What you should know about an epidural (before you get one)!

As a hospital-based birth doula, the majority of my clients choose to use an epidural for pain management; and after witnessing dozens of births using an epidural, there is one thing that frustrates me to no end! … and that is when someone is pregnant and when talking to other parents about their plans or nervousness for birth the experienced parents say “Oh, just get the epidural!” … like that somehow magically takes away the whole “giving birth” thing.

An epidural is a highly-effective pain management tool that I am very happy we have in our box of tricks to help labor progress smoothly and comfortably for all involved. BUT, the epidural is not a magic cure to the ailments of birth, and I think it’s time we start truly preparing people for the experience of birth, whether they are planning on using medical pain management or not.

Here are a few things I want you to know before choosing to use an epidural for pain relief:

Epidurals take away pain, they do not take away pressure.

When you get an epidural you should expect it to take away the sharp pain of contractions, but it won’t cover the feeling of pressure in your pelvis, cervix, and vaginal canal. You will also most likely still feel the “ring of fire” as baby crowns. “Pressure” doesn’t sound too bad, until you consider how much pressure is being applied to your body when a baby’s head is coming down through your pelvis and out your vagina!

I once had a doctor describe it to my client by saying, “being crushed is also “just pressure,” but we would consider being crushed a painful experience.”

This is why you will often hear people say that their epidural “wore off” at the end of their birth. It isn’t because the epidural just up and stopped working, but it is because the main source of pain during the second stage of labor (pushing phase), is the intense pressure baby is applying as they are moving down and out.

This information is not to scare you, as I am sharing it because I think that knowledge is power. I would rather you know and prepare for the intensity of the experience, then be overwhelmed and scared when experiencing it.

and that leads me to my next point which is…

You still need to prepare for pain with alternative coping methods.

It is vital to a positive birth experience that you still prepare for pain or discomfort even if you are planning on requesting an epidural the moment you get admitted to the hospital.

First off, unless being induced, most hospitals will not admit you until you are in active labor, or around 5-6cm dilated. Early labor can take a long time if it is your first-time giving birth, and it’s important you are prepared to cope with the pain of the contractions until you are able to get admitted to the hospital.

Second, it takes some time to go through the process of getting admitted to the hospital and then get ready for the epidural. You’ll have to go through triage, get checked and monitored for 20-30 minutes, then if you are admitted you might have to wait for your room to be ready and then walk there. Once admitted you’ll have to get an IV put in and get a bolus of IV fluids before they can administer the epidural (blood pressure can drop with an epidural so they must do IV fluids beforehand to prevent a dangerous drop in blood pressure). Once anesthesia shows up they will run through consents with you and tell you what to expect. The actual process of the epidural placement usually takes about 15-30 minutes, and then it will take another 15-30 minutes for the medication to set in.

Additionally, while rare, the epidural may not cover one side of your body, or you could still experience “hot spots” of pain, not to mention the pressure feeling we talked about in the point above!

It is important that you learn other ways to cope with the pain during this time, so you’re not left feeling out-of-control during the process. Some great coping techniques that I use frequently with my clients who get epidurals are breathing techniques, squeezing a comb in the pad of your hand, counterpressure or massage against hot spots, position changes, meditation, and heating pads.

Movement is your friend.

While you won’t be able to get out of bed once you get the epidural, it is imperative to your labor progression that you don’t just lie down and take a nap for a few hours, expecting labor to continue along smoothly. While that can certainly work for some, it is definitely the exception and not the rule to a smooth labor.

In labors where the person is unblocked (not using an epidural), they tend to instinctually move through their contractions to help lessen the pain. This act opens the pelvis in all different directions to let baby move down with the contractions.

To imitate this with epidurals, it is important to keep changing positions every 20-30 minutes, to let your baby find new ways to move through the pelvis. Common positions we do with people with epidurals are various side-lying positions, supported all-fours, throne position or a supported squat, and butterfly legs (with the options for alternate legs propped on the peanut ball). Make sure you ask your doula or nurse to help you change positions frequently, and feel free to grab our labor positioning guide to help.

If you are hiring a doula and planning to get an epidural, it is very important you ask them how they help you after the epidural is placed. Some doulas know much more than others about fetal positioning and how to help babies move through the pelvis optimally with birth positions. A common resource for fetal positioning is Spinning Babies. I would highly recommend to anyone planning on having a doula at their planned epidural birth to ask if the doula has any education in spinning babies protocols or has taken the spinning babies’ workshop.

It comes with other interventions.

