What they Don’t tell you about getting an epidural
Epidurals are magical! There is no question about that. They allow women to have practically pain-free experiences giving birth while still being awake and alert. An anesthesia marvel.
This pain relief is well-known, but the before-after-and-during- sensations and symptoms are NOT so commonly talked about. In this post, we will dive into the common symptoms that come with an epidural, how to get the most out of your epidural, and other tips to help the process go as smooth and calmly as possible!
What an epidural can and cannot do
Pain relief is the major focus for the epidural, but what many people don’t realize is that there are many other sensations at play during birth. An epidural does not take away the pressure felt internally by your baby descending further and further into the birth canal. There are other hormones at play that make you feel jittery, tremors, and chattery teeth.
Epidurals work by adding anesthetics (numbing) and pain medications through a needle like catheter in the epidural space of your spinal column. It is essentially blocking your pain receptors from sending signals to your brain that you are feeling pain. It doesn’t however block other receptors in your body.
Epidurals do not take away the other mechanisms at play when birthing a baby. Chemicals in your body like hormones such as adrenaline, oxytocin, and endorphins are all working together to bring your baby to the outside world. Adrenaline for example, can cause some dry mouth, sweating, shaking or tremors, and is not changed from getting an epidural.
Although you can no longer feel the sensations of contractions, epidurals do not take away the pressure that comes with a baby moving in your abdominal and pelvic cavity. Birthing a baby has very similar feelings to a large bowel movement. This feeling does no generally go away and many people describe pressure and tension in their hips as their baby moves lower to their exit.
basic steps of getting an epidural
Disclaimer some of these steps may be altered based on individual hospital policies, but generally speaking, this will be similar in most hospitals.
Before getting your epidural there are a couple of things that go on. First, you have to request the epidural from your nurse. Then, depending on what stage you are in labor, your nurse may request to do a cervical exam to see how dilated you are. Again, this is because epidurals are not recommended until you are closer to active labor. Before calling the anesthesiologist, your nurse will start running fluids through your IV to prepare for the epidural. Flow rates can differ, but estimate that this will take about 20 minutes to run.
Now that this step is complete, your nurse will call for the anesthesiologist. Depending on their availability, they can be in at a moments notice or you play the waiting game. Once your anesthesiologist is in your labor room, they should talk you through the consent, benefits and risks, of the procedure which can take anywhere from 5 to 10 minutes.
Now, you are finally ready to get the placement and start feeling that sweet relief! The next steps are condensed and again will change slightly from hospital to hospital, but are close to universal. Additionally, you can expect your anesthesiologist to walk you through these steps as she or he is doing them.
placement of the epidural:
You will sit in the middle of the hospital bed with your partner either sitting on a chair in front of you or waiting outside.
You will be asked to curl over your belly and push your middle to lower back towards the anesthesiologist behind you.
They are usually great about taking pauses so you can focus between contractions as they continue their procedure. Be sure to speak up if you need another moment or a pause between steps.
The anesthesiologist will begin cleaning your back and then place a thin plastic sheet over your back. There is a small hole in the plastic sheet where the anesthesiologist will be working on your back.
Numbing medication will be injected in a couple areas around your spine where the anesthesiologist will be working. This can feel sharp and itchy at first, but becomes numb quickly. This is done to make the procedure more comfortable as they are placing the catheter.
The anesthesiologist will then begin to place the catheter needle into your spine. They feel around your back and use a long needle to insert the catheter into the epidural space in your spine. As they do this, you may feel a twinge in your nerves. Anesthesiologists will ask you questions to determine the correct placement.
After they have assured that the placement is correct. They administer a few medications to start your pain relief. The medications used can vary based on the anesthesiologist, but often consist of an anesthetic and combinations of narcotics.
The anesthesiologist will remove the plastic sheet on your back and tape the catheter with it’s extending medication line to your back. With the assistance of your nurse, they will help you get into a comfortable position on your back so they medication can begin to travel down via gravity and start relieving your pain.
The medication line starting from your back will hook up to a device on the wall that administers the medication at a continuous rate. There is often a button you can press that will give you a boost of the medication, but there are safety efforts in place so that you cannot overdose by pressing the button too often.
Your nurse will then put a blood pressure cuff on you. From this time on, your blood pressure will be monitored at specific intervals that are determined by a number of conditions. Some intervals between blood pressure readings are 5 minutes and others are 15 minutes.
Your nurse will place a catheter in your bladder to control for your urine output. With the epidural, you are numb from about the top of your belly to your toes, meaning you would not have control of urination.
After getting the catheter for urine placed, your job is to rest and continue to labor on! You can expect that after all of these steps to start feeling less and less pain with each contraction. The full effect of the epidural can be felt about 10-20 minutes after completion.
common and major side effects of an epidural
Getting an epidural for pain relief is a personal decision. Epidurals are incredible for a myriad of ways, but knowing some of the side effects may take away from some of their magical benefits. The following is a list of common side effects, many of which I see first hand as a birth doula supporting families who choose this option.
If you experience any of these sensations or have questions about them talk to your healthcare provider. These can be serious issues and should be addressed as soon as possible.
side effects of an epidural:
Lowered blood pressure- The initial fluids you receive are in part to reduce this effect.
