An epidural is an injection in your back, near the nerves that carry pain signals from the lower half of your body. It is a popular method of pain relief during childbirth. There isn't a universal best time to get an epidural during labor — your needs and your doctor's assessment will be the guides. An epidural injection is a powerful tool and must be used with caution and knowledge.
Pain relief during childbirth can be a necessity. You should discuss epidurals with your doctor or midwife during your antenatal visits and write them into your birth plan. Your doctor may tell you about other methods of pain relief also — medicines given by injection into your thigh or intravenously, spinal blocks, combined spinal epidurals, and local pain medicines.
Non-medicinal methods include Lamaze, acupuncture, and massage. Epidurals are the most frequently used method for pain relief during childbirth — 61% of people having a vaginal delivery opt for them.
What Is an Epidural?
An epidural is an injection of local anesthetic given into the space around your spinal cord and nerves. It numbs the lower part of your body, giving you substantial relief from pain. Doctors use epidural injections for:
- Pain relief during childbirth, including cesarean sections
- Numbing the lower half of the body for surgery
- Pain relief after some types of surgery
- Pain relief for sciatica or slipped disc, in combination with steroid medicines.
Epidurals are also known as epidural anesthesia, epidural block, and regional anesthesia. Your doctor will inject local anesthetic drugs such as bupivacaine, chloroprocaine, or lidocaine. Sometimes, they combine these medicines with narcotics like fentanyl or sufentanil to decrease the required dose of local anesthetic. Epidurals start working 10 to 20 minutes after the first dose is given.
Are Epidurals Safe?
Yes, epidurals are safe. They're a form of local anesthesia and only affect the small area of your body where the medicine is injected. Epidurals won't usually make you drowsy or sick.
Some medicines for pain relief during childbirth cross the placenta and affect your baby. Babies may have breathing difficulty at birth and need a medicine injection to reverse the effect of these medicines. Epidurals are safe for your baby.
Only small amounts of the medicines used in epidurals reach your bloodstream and your baby. Epidurals do not affect your baby's Apgar scores or the chances of needing intensive care.
Do epidurals increase cesarean sections? Epidurals let you feel the pressure from uterine contractions (without the pain) and retain your ability to push the baby when needed. They don't lead to fetal distress or the baby getting stuck. Epidurals don't increase the possibility of cesarean section, vacuum extraction, or forceps delivery.
Do Epidurals Work?
Epidurals numb your body from your belly button to your toes. You will be awake and alert and able to feel the pressure of contractions. You'll be free from pain but able to push when needed.
Epidurals are used during labor and if you need a cesarean section. The anesthesiologist will give additional medicine through the epidural catheter to numb your body for surgery.
About 10% of birthing parents do not get adequate pain relief and must have further pain control measures.
How long does the epidural last? As long as you need. More medicine can be injected through the catheter if you start feeling pain. Once an epidural catheter is in place, your midwife can give top-up doses. When the epidural catheter is removed, your sensations and strength in your legs will return in about an hour.
Epidural Side Effects
An epidural is a powerful tool for pain relief. It blocks transmission in the pain sensation nerves and affects nearby nerves. You will feel weakness in your legs and be unable to walk for some hours. Other side effects:
- Tingling sensation in your skin.
- Placing the catheter may cause you some discomfort.
- Low blood pressure. You may feel lightheaded or nauseous
- Itchy skin
- Incontinence (inability to control urination)
- Nerve damage
How Do Epidurals Work?
Epidurals are a skilled procedure usually performed by anesthesiologists.
- They'll ask you to sit leaning forward or lie on your side with knees drawn up to your chest.
- They'll give you an injection of local anesthetic in your skin to numb the area.
- Once your skin is numb, the anesthesiologist will introduce the epidural catheter on a needle.
- After they judge they've reached the right place, they withdraw the needle, leaving only the flexible catheter in place.
- This catheter is used to inject measured amounts of medicine.
Your doctor will usually give you an intravenous drip. They will also monitor your baby's heartbeat with a fetal monitor.
When the epidural is stopped, you should rest in a lying or sitting position till your legs feel strong again. You shouldn't drive, operate machinery, or drink alcohol for 24 hours after having an epidural.
When Is the Best Time to Get an Epidural?
There is no definite time. You can have it when you want it — at the beginning of labor, in the middle, or toward the end. The anesthesiologist will want to be sure that you are actually in labor and that you can stay still for the few minutes they need to precisely place the epidural catheter.
When is it too late? It takes 10 to 15 minutes to set up an epidural and an additional 10 to 15 minutes for you to feel relief from the pain. If you ask for an epidural shortly before you deliver, there may not be enough time for it. It's best to ask for it before your labor is advanced and the pain is overwhelming.
Labor and delivery can be intensely painful. It is no longer considered acceptable for birthing parents to suffer pain when safe, effective treatment is available. Epidurals are given by an anesthesiologist, so you can't have one at home or a birthing center. Remember that you can choose to have an epidural during labor even if you had decided against it earlier. An epidural allows you to stay calm and focus on delivering your baby.