the worksheet with your health professional.

Circle the answer that best applies to you.

I have a physical condition that makes epidural anesthesia unsafe. Yes No Unsure
I'm keeping my options open, because I don't know what will happen during childbirth. Yes No Unsure
I don't know whether I'll ask for an epidural, but I will consider it if I have enough pain. Yes No Unsure
I want no pain at all-I want an epidural as soon as they can give me one. Yes No Unsure
I want to be able to walk around when I'm in labor. Yes No Unsure
I want to be able to feel my contractions, so I can push when it's time and have a regular vaginal delivery. Yes No Unsure
I am concerned that an epidural could prolong my labor. Yes No Unsure
I am concerned that an epidural could require an assisted delivery, which could cause painful perineal tearing or injure my baby. Yes No Unsure
I won't be using pain medication, no matter what happens. Yes No Unsure

Use the following space to list any other important concerns you have about this decision.

 

 

 

 

 

What is your overall impression?

Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to use or not use epidural anesthesia.

Check the box below that represents your overall impression about your decision.

Leaning toward having epidural anesthesia

 

Leaning toward NOT having epidural anesthesia

         
  • Labor, Delivery, and Postpartum Period
  • Pregnancy

Citations

  1. American College of Obstetricians and Gynecologists (2004). Pain relief during labor. ACOG Committee Opinion No. 295. Obstetrics and Gynecology, 104(1): 213.

  2. Eltzchig HK, et al. (2003). Regional anesthesia and analgesia for labor and delivery. New England Journal of Medicine, 348(4): 319–332.

  3. Poole JH (2003). Analgesia and anesthesia during labor and birth: Implications for mother and fetus. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 32(6): 780–793.

  4. Cunningham FG, et al. (2005). Forceps delivery and vacuum extraction. In Williams Obstetrics, 22nd ed., pp. 547–563. New York: McGraw-Hill.

Author Kathe Gallagher, MSW
Associate Editor Terrina Vail
Primary Medical Reviewer Renée M. Crichlow, MD - Family Medicine
Specialist Medical Reviewer Kirtly Jones, MD - Obstetrics and Gynecology
Last Updated January 7, 2010

WebMD Medical Reference from Healthwise

Last Updated: January 07, 2010
This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.

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