An epidural is a powerful form of anesthesia that numbs parts of the body to relieve pain, and is commonly used during childbirth. Although more than half of women who give birth in hospitals use them, many expecting mothers are apprehensive.
But according to Jennifer Buck, MD an OBGYN, there’s less to worry about than we might think. Here, Dr. Buck answers your most pressing questions about the procedure.
Q1: What is an epidural?
A: During an epidural, an anesthesiologist uses a needle and a small tube, called a catheter, to deliver anesthetic to an area called the epidural space, located just beside the spinal cord in the lower back. The medication begins working within 10 or 20 minutes after insertion, but the catheter is typically left in position so more anesthetic can be given as needed. Women who opt for an epidural during childbirth will likely experience less pain while remaining awake and alert during the delivery.
While epidurals are used commonly in obstetrics, they can also be administered during other procedures that involve the lower parts of the body, such as the pelvis, legs, urinary tract or female reproductive organs.
Q2: Who can get one? (And who can't?)
A: Epidurals are safe for most women, and they are the most popular pain-relief method used during labor, according to the American Pregnancy Association. But there are some restrictions.
"The number one concern would be if a woman has difficulty forming blood clots," Buck says. Those with bleeding disorders, like hemophilia and von Willebrand disease, may be at an increased risk of excess bleeding around the spine during and after the epidural procedure.
Patients taking blood thinners may also be at an increased risk of epidural-related internal bleeding, and may therefore not be good candidates for an epidural. According to the US Food and Drug Administration, patients should speak with their doctors about a safe time to take blood thinners following an epidural.
In rare cases, other women may have to forego an epidural if the anesthesiologist can't properly insert the catheter due to prior back surgery or scoliosis. Speak with your healthcare provider about existing conditions or medications that might interfere with your ability to have an epidural.
Q3: How will it affect labor?
A: Some women fear getting an epidural might prolong the delivery process or increase the likelihood of having a C-section. Despite these worries, an epidural does not increase a woman's likelihood of needing a C-section. Whether or not an epidural will affect the length of delivery is unclear, but one study suggests it won't.
A 2017 study of 400 women suggested that an epidural had no effect on the length of time between complete cervical dilation and delivery. Of the women in the study, half were injected with epidural anesthetic and the other with a saline solution, with no noticeable differences in labor duration, position of the fetus or the rate of episiotomy. An epidural may affect a woman's ability to sense when it's time to push, but it shouldn't inhibit the ability to push. An epidural may increase a woman's likelihood of needing an instrumental delivery, whereby a doctor uses forceps to assist in vaginal delivery.
If labor is not progressing, Buck may recommend that her patients try an epidural, which may ease labor pain and relax the woman. But she reassures women that opting for an epidural is not a sign of weakness. "A lot of people feel like a failure if they get an epidural," Buck says. "But there's no gold medal at the end if you don't get an epidural."
Q4: Will it hurt the baby?
A: A child is connected to the mother by the umbilical cord, which supplies oxygen and nutrients until birth. The food you eat, the air you breathe and the medications you take all make their way to the baby, and an epidural is no different. Minimal amounts of anesthetic do reach the baby, but don't typically have negative effects.
Although epidurals have no known long-term disadvantages for the baby, they may cause a bit of short-term concern. When administered, mothers may experience a decrease in blood pressure, which might slow the baby's heart rate. But, according to Buck, "this is very easily treated with fluids or medication delivered via IV."
Q5: What are the risks for the mother?
A: "With any procedure there are always risks, but the likelihood of somebody having a significant complication from an epidural is very low,” Buck says.
Although it's not a permanent concern, epidurals can cause a decrease in blood pressure, making monitoring the mother and baby important. There are also risks of more serious, though uncommon, complications including bleeding around the spine, nerve damage, allergic reactions and infections such as meningitis.
Q6: How bad are the side effects?
A: Most side effects of epidurals are not serious. The anesthetic can sometimes cause itching of the abdomen, arms or legs, Buck explains. Because an epidural can also cause numbing of the legs, about 15 percent of women who receive one may have short-term difficulty emptying their bladders. In those cases, a urinary catheter can be inserted to remedy the problem. Additionally, roughly 23 percent of women who receive an epidural may experience an epidural-related fever.
Post-epidural headaches are another potential side effect. "Sometimes the mom can develop a really bad headache that can last for up to a week," Buck says, which is likely the result of an epidural injection that's punctured the layer around the spinal cord, allowing some spinal fluid to leak. Thankfully, this happens in only 1 percent of women who have an epidural, and as the puncture heals, the headache should subside on its own. In case headaches don't resolve themselves, your doctor can inject a small amount of blood near the spinal hole, which will help seal the wound and relieve headaches.
Have more questions? The Medical Center of Aurora is the best labor and delivery hospital in Denver and Aurora. Click here to make an appointment with one of our skilled providers.