When I was pregnant with my son people seemed to come out of the woodwork with “advice” about labor and birth. The most common thing I heard was that I had to have an epidural because it wasn’t possible to give birth without an epidural. I heard from many women that said pain was unnecessary in birth and why would I go that route when I could easily just get an epidural. So, I did what I always do when I’m given “advice”: I go and research to figure out my own opinion.
The first thing I wanted to know was what an epidural actually was and how it was given. An epidural is an injection of a local anesthetic into the lumbar area of the spine. It’s injected between the spinal cord and the dura with the intention of eliminating sensation from the point of the injection downward. In order to receive the epidural you will be asked to either lie on your left side or to sit up in a curling motion so the spaces between your vertebrae open.
A small area on your back will be injected with a local anesthetic to numb it. Then you will be asked to sit very still while a needle is inserted into the numbed area surrounding the spinal cord in the lower back. After that a small tube, or catheter, will be inserted through the needle into the epidural space. The needle will be removed leaving the tube in place which will be secured to your back. A test dose will be given to make sure you don’t have any adverse reactions. Then, you will be given a full dose of the medication. Hospitals and anesthesiologists will differ on the dosages and combinations of medication, but the epidural will contain a local anesthetic and a narcotic or opioid.
Like with any intervention, there are both risks and benefits to epidurals. Both must be weighed carefully to see if the benefits outweigh the risks or vice versa. Some of the benefits are that if you are having a long labor and you are exhausted and epidural can allow you to rest and recover your strength. When they work as fully intended, epidurals are also the most effective pain relief during childbirth. Providing adequate relief from pain, such as intense physical and emotional responses to pain, can allow you to have a more positive birth experience. Should further complications occur and a cesarean becomes necessary, an epidural will allow you to be conscious and aware during your baby’s birth and provide effective pain relief after surgery.
The risks are that the epidural may provide only partial pain relief. Some women report inadequate pain relief or numbing of the wrong areas of the body. There is a greater chance of an assisted birth by vacuum extraction or forceps because the baby may be unable to find an optimal birth position. Epidurals can cause you to have low blood pressure which could lead to more IV fluids, medications, and oxygen. Continuous fetal monitoring as well as monitoring for your vitals will become necessary. In addition, you will also need a catheter. There is a chance of a maternal fever and maternal retention of urine. The use of an epidural can also stall labor so synthetic oxytocin may be used to speed up labor. If the baby has trouble handling the labor from the synthetic oxytocin there is an increased risk of a cesarean. Epidurals can lengthen the pushing phase and make it difficult for you to push because you can’t feel the contractions or the urges. This can all lead to an increased risk of severe tearing and potential pelvic floor problems after birth. Due to the numbing sensation you will also be unable to move for up to a few hours after the birth and you will need assistance.
Finally, I wanted to know the possible side effects to the mom and baby from an epidural. For the mother, the epidural can interfere with the major hormones of labor and birth that naturally occur. There can be a drop in the mother’s blood pressure. The numbness also makes the mother unable to pass urine which will require the use of a catheter. The mother may experience itching, shivering, sedation, or nausea/vomiting. A rise in temperature may occur which may result in precautionary treatment for fever. Inadequate pain relief may be given by the epidural. 1% of women get a severe headache called a spinal headache. This can last up to 6 weeks and is caused by the epidural needle puncturing the dura. The spinal headache can be treated with a spinal tap which is an injection of your blood into the epidural space. Some other rare, but more serious complications include: slurred speech, drowsiness, convulsions, and death. Later complications may include: weakness and numbness for several months, damage to a nerve during epidural placement, abscess or hematoma which can compress the spinal cord, or toxic reactions in the covering of the spinal cord which can lead to paraplegia.
The potential side effects and risks to the baby are that the medications in the epidural does cross the placenta so babies can be affected by these drugs during and after labor. During the labor itself babies may experience reduced blood and oxygen supply which can cause fetal distress and lead to an instrumental birth. If the mother develops a fever, the baby is more likely to be born with a low APGAR score which would require assistance such as resuscitation and time in a special care unit. A maternal fever may also cause the baby to have invasive procedures to rule out and treat suspected infections. The baby may also be sleepy at birth and have difficulties with initial breastfeeding due in part to the epidural.
Epidurals can be a wonderful thing and at time the benefits do outweigh the risks, but before making this decision to just have an epidural for the sole purpose of not wanting to participate in labor it’s important to educate yourself on the risks and benefits to you and your baby. Don’t go with anything someone says without researching and making an educated decision for yourself.
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