Pain Relief in Labor and Delivery: The Epidural

If you’re pregnant, you’ve probably already been asked if you’re going to get an epidural. Epidurals, like cilantro and selfie sticks, are one of those things people have SUPER strong feelings about. For every person who is 100% for them, you’ll find another who is 100% opposed. Epidurals are very common, with around 60% of American women opting for one, but they still come with risks.

If you’re contemplating if you should go for the epidural or not, a quick 101 on the ins and outs can help.

What is an epidural?

An epidural refers to the delivery of regional anesthetic into the epidural space, via a carefully placed needle or catheter (this varies depending on if you are getting a standard epidural or a “walking” epidural which we’ll cover shortly).

In a non-medical nutshell, this means a carefully curated mix of medications is injected into a very specific location in your lower back, resulting in less to no pain.

The cocktail of meds is determined by an anesthesiologist and is usually a combination of a numbing agent, like lidocaine, and an opioid or narcotic (like fentanyl or sufentanil). The combination of drugs is designed to provide immediate pain control and long-lasting relief. It can be delivered either as needed, or continuously via a pump.

How they work:

An epidural works by providing medication that both numbs and provides pain relief to the region of your spinal cord that controls your lower half. The medication can be increased or decreased depending on how much you want to feel, though it takes more time for the medication to wear off than it does to kick in.

There are two main types: Standard and “Walking”/low-dose epidurals

Standard epidural:

An anesthesiologist inserts a needle into the epidural space, and threads a catheter (a thin, hollow tube) through the needle before removing it. Medication is delivered via the catheter, as needed or continuously through a pump. Mom is stuck in bed, with little to no feeling in her lower half, which can be viewed as both a pro or a con depending on your circumstances/birth plan/comfort level/desire to watch hours of Animal Planet.

“Walking” epidural/low-dose epidural, (also called a combined spinal):

In a “walking” epidural, the anesthesiologist inserts the needle into the intrathecal area, and delivers a dose of medication that has a finite timeline. The length of time it lasts varies depending on what drugs are used. Unlike a standard epi, the drugs aren’t given continuously, or via a magic button next to mom’s bed.

That said, in a “walking” epi, a catheter is still placed, so if it just gets to be too much, there’s an option for more meds. It’s also worth mentioning, the term “walking” epidural can be a bit of a misnomer, as not all moms who receive it will be able to walk around. In general though, it allows for a little more feeling and movement, which can be nice or horrifying if you are ALL SET on labor pains.

How painful is getting an epidural?

This really varies depending on your pain tolerance, and what you’ve already been through. The area where the needle is placed is numbed (with needles), and women report feeling nothing to “10 bee stings” (this is oddly specific, but also perfect) when the epidural needle is inserted. The tricky part can be holding still while being rocked by serious contractions, but the hospital staff has a way of getting you through it.

In both options, the epidural is placed when mom is 4-5cm dilated and is in active labor.

Are there benefits to getting an epidural?

There are approximately eleventeen billion different reasons why you may opt for an epidural, and every single one of them is valid. This is your birth, and if you want an epidural, then by golly, you ask for that epidural. As far as benefits, the obvious one is a pain-free labor and delivery. In a textbook scenario, where the perfect epidural is administered, the recipient can enjoy being mentally and physically present (meaning she can still effectively push), all without feeling any contractions or ring-of-fire business. Magical, I tell ya!

But even those who tolerate pain well can find unexpected benefits from getting an epidural. Here are a few other scenarios where an epidural might be beneficial:

You might be tired. Like really tired. Labor can take a long ass time, and no shocker here, can be physically draining. Giving your body some time to rest and recharge before you have to push can help you get ‘er done.
Your overall birth experience may be remembered more fondly if you aren’t in excruciating pain. Not everyone will feel this way, but pain can be stressful. Removing it from an already stressful equation can shift your focus, allowing you to notice and absorb other things.
It can help you cope if you’re feeling overwhelmed. Birth is intense! Taking the pain out of it can help you regain your focus if things are feeling out of control, and other fail-safes have, uh, failed (camera pans to terrified husband panting into a paper sack, and cell phone with 93 outgoing calls to doula who is MIA).
If things don’t progress, you can likely stay awake for your c-section, rather than needing full anesthesia. It also allows you to have quick access to post-surgical pain relief.
It should provide pain relief without zonking you out, allowing you to participate and be present for your labor and delivery.
There are no long-term known disadvantages reported with having an epidural.

Are there risks with getting an epidural?

Of course, as with any medical procedure, there are also some serious things to consider before screaming for ALL THE DRUGS:

Medications used during labor make their way into your soon-to-be-born baby’s bloodstream, which may slow their ability to get into proper birthing position.
Labor can be slower, with more births requiring interventions. It should also be noted that there are reports of labor progressing faster after mom is able to relax, so this one should be taken with a grain of salt.
The medications used can cause your blood pressure to drop, leading to dizziness and nausea. Barfing your brains out doesn’t make labor any easier.
About a quarter of women who receive an epidural also get a fever.
You may have trouble urinating; though it should also be noted a urinary catheter is commonly placed in women who get an epidural.
Some women report trouble pushing.
You may be part of the very unlucky, very small percentage of people who get a severe headache.

In conclusion

When it comes down to it, deciding on whether or not to get an epidural is an extremely personal choice. Sometimes knowing if you’re going to do it isn’t clear until you’ve experienced the pains of labor, whereas other times knowing the risks is enough to cough up the moolah for extra Hypnobirthing classes.

On a personal note, I opted for an epidural with both of my deliveries, and had two completely opposite experiences. My first was absolute perfection. The second, not so much. Knowing what I know about my own pain tolerance and mental tendencies (can we say PANIC!), I’d still probably go for it a third time. Knowing what it can be like when it’s NOT so perfect, however, keeps me from recommending it to every pregnant lady I encounter.

Whatever you do, know that there’s no wrong way to birth that baby.