Epidurals: What Should I Know?
Regional Anesthesia (aka Epidurals): What Should I Know?
In this blog we dive into what a regional anesthesia is, what are the benefits, and what are the risks. The goal is to educate you so you have a jumping point for information and you can begin to make a more informed decision. Let’s dive into it.
What is regional anesthesia?
Regional anesthesia is a combination of drugs that reduces pain by decreasing sensation. Regional means it takes away feeling in a certain part of the body; unlike systemic which would be the whole body or the entire system.
There are three types of regional anesthesia:
Epidural: A procedure that includes a small needle inserted into the lower back into the epidural space. The needle is removed and the catheter is left in the back so more medication can be given if needed. It takes around 10 minutes to set up and about 10-15 minutes to work. The medication can be adjusted throughout the labor and is used for longer pain relief.
Spinal Injection: A procedure which includes using a needle to inject medication directly into the spinal fluid. The needle is removed. The effects are instant and will last for about 2 hours.
Combined spinal-epidural (CSE): A procedure which involves both the spinal injection and then the epidural. You will get immediate as well as continuous pain relief and this can last from early labor until pushing.
For all three types you will first receive IV (intravenous) fluids to decrease the risk of blood pressure dropping. An anesthesiologist will either have you sit or lie down on your left side and clean your skin with an antiseptic. You will curl your back, which is important for proper placement, and then the needle is inserted into the lower back. Depending on which type you receive a catheter will be placed in your back or it will just be an injection. Another catheter is inserted into your bladder to drain the bladder.
Usually regional anesthesia is a combination of a low dose narcotic and a low dose of an anesthetic drug.
Purpose:
The main purpose is pain relief. Epidurals provide the most effective pain relief while using the least amount of medication and have the least effect on the birthing persons mental state and the baby.
Around 60-70% of birthing people/mothers receive or request an epidural.
I think it is important to note that receiving an epidural can medicalize your birth. This means, it is typically not just an epidural that you will receive. Alongside an epidural you will usually have blood pressure monitoring, oxygen monitoring, extra IV fluids, catheter, you will be more confined to bed (not able to move around the room) and continuous fetal monitoring. An epidural DOES NOT mean you cannot move at all (more to come in a future blog). Movement is still an important component to labor even with an epidural.
What are the benefits?
Decreased effect on the birthers mental state than systemic drugs as it is not given directly into the blood vessel.
Safer for baby versus pain medication via IV.
If the pain is exceeding the ability of the birthing person/mother to cope, it helps to manage the pain.
If the labor is long and/or the birthing person/mother is exhausted, it gives the opportunity for the birthing person/mother to relax and rest.
What are the risks?
The birthing person/mother is more likely to need forceps or vacuum delivery during the second stage of labor.
Low blood pressure for the birthing person/mother or baby heart rate drops, this increases the risk for a cesarean delivery if there is fetal distress.
The birthing person can experience a “heavy motor blockade.” This means the birther is unable to feel or move their legs.
Increased time in the second stage of labor.
The birthing person/mother may feel itchy.
The birthing person/mother may feel sick/nausea though less likely than with systemic drugs.
1 in 8 people will not have satisfactory pain management. Meaning the pain management may not be as good as they thought or it may be patchy.
1 in 100 birthing people/mothers have a spinal headache.
Considerations:
May require additional IV fluids. Having excessive fluid can cause engorgement of the breast, and may make it more difficult to breastfeed. Studies are very inconclusive on the impact of regional anesthesia and breastfeeding. Overall, it would be beneficial to have increased lactation and breastfeeding support if an epidural was used. Especially if higher amounts of medications were used.
The birthing person/mother is much more likely to need Pitocin in order to progress labor as an epidural can slow down the progression of labor.
Overall there is a lot to consider when trying to make the decision about whether or not to use regional anesthesia for pain management as it is an intervention and procedure. I often talk about using a scale from 0 to 10 to help you decide if it is an intervention you want.
0 means the birthing person/mother is not interested in feeling pain and the benefits of using this intervention outweigh any risk.
10 means the birthing person/mother is not interested in using this intervention for any reason. If this is the case, it is highly recommended to take birth education courses and learn various comfort techniques so that the birthing person/mother and any support have strategies to implement.
Let us recognize that 0 and 10 are extremes and if the birthing person/mother leans in one direction versus the other it helps to determine how the birthing person/mother and birth team will implement this intervention.
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In health,
Emma Lengerich PT, DPT, OCS, CMTPT, Birth Doula
Foundations PelvicPhysio, LLC
References:
Anim‐Somuah M, Smyth RMD, Cyna AM, Cuthbert A. Epidural versus non‐epidural or no analgesia for pain management in labour. Cochrane Database of Systematic Reviews 2018, Issue 5. Art. No.: CD000331. DOI: 10.1002/14651858.CD000331.pub4. Accessed 05 September 2023.
French CA, Cong X, Chung KS. Labor Epidural Analgesia and Breastfeeding: A Systematic Review. J Hum Lact. 2016 Aug;32(3):507-20. doi: 10.1177/0890334415623779. Epub 2016 Apr 27. PMID: 27121239.
