The 411 on Epidurals
What is an epidural?
Epidural has been a common practice since the 1980s*. It is a corticosteroid injected into the epidural space around your spinal cord. “When a regional analgesic medication is injected directly into the epidural space, it blocks pain signals from going to the lower body through these nerve pathways.”* Within 20-30 minutes you lose feeling from the waist down (depending on the location the epidural is placed.) Although common and usually safe, some of the side effects are: low blood pressure, temporary loss of bladder control, itchy skin, feeling sick, headaches, and in some cases nerve damage.*
When should you choose an epidural?
Generally, epidurals aren’t offered until the mother is beyond 3-4cm. It is too late for an epidural if the baby’s head is crowning (epidural policies vary doctor to doctor).
Why should you choose an epidural?
Epidurals are chosen for pain-related reasons only. Unlike Pitocin, they do not speed up labor and in some instances can even stall a labor.
What should I know before choosing an epidural?
Informed consent is a huge part of what doulas do. We are passionate about momma being fully informed on birth practices within hospitals. What you should know before getting an epidural are the side effects. Since epidurals can negatively impact things like blood pressure, this may also affect your baby and increase the chances for cesarean intervention.
“Women having epidurals were 2.5 times more likely to have a cesarean (20% vs. 8%), or put another way, 12 more women per 100 having epidurals had a cesarean (absolute excess), which amounts to 1 additional cesarean for every 8.5 women having an epidural (number needed to harm).”*
What are some things you can do before choosing an epidural?
● Consider how dilated you are.
○ The earlier you receive an epidural, the higher the chance of interventions.
● Have you tried changing your position and alternating pain coping techniques?
○ You have the freedom to switch it up! Get in the shower or out of the birthing tub. Walk around or go from side lying to all fours.
○ Look into other coping techniques like TENS, holding a comb, hypnobirthing techniques…etc
● Do you need to wait it out?
○ Sometimes your body is at a plateau and if you give yourself some time, you’ll get over that hump on your own. It's normal to want to rush through labor - it's uncomfortable! But if you take a deep breath and remember that labor is a marathon and not a sprint, you may find it easier to wait it out.
● Are you in transition?
○ Transition is the hardest part of labor but thankfully the shortest! It’s the final phase of active labor as your body is working on the last bit of dilation to get your cervix complete (10cm) for pushing. Transition can be a quick 10 minutes or last an hour (sometimes longer, sorry). The key is knowing the signs of transition – longer/stronger/harder contractions and you may start to feel pressure. Reminding yourself you’re almost to the finish line can get you through transition. Many women enjoy pushing and you’re almost there!
● Did something change that's affecting you mentally, emotionally, spiritually?
○ Did you receive bad news? Did something happen that made you upset? Is your labor being interrupted too much? Do you suddenly have thoughts that “I can’t do this!”. These types of things can pull you from “the zone” and push you to look for a way out. The stress on your body coupled with the stress on your mind can be too much for one person to juggle and the answer is what you feel is most easily dealt with - the pain!
As a doula I do not encourage epidurals for pain relief. That doesn’t mean I’m always against them though! I believe no labor should be torture. In the cases where the momma makes the informed decision to receive an epidural - I support that informed decision!
In the end, I want your birth experience to be just that - YOURS. Whether a medicated hospital birth or unmedicated homebirth, you and your baby are the most important factors.
Humenick SS. Birth environments. J Perinat Educ. 2000 Spring;9(2):vi-vii. doi: 10.1624/105812400X87572. PMID: 17273198; PMCID: PMC1595017.
“Epidural Pros and Cons”. Birth Injury Help Center. https://www.birthinjuryhelpcenter.org/epidural.html
”Overview Epiduals”. NHS. March 20, 2011. https://www.nhs.uk/conditions/epidural/
Goer H. Epidurals: Do They or Don't They Increase Cesareans? J Perinat Educ. 2015;24(4):209-12. doi: 10.1891/1058-1243.24.4.209. PMID: 26834442; PMCID: PMC4718011.