The Epidural Truth–Told Straight from an Anesthesiologist

The Epidural Truth–Told Straight from an Anesthesiologist

Add epidurals to the list of things you can’t quite prepare for when you’re expecting.

Does it really hurt when the needle goes in? Can the medication stall labor? Will you be able to feel anything if you get one? If you’re open to pain medication, when is the best time to get one?

While an epidural may offer much-desired pain relief, there are a few things you may want to know if you’re thinking about adding one to your birth plan.

While everyone seems to have different experiences with epidurals, we talked to Dr. James Lozada, DO, an anesthesiologist at the Northwestern University Feinberg School of Medicine for more insights on what to expect if you’re considering an epidural (neuraxial analgesia) during childbirth. (Don’t confuse it with a spinal block, which is a one-time shot of medication also delivered into the spinal area.)

You’ll probably get a urinary catheter, too.

After an epidural is placed in your back, you are unable to walk around so a Foley catheter may be inserted for a variety of reasons. This will drain your bladder. Lozada explained that it can prevent injuries to the bladder during vaginal and cesarean deliveries because an empty bladder makes it easier for the baby to descend.

“During cesarean delivery in particular, a Foley catheter allows anesthesiologists to monitor urine which may be the first sign of unintentional bladder or ureter injury,” he said.

Other patients require close monitoring of fluid intake and urine output, especially for patients with preeclampsia. Epidural (and spinal) medications can lead to bladder distension or trouble urinating—another reason why catheters are advised.

“When a Foley catheter is placed, most hospitals wait until after the woman has an epidural or spinal, so she doesn’t feel the catheter being inserted,” he said, adding that it’s not always possible. During a vaginal delivery, the Foley catheter is removed just before pushing.

So, do you really need a catheter? There’s no universal “standard of care” for catheter timing or placement, which is why we may know some women who had to have them and other who didn’t. It is standard, however, to place a Foley catheter for high-risk pregnancies, cesarean deliveries and in those patients who need close monitoring.

“There is ongoing research looking at whether there is a difference in Foley catheter placement versus intermittent catheterization as needed during labor for healthy women having vaginal deliveries,” he explained.

It’s pretty quick.

Placing a labor epidural is normally a relatively quick process—typically about 20 to 30 minutes, Lozada said.

“Most of my patients are grateful to have pain relief, surprised at how easy epidural placement is, and are able to rest for the first time during labor,” he added.

It’s not too painful.

The procedure involves you sitting on the edge of the bed or laying down on your side.  You will be given IV fluids to help your blood pressure stay normal.  The worst part is an injection of lidocaine in the back which numbs the area, which will burn for 10 to 15 seconds, then go away.  After that, you’ll probably just feel pressure when the epidural catheter is inserted.  It’s possible some of the medications we use will cause itching, which most women tolerate well. Itching usually resolves in an hour or so.  The legs will likely have numbness or tingling. You won’t be able to get up and walk after the epidural is placed.

Epidural placement is a sterile procedure, so many places ask visitors to leave the room during placement to decrease the chance of infection.

The epidural will take away sharp pain, but you may still feel pressure…something Lozada said he wants women to feel so they have some control over pushing.

It can shorten or lengthen labor.

While an epidural won’t increase the rate of a cesarean, Lozada notes, it can shorten or prolong labor depending on the stage a woman is in when the medication is administered.

Labor epidural has a variable effect on the first stage of labor, shortening in some women and prolonging in others, he said. “Whatever effect does occur is short, has no adverse effects on mother or baby, and has little clinical significance,” Lozada added.

If given during the second stage of labor, it adds about 20 minutes on to the labor.

According to the ACOG, so long as progress is being made, the baby is doing well and the mother’s pain is controlled, duration of labor alone does not mandate intervention. They contend that extending the second stage of labor will help many women deliver vaginally.

Not everyone can have an epidural.

Almost all women can receive neuraxial analgesia. Only a few absolute contraindications exist:

  • Brain tumor or other medical condition that increases pressure in the brain
  • Infection at site of needle placement
  • Low platelets (often seen with preeclampsia or other medical conditions)
  • Taking anticoagulation medications

You can get one at any point.

If you know you want one, speak to your doctor or the anesthesiologists sooner than later. You may want to ask the nurse how much notice you need to give between the time of request and administration (my midwife advised that I give the hospital at least a half hour, for example).

“For many years, [the] ACOG (American College of Obstetricians and Gynecologists) recommended that women delay requesting labor epidural until their cervix was dilated to 4 cm.  Many hospitals adopted that and continue the policy,” Lozada noted.

However, in light of more recent studies showing labor epidural has no impact on the cesarean rate, ACOG revised its recommendation to say that women shouldn’t fear an unnecessary C-section when they choose a pain relief method, and that a woman can have the medication whenever she wants.

Overall, Lozada said having an epidural is a personal choice that is impacted by physical, cultural, socioeconomic, and emotional factors.

While neuraxial analgesia (epidural/spinal) is considered the most effective pain relief method, other techniques may offer women the amount of relief and labor experience they seek, he added.

Images courtesy of Getty Images.