Many women find the pain of labor too intense to bear without effective pain relief, and an epidural analgesia provides the best pain relief compared to all other methods. In the US, more than 80 percent of first-time moms ultimately have an epidural analgesia, other take a wait and see attitude.
How It Works
Epidural analgesia works by delivering very small doses of an anesthetic through a hollow tube to the epidural space, which surrounds the spinal cord. The anesthetic numbs nerves from the waist down, including the uterus. Epidurals are given by an anesthetist. You will have to bend forward so that he or she can guide the hollow tube through a needle and in to the correct position. You will have a local anesthetic first, which may sting a little, but other than that you shouldn’t feel any pain as the epidural is placed. Once the tube is in position, it is taped to your back to secure it so that more anesthetic can be given easily at any time.
An epidural takes about 20 minutes to administer. Most women notice pain is reduced almost immediately, but the full effect may take 15 to 20 minutes. The benefits of epidural analgesia are that pain control is excellent and that very little medication escapes in to your blood stream. This means that you are mentally alert, and your baby is not sleepy after birth from pain medication crossing your placenta. The other benefit of epidural analgesia is that medication is being given continuously, so you have pain relief for the entire duration of labor.
Types Of Epidural
More modern epidurals, such as the mobile epidural use the least amount of medication possible, allowing you to move your legs (but not usually walk) and to feel pressure as the baby’s head moves down the birth canal. Women who feel pressure can push more effectively, reducing the likelihood that they will need a cesarean or forceps delivery. Some hospitals allow you to control the epidural yourself by pressing a button that slowly releases more of the analgesic. Another type is the combined spinal epidural analgesia, in which a small amount of medication is injected in to the spinal space before the epidural tube is placed. This provides faster pain relief and is often used for women who are close to delivery when the epidural takes place, or when a cesarean delivery is needed.
Timing The Epidural
Many physicians will delay offering an epidural until you are 4cm dilated. However, this is an arbitrary cut off, so if your pain is very intense an early epidural is still an option. Discuss the various scenarios with your care provider before you go into labor.
Like all medical interventions, epidural analgesia has side effects for you and for your baby, although the chance of a serious side effect is very small.
Most studies of epidural analgesia suggest that contractions are weakened, which means there’s more chance that you will need oxytocin to return your contractions to their normal strength. On average, choosing epidural analgesia will prolong the active phase of labor by about one hour. Epidural analgesia can also prolong the pushing stage of labor by up to an hour. Since the pushing stage is often exhausting, an epidural can make it more likely that your care provider will suggest a forceps delivery.
Increased Use Of Forceps
Epidural analgesia decreases your ability to push effectively and approximately doubles the chances that you will have a forceps or vacuum assisted delivery. Asking for your epidural analgesia to be turned down before you start to push may increase your chances of being able to push effectively and avoid a forceps delivery.
Choosing epidural analgesia quadruples your risk of developing a fever during labor. Although most experts don’t believe the fever is related to infection, you may end up being given antibiotics during labor. The longer you have the epidural, the more likely you are to have a fever.
Inadequate Pain Control
About 9-15 percent of women still have significant pain despite epidural analgesia. While this can sometimes be treated by giving additional medication, or by replacing the epidural catheter, pain control cannot be achieved in all women.
Up to 26 percent of women with epidural analgesia will have itching, which is usually treated with IV medication.
Rare Side Effects
There is a small risk that the anesthetist may puncture the sac covering the spinal cord, causing spinal fluid to leak out. This can result in a severe headache that may be difficult to treat.
Myths About Epidural Analgesia
One of the big myths about epidural analgesia is that it is responsible for chronic back pain. But studies have found instead that pregnancy it self is responsible for back pain. Women who have back pain during pregnancy are more likely to have back pain after they have delivered. While you may have a sore spot and a small bruise on your back after epidural analgesia, choosing epidural analgesia does not place you at higher risk for long term back pain. A second popular myth is that it will affect your ability to breastfeed. However, most studies have not found that epidural analgesia affects ultimate breastfeeding success. Your baby is much more likely to be sedated after large doses of narcotics given by injection, than from the small amount of narcotics used in epidural analgesia.