Epidurals
Welcome to our section about epidurals. We will talk about what an epidural is, when you can get one, benefits, side effects, and complications.
What is an Epidural?
Lumbar epidural (or epidural for short) anesthesia is a common way to treat labor pain. The World Health Organization recommends lumbar epidurals for treating labor pain because of their success and low risk for side effects. Epidurals are used in 75% of deliveries in the United States.
An epidural involves placing a small plastic tube into your back. Numbing medicine is placed into the tube to help with your labor pain.
After receiving an epidural your belly area down to your toes will be numb. Epidurals will reduce sharp pain but you will still feel pressure when giving birth.
An epidural is the most effective way of treating labor pain. Medication given in the epidural has little effect on your baby.
Definitions
Lumbar: The lower area of your back below your ribs to your hips
Epidural: A space in the back near the spine
Anesthesia: Medicine to treat pain
Labor & Delivery Unit: The area of a hospital where moms deliver babies
When can I get an Epidural?
An epidural is placed once you are in labor. Labor starts when your contractions become regular, about 15-30 minutes apart. Tell your doctor as soon as possible that you want an epidural. An epidural can be placed at any point of labor right before you give birth. Your doctor will tell you when it will it be too late to get an epidural.
It is important that you are able to sit still during placement. Do not wait until your contractions are too painful! Also keep in mind the amount of time it may take for an anesthesia provider to come to you.
Definitions
Labor: The process of childbirth where your body gets ready to deliver your child.
Contractions: Regular cramps in your lower belly, lower back, and thighs.
Who places an Epidural?
An epidural is placed by an anesthesia provider- an anesthesiologist or a certified registered nurse anesthetist (CRNA). These providers go through rigorous training to place and manage epidurals.
Provider: A doctor or advanced practice nurse.
Anesthesiologist: A doctor that is trained to give anesthesia.
Certified Registered Nurse Anesthetist: A nurse that is trained to give anesthesia.
Epidural Placement
When you ask for an epidural, your doctor will make sure that an epidural will be safe for you. There are a few conditions when it is not safe to have an epidural. After your doctor orders the epidural, an anesthesia provider will come to talk to you. You will be told about the benefits and risks of an epidural and you will be asked to sign a consent form.
After you sign the consent form, the procedure generally goes as follows:
1. Getting into Position
You will be asked to sit at the edge of the bed or to lay on your side. Your nurse will assist you into one of these positions.
2. Cleaning your back
The anesthesia provider will clean your lower back and place a drape on your back to prevent infection.
3. Numbing medicine
Numbing medicine will be injected into your skin using a very small needle. This helps you not feel the epidural needle. This is the most painful part of the procedure.
4. Epidural Needle
The anesthesia provider will place a different needle into the site. You may feel pressure on your back. It is very important to stay as still as possible!
5. Epidural Tube Placement
A long, thin plastic tube will be placed and will stay in your lower back. The needle is removed.
6. Bandage and Taping
A large bandage and tape will be placed over the epidural tube so that it does not move.
7. Epidural Testing
You will be given a “test-dose” of medication, this is to make sure that the tube is in the right place.
8. All Done
Your provider will let you know if the epidural is okay to use. Once it is, numbing medicine will go into your back from the tube. Numbing medicine is given through a pump. You will also be given a special button that you can press to give yourself extra pain medication. There is a lockout time on the button, so you can't give yourself too much medication.
9. Relief
You will begin to feel the effects of the medicine after 10-20 minutes. Your legs and belly will slowly get weak and numb.
10. Safety Check
Every now and then, your nurse will check where you are numb. This lets your doctor know your epidural is safely working.
11. Removal
After you have delivered, the epidural will be removed shortly after.
Effects of the epidural can last about two hours after the medication has been stopped.
What are times when I can't get an Epidural?
Most people can receive an epidural. Your doctor will let you know if having an epidural is a safety risk for you or your baby.
These are some reasons why you may not be able to get one:
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You have low platelet counts
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This means your risk of bleeding a lot is high
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You are bleeding too much
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You have an infection in your back
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You have an infection in your blood
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You are still in early labor
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After getting an epidural, you will not be able eat solid food or get out of bed
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Your hospital team will talk to you about ways to manage early labor pain so that you can eat solid food for as long as possible. You need your energy!
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Your labor is moving too fast for the medicine to be put in
Definitions:
Platelets: A part of your blood that stops bleeding.
Cervix: An area before your vagina that the baby must pass through.
How an Epidural changes your care
Our goal is your safety and comfort
Care around epidurals:
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Epidurals can make it hard to go pee. You will need a catheter to help you pee.
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You will not be able to eat solid food to prevent nausea and vomitting
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Your nurse will help you move in the bed because your legs will be weak
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You will be asked to not get out of bed because of leg weakness
Epidural Benefits
Lower Pain Scores
Those with epidurals have lower overall pain scores to those that don't receive one.
Less Nausea/Vomitting
Compared to other pain medications, epidurals have a lower chance of causing nausea and vomiting
Higher Patient Satisfaction
Epidurals help lessen the pain and anxiety of labor. This helps you focus on your special day.
