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The Facts on Epidurals for Labor

The Facts on Epidurals for Labor

If you are pregnant, chances are that you have heard stories from other women regarding their epidural experiences. Here are some popular myths, along with the facts:

MYTH: Epidurals are too dangerous.

FACT: Epidural analgesia is the most commonly used method for pain relief during labor. It is also the most effective. In most cases, it provides the mother with excellent pain relief with minimal risks to mom and baby.

Before placing an epidural, the anesthesia team member will talk to the woman. He, or she, will review her medical history, as well as ask about any problems that she may have had with any type of anesthesia in the past.

Before an epidural is placed, the woman will have an intravenous line in place. Most of the time, IV fluids will be given before the procedure. Epidural analgesia may cause the woman’s blood pressure to drop. Providing fluids, known as a “bolus,” beforehand lessens the degree of the drop in blood pressure. If mom’s blood pressure drops too low, medication can be given quickly to raise it. The blood pressure is taken at very frequent intervals after the epidural is in place and medication is given through the epidural catheter.

MYTH: The needle used to place an epidural is huge and the process is extremely painful.

FACT: Before any needle is placed into the epidural space, the area is numbed with a local anesthetic, the same kind that dentists use before a dental procedure. This may sting for a few seconds, but it numbs the area on the back where the epidural will be placed.

When the epidural catheter is placed, the woman will feel only pressure, but not actual pain. The epidural catheter is very small, soft, and flexible. A sterile dressing is placed over the site, and then tape is used to prevent the catheter from coming out before baby is born.

MYTH: An epidural can’t be given if the woman is too far into her labor, missing her “window of opportunity.”

FACT: Epidural anesthesia can be given at any time during labor. This includes early labor, or when the cervix is fully dilated. The American College of Obstetricians and Gynecologists (ACOG) states that maternal request for pain relief during labor is sufficient reason to receive an epidural, as long as there are no medical contraindications. Such contraindications may be a platelet count that is too low, which would increase the risk of bleeding, or a deformity, or previous injury to the spine that would make epidural placement too difficult

MYTH: Epidurals wear off too soon to be helpful.

FACT: The medication used for epidurals is given by a continuous infusion via a pump. Most of the time, if contractions become painful before baby is born, additional medication can be given through the epidural catheter.

When the cervix is completely dilated and baby moves lower in the birth canal, it is common for the woman to feel pressure (the same feeling as needing to have a bowel movement). It may not be possible to relieve this feeling, and, the sensation helps the woman to push more effectively.

MYTH: It will take longer to push baby out with an epidural.

FACT: If a woman begins pushing too soon, before baby drops lower into the birth canal, she may push longer because she doesn’t feel the urge to push. It is common practice to allow the woman to “labor down.” This means that, although the cervix is completely dilated, pushing is delayed until baby is lower in the birth canal.

MYTH: Epidurals don’t work.

FACT: If a woman experiences no, or minimal pain relief after receiving her epidural, there are measures that can be taken. More medication, or a different type of medication, can be given through the epidural line. Sometimes, the tiny, flexible catheter may need to be adjusted. If these measures do not work, the epidural catheter can be removed and another epidural placed.

MYTH: A woman may receive too much medication, which may cause serious side effects for mom and baby.

FACT: The medication that is given through the epidural is delivered by a pump designed for epidurals.

The dose is set by the anesthesiologist or CRNA (Certified Registered Nurse Anesthetist). If the woman is given a button to push if she begins to experience pain, the pump is programmed to deliver a specific dose at specific time intervals. If the woman pushes the button before another dose can be safely given, the pump will not administer another dose until it is time.

 

Reference: Toledano, R., & Leffert, L. (2017). Neuraxial analgesia for labor and delivery (including instrument delivery). UpToDate. Retrieved from https://www.uptodate.com

 

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