As a doula, I am very supportive of everyone who would like to use an epidural for pain relief. There are many births I have been eternally grateful to the medical world for coming up with a safe and effective pain relief tool for laboring people. But like any intervention, I think it is best used with informed consent as to what to expect.

Just a note: these are the most common interventions I see after an epidural is placed, but please ask your doctor or midwife for your hospitals specific policies if you are concerned.

Once an epidural is placed, it is hard for the laboring person to know what is happening to their body during the labor process since they can no longer feel their contractions. This means they need to be monitored more thoroughly so the medical staff can see if things are progressing normally and if baby and mom are reacting okay to the anesthesia. This means that they will need to switch to continuous fetal monitoring if they were previously using intermittent monitoring to monitor baby’s heart rate and contractions. It also means that the person in labor may be encouraged to get cervical checks more frequently to see how labor is progressing.

Since the epidural can cause blood pressure drops, they will monitor your blood pressure very frequently. Usually, they take a blood pressure reading every 5 minutes at first, and then switch to every 15 minutes until the baby is born. They will also continue to keep you on IV fluids to keep your blood pressure up. If your blood pressure drops too low, it can cause your baby’s heart rate to drop also; and if that happens, they will most likely give you a medication to increase your blood pressure.

The other most common intervention after an epidural is a urinary catheter. Lots of people express they do not like the idea of a catheter, but it is an important thing to have with an epidural for a few reasons. One, being that it is most likely the only way you can empty your bladder. Some people ask if they can use a bedpan, but with an epidural making you numb, there is usually a disconnect between your bladder and brain that makes it is nearly impossible to release your bladder. Next, if your bladder is very full, it can act like a water balloon that holds up your baby from descending. This can cause labor to be held up, or if the baby tries to descend on a very full bladder it can cause bladder injury. The only scenarios I’ve seen catheters be avoided is when labor is progressing very quickly, and the person delivers within an hour or two of the epidural placement. If worried about the catheter, it is important to know that they do not place the catheter until the epidural is working thoroughly, so it shouldn’t hurt at all.

While the above interventions are more often than not the standard procedures that go along with an epidural, there are other interventions I see more often after my clients get an epidural, but they are not interventions that are “required” for epidural placement.

When people get an epidural in a spontaneous labor before active labor (6cm), I sometimes see that their body relaxes too much, and contractions space out or dwindle. This is thought to be because the body was not in a strong enough active labor pattern to keep flowing smoothly when interruptions to the body occur. A few interventions used in this scenario are either pitocin or AROM (articifical rupture of membranes or “getting your water broken”) to augment (or speed up) labor.

Just a note: Alternatively, when my clients get an epidural once active labor has already kicked into full gear, I commonly see epidurals speed up the labor process as it allows the body to relax and not tense against the contractions and lets them be more effective. Usually, hormones are flowing enough to not be interrupted at this point. Additionally, I don’t see as much of a difference in timing of the epidural during an induction, as the medications are causing the contractions and therefore do not get interrupted like the natural flow of hormones in a spontaneous labor.

The other interventions I see more commonly in births using an epidural compared to those not using one, is an intrauterine pressure catheter (IUPC) and a fetal scalp electrode (FSE). Neither of these interventions are caused by epidurals but tend to happen when a higher level of monitoring is needed to know what is happening inside the women’s body. The IUPC is an internal monitor that is placed inside the uterus after the bag of waters is broken and helps measure the strength of contractions. A FSE is another type of monitor that better tracks fetal heart tones to give doctors a clearer picture of how baby is doing. The FSE is also only placed once the water has been broken as it monitors baby’s heart tones by a small wire that goes into baby’s scalp. While scenarios as to why these are used varies and is best explained by a doctor, I see it be used commonly when doctors or midwives are trying to get a better look as what is going on if mom or baby are not doing well, so they can make the best plan of care. I believe I see them more frequently with epidurals just because as more interventions are introduced, there is a higher chance of complications or interruptions that may require doctors to have a better understanding of what is happening inside the women’s body (especially since they can’t feel what is happening).

As all things in life, everything comes with risks and benefits. For most people in labor, the “risks” associated with an epidural are very small compared to the amazing benefit of pain relief from their contractions. My goal is always to empower people who are planning their birth to make the decisions that align with their goals as they bring their baby into this world, and a well-informed choice to pursue an epidural for pain relief can absolutely be a part of a positive and confident birth plan!

Wondering when you should get an epidural? Download our free flowchart and bring it to your birth to help you decide in labor when is the best time for YOU to request an epidural.