Lower Chance of Breathing Complications
Other pain medications have a higher chance of affecting your breathing and can increase breathing problems
Less pain medication
Those with epidurals need less additional pain medications.
Better APGAR scores
APGAR is a tool used by doctors to check for how awake a baby is after birth. The higher the score, the less likely a baby needs additional hospital care
Side Effects
What are the side effects of Epidurals?
Common side effects after placement:
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Dizziness
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Nausea/Vomiting
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Your nurse can give you medicine to treat this
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Low blood pressure
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You will get fluids through your intravenous (IV) catheter to prevent this
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Shivering
Please tell your nurse or doctor if you feel any of these symptoms:
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Ringing in your ears
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Numbness or tingling around your lips
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Trouble breathing
This can mean that you are receiving too much medication.
Additional effects of overdose can include:
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Seizures
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Fainting
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Trouble breathing
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Coma
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Cardiac arrest
Potential Complications
Risks with getting an epidural are well-known. There are multiple safety steps to keep you from getting hurt. Like any medical procedure, epidurals have risks.
Ineffective pain relief
The most common problem of epidurals is that they don't provide enough relief. To fix this, the epidural can be redone or other types of pain medicine can be given.
Post-dural Puncture Headache
The most common injury from an epidural is called a post-dural puncture headache. This happens when the epidural goes too deep into your back and goes into the sac that holds your spinal cord. This is an uncommon complication, but it can be uncomfortable. This injury causes a headache that gets worse when standing up and gets better with laying flat.
There are a few treatments for this injury. Treatments include pain medicine such as Tylenol, caffeine, or an epidural blood patch. An epidural blood patch is when an anesthesia provider draws blood from your arm and puts it into your back. The blood is injected in the same area as where the epidural was. The injected blood will plug up the hole caused by the epidural. The procedure is similar to placing an epidural. Headaches usually get better right after the blood patch is placed. However, it can take a couple days to notice an improvement.
Most post-dural puncture headaches get better without treatment. Headaches can last for a few weeks
Infection
Like any procedure, there is a small chance for infection. There are many safeguards to prevent infection but there is still a risk. Depending on the infection, treatment includes antibiotics or surgery.
FAQs
1. What are my other options for pain relief besides an epidural?
You can receive pain medicine through your intravenous catheter (IV). There are also relaxation techniques to help reduce pain.
2. Does an epidural hurt?
The most painful part of an epidural is when numbing medication is put into your skin. This is before the epidural is put in. A tiny needle is used to put in the numbing medication. The epidural feels more like pressure than stinging in your back.
3. How big is an epidural tube?
About the size of one angel hair pasta.
4. Will an epidural harm my baby?
No, the medicine does not go into your blood and will not be passed into your baby.
5. If I say no to an epidural, can I change my mind later?
Yes, you can always ask for one but you may not be able to get one if you can't sit still enough for the procedure.
6. Will an epidural slow my labor?
There are no studies that say epidurals for sure slow down labor. However, epidurals will make your legs numb and weak, making it hard to move around. You will also not be able to get out of bed. Walking and moving around can help with positioning and the opening of your hips to help labor move faster.
7. Will I be paralyzed after an epidural?
The numbing medicine will make your legs weak temporarily. Actual injury and paralysis can happen but the chance is very small. Injury like this happens 1 in 250,000 epidurals. That's a 0.0000004% chance.
Where Did We Get This Information?
References
American Pregnancy Association. (n.d.). Epidural- Everything you need to know about it. American Pregnancy Association. Retrieved on October 4th, 2023 from https://americanpregnancy.org/healthy-pregnancy/labor-and-birth/what-is-an-epidural/
Barash, P. G., Cahalan, M. K., Cullen, B. F., Stock, M. C., Stoelting, R. K., Ortega, R., Sharar, S. R., & Holt, N. F. (2017). Clinical Anesthesia (8th ed.). Elsevier
Bupa Health UK. (2019, September 12). How an epidural is given during childbirth [Video]. YouTube. https://www.youtube.com/watch?v=Bi0u8ARwev8
Cleveland Clinic. (2023, April 13). How an epidural is given during labor [Video]. YouTube. https://www.youtube.com/watch?v=wVnI2qVZDAk
Halliday, L., Nelson, S. M., Kearns, R. J. (2022). Epidural analgesia in labor: A narrative review. International Journal of Gynecology & Obstetrics, 159 (2), 356-364. https://doi.org/10.1002/ijgo.14175
Johns Hopkins Medicine. (n.d.). Epidurals for Labor Fact Sheet. Johns Hopkins Medicine. Retrieved on October 4th, 2023 from https://anesthesiology.hopkinsmedicine.org/wp-content/uploads/2019/04/Epidural-Handout-11-20-2018.pdf
National Health Service. (2023, February 01). Epidural. National Health Service. Retrieved on October 4th, 2023 from https://www.nhs.uk/conditions/epidural/
Smith, A., LaFlamme, E., & Komanecky, C. (2021). Pain management in labor. American Family Physician, 103(6), 355-364.