Nausea- A side effect of rapid lowered blood pressure. Most likely to occur within that first 20 minutes after initial medication is administered.
Numbness- Your legs may feel heavy, you may be unable to lift your legs, and you may experience the tingling sensation similar to when your foot or hand “falls asleep”.
Itchiness- A reaction to one or multiple of the medications used for pain relief. This can continue on for 24 hours after your epidural is turned off.
Swelling- This can be a side effect of the fluids given or fluid build up from being confined to bed for the remainder of your labor.
Headache- The epidural headache occurs in about 1 out of every 100 women who receive an epidural. It can be pounding, throbbing, or pulsating. It can begin while you are at the hospital or arrive after you are discharged.
After getting an epidural, you will be placed on a clear, liquid diet only. This is not technically a side effect, but something to consider. Think drinking ginger ale, juices, eating ice chips, jello, or maybe a popsicle until after your baby is born.
The side effects should be understood carefully. They play into the benefits and risks of getting an epidural. Remember, that this is your choice alone and should be made from a place of power, not from fear. Check out the previous blog post BRAINS about how to make informed decisions in labor that align with YOU!
How to get the best use of your epidural
You might be thinking “what do you mean get the best use out of an epidural?”, and that is totally normal. There are many different factors that come into play when having an epidural: how dilated you are, movement, and gravity. These are all things to consider and can help you feel the most pain relief, while still progressing in labor and feeling the pressure sensations.
Getting your epidural at the right time
Sometimes getting an epidural in early labor can actually slow down the process of labor. It’s recommended to wait until you are in active labor, about 5 to 6 cm dilated. There is no way of knowing ahead of time if the epidural with slow down, stay the same, or speed up your labor, but reading the following paragraphs can help encourage your body to keep on laboring while you have pain relief.
Most hospitals will allow you to get an epidural at any time. Some will encourage you to wait until contractions are strong and close together. Remember, you are your own best advocate. If you think you are ready for the epidural, there is no reason for you to feel hesitant about asking. Again, some may ask you if you can wait longer, this is a personal choice and only you can decide in that moment.
Movement is the key to an effective epidural
How can movement be the key when you are restricted to bed? Again, another great question.
Epidurals work by way of gravity. Changing your positions often (think laying on your right side then switch to laying on your left side) can help create an even coverage of the medication. This allows you to feel the pain relief without having a spots or regions that still feel painful. Changing positions about every 20 to 30 minutes can also help to evenly dilate your cervix and add pressure to your cervix in all 360 degrees.
If you have been awake laboring for hours, I do recommend getting in a nap either while changing positions or hold off on some of the following movements until you have gotten that much needed rest. Hopefully, after getting into a new position you can be comfortable enough to doze off and gather more energy.
It’s time to become a Cirque Du Soliel contortionist! Grab more pillows than you imagine you need, your partner, your doula if you have one, and your nurse because these positions can take quite a few hands to get comfortable.
Here are a couple of positions to try:
Side-lying on either side: Pillow(s) between the knees, your hips stacked vertically with the bed laying flat. A pillow tucked under your belly for support and maybe a pillow to hold
Exaggerated side-lying on either side: laying on your left side, stack your hips vertically, extend your bottom leg out straight and bend your top leg at a 90 degree angle. Place pillow(s), a peanut ball, or stirrups under your right leg (upper leg). You will notice a stretching of the right hip and pelvic area.
Throne: Sit the bed up vertically. Lower the feet portion of the bed. Sit up like you have the most perfect posture and place your feet together like you are sitting in butterfly position. Your feet should be 6 to 12 inches lower that your bottom.
Hands and knees or All-fours: Depending on the hospital or on the severity of numbness you are experiencing, this may be a position that is not encouraged. You can lift the head portion of the bed and rest your arms on top. Then you can find a kneeling position. This allows the bottom portion of your pelvis to be able to expand. If your baby is low in the pelvis, turning your knees inward can open the outlet of the pelvis further. Giving your baby just a few extra centimeters of wiggle room.
With many of these above positions, you can add some rocking motions or swaying of the hips that can assist in labor progression. Whenever you are in a side-lying position, have your partner, doula, or nurse (if she is available) hold your top leg then push it in and out like you are kicking the air. This can also help to open space in your pelvis and keep labor progressing without you doing too much work!
Now that you know
Now that you have a deeper understanding of labor with an epidural, what do you do? Having a proper plan in place to cope with labor pains before getting an epidural is a great place to start. Think about how you can utilize movement, your mental strength, breathing, and a wide array of coping strategies you use in everyday life.
There are so many creative movements, positions, and contortions you can try while you have an epidural to keep labor progressing. Don’t be afraid to ask for suggestions or help! And be on the look out for more blog posts about my favorite positions to try with an epidural.
Check out the spinning babies website for additional information on great positions and movements to try! Connect with your local childbirth educators and birth doulas to get more information specific to your body as well.
Epidurals are a great tool to use during your labor. Having nerves about birth and getting an epidural are totally normal, but hopefully this blog post gave you the education you need to make those decisions and labor smarter.