An epidural is a process for injecting a local anesthetic, which can be used during labor to relieve the pain of childbirth. The injection is done in the lower back, around the spinal nerves. The labor pain is effectively blocked, while still facilitating the movement of the lower body, allowing the person to push out the baby when needed.
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Because the injection of the epidural is done around the spine, the procedure is carefully regulated. Before receiving an epidural, most people have a drip for fluids inserted to their arm called a cannula. This is a safety precaution in case the blood pressure drops during the epidural, which is sometimes the case. Low blood pressure occurs in around 14 of 100 women. During injection, most are asked to either bend over a pill or curl into a ball while lying on their side.
After cleaning with an antiseptic, a small volume of local anesthetic is inserted in the skin of the lower back. The epidural needle is inserted between the bones of the spine to the area surrounding the spinal nerves, called the epidural space. The patient must remain still, so the insertion will be done when the contractions stop.
A single injection is usually not enough as a dose to last through the entire childbirth, which is why a catheter is usually inserted. After the needle is inserted, a small and soft plastic tube is inserted, and the needle is removed. It is the tube that distributes the anesthetic and acts as a catheter. It typically takes somewhere from 5 to 30 minutes for the anesthetic to take effect.
The epidural is usually given during the first stage of labor but can be given at any stage. The catheter can be affixed to a pump that supplies low volumes of anesthetic continuously. Sometimes, the pump is controlled by the patient.
Advantages and disadvantages of an epidural
Epidurals are most commonly available in hospitals but are rarer in birth centers and are not used for home births. Epidurals are widely used because they are usually very effective, very safe, and do not inhibit movement during the rest of childbirth. However, some experience little or no pain relief following the injection of an epidural.
Epidurals can be very effective for people with longer labor. Since long labors can be draining, epidural can allow for some sleep and recovery of strength. For those who need or want to have a cesarean, an epidural injection can allow the patient to be awake.
While these benefits are responsible for their widespread use, some people cannot have epidural for various medical reasons such as blood clotting problems. Furthermore, some complications are possible. For example, some people need a catheter in the bladder to assist in passing urine. Difficulties in urination occur in around 15 out of 100 women.
The epidural can also cause a loss of feeling in the legs, difficulty in pushing during childbirth, and it might slow the second stage of labor. The baby must also be closely monitored during labor when an epidural is used. In 23 out of 100 women, an epidural can cause fever.
Some people also avoid using epidurals because of the potential side effects. Occasionally, patients feel cold or itchy following the epidural. Similarly, but rarely, some develop a skin infection. Some people experience bad headaches around 24 to 48 hours after use, which occurs if the epidural pierces the protective layer of the spinal cord. This occurs in around 1 out of 100 women. Some people very rarely develop nerve damage for life.
Common worries and misconceptions
Because the baby shares the internal environment of the receiver of the epidural, there have been some misconceptions about how this can affect the health of the baby and the process of childbirth. For example, some have claimed that using epidural increases the use of cesarean deliveries, but there is no evidence to indicate that this is true.
While the baby is still connected to the mother via the umbilical cord, any medication used by the mother will also enter the baby’s body. However, anesthetics that may be transferred to the baby do not have strong effects on the baby. Other common worries include that epidurals can influence lactation, but there is no evidence for this.
- Pregnancybirthbaby.org.au. 2020. Epidural. [online] Available at: <https://www.pregnancybirthbaby.org.au/epidural#:~:text=An%20epidural%20is%20a%20procedure,out%20when%20you%20need%20to.> [Accessed 1 September 2020].
- Institute for Quality and Efficiency in Health Care (IQWiG). 2018. Pregnancy and Birth: Epidurals and Painkillers for Labor Pain Relief. [online] Available at: <https://www.ncbi.nlm.nih.gov/books/NBK279567/> [Accessed 1 September 2020].
- Leighton, B., and Halpern, S., 2002. The effects of epidural analgesia on labor, maternal, and neonatal outcomes: A systematic review. American Journal of Obstetrics and Gynecology, 186(5), pp. S69-S77.