What’s an epidural? How does an epidural work?
Whether you plan on getting an epidural from the moment you find out your pregnant, or hours deep into labor, it’s important to be informed about the procedure.
In fact, even mamas who plan to go natural should get educated about epidurals just in case they need to change their plan once they’re in labor (which is exactly why I teach about them in my natural birth course!).
As a labor and delivery nurse, I’ve seen hundreds of epidurals, so if you’re curious about how it all goes down, you’ve come to the right place!
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When to get an epidural in labor?
In all honesty, when you ask for one! With that said, in my experience, the best time to receive an epidural boils down to 3 factors:
- You’re having painful contractions
- Your cervix is changing
- You should NOT be feeling the urge to push yet (oops too late!)
Contrary to popular belief, there is no magic number of centimeters you should be. Although, most of the time if all three of these factors are in play, you are probably around 4-6 centimeters dilated. Every woman is different, though, and I have had patients get epidurals at 1 centimeter, and at 10 centimeters dilated.
Related: Epidural Facts You May Not Know
Should I get an epidural? Epidural pros and cons
Birth stats show that somewhere between 60% and 80% of women birth with an epidural in the US. While we don’t know how many of those women planned it or not, there’s no doubt, it’s extremely popular.
And for good reason.
While there are some possibilities for minor side effects, on the whole more and more research is showing that epidurals do NOT lengthen labors or carry a high risk for significant side effects—they’re absolutely safe!
Pros of an epidural:
- Most mamas experience very little or no pain once their epidural is in place. In fact, according to a Parents Magazine article with an OBGYN, less than 5% of women have epidurals that don’t relieve pain
- Getting an epidural will allow you to rest and relax during labor which means you aren’t entering motherhood completely exhausted from birth
- Knowing you want an epidural can provide a more positive birth experience because of the sense of control (the caveat here is when birth moves TOO fast, and you’re unable to get an epidural)
- Most mamas feel completely alert and present during their epidural births
- Epidurals are totally safe! From a medical standpoint they are considered to be a very safe option for pain control during labor
Cons of an epidural:
- In some cases, it can slow down or stall your labor which results in the need for labor augmentation, or in some cases, an unplanned C-section.
- You may get a bad headache after delivery called a SPINAL HEADACHE. While rare, I have seen a few in my practice and it’s worth mentioning. When you are signing a consent form for the anesthesiologist to place your epidural, this “Spinal Headache” is listed as a rare complication that you may face as a result of the procedure
- There are less serious, but sometimes uncomfortable side effects like extreme itching and shivering
- It may increase your risk for tearing because pushing can be more difficult (read about both in this article about preventing tears)
- It can cause low blood pressure (but this is why we prep you with IV fluids)
- Some mamas can’t get epidurals! (though this is pretty rare, and you’ll likely know if this is you way ahead of time). Reasons include: low platelet levels, previous spinal surgery, unable to sit still during epidural process, and a few others
The epidural process from start to finish
Getting an epidural is a process. It’s not a quick shot you can receive that makes the pain go away immediately. It takes approximately an hour to feel relief from the procedure once you’ve asked for one.
As your labor and delivery nurse, I do need to complete some pre-procedure tasks before you are able to see the anesthesiologist.
Let’s go over those preliminary steps:
1. Getting prepped
- You need IV access. Usually this only takes minutes if you have great veins. But, sometimes if you are a difficult stick this can delay the process a bit.
- I need to collect some blood from you, specifically your platelet count. Platelets are a component of your blood that helps your body to clot when there is blood vessel injury (i.e. when you get a cut, or in this case getting a needle stuck in your back!)
- Your platelet count needs to be over a certain number. If it’s too low, you can get what’s called a hematoma in your back where the anesthesiologist has placed the epidural. A hematoma is basically just a huge collection of blood. And, having one in your back can put pressure on your spine, which can cause nerve damage! Let’s just say, it’s bad!
This lab usually takes about 15-20 minutes once I’ve sent it down to the lab.
Then, you’ll get started on your IV fluid. While we are waiting for your platelet count to result, you will be getting an entire bag of normal saline through your IV. This is generally the longest part of the process. It depends on where your IV is, and what size gauge it is, but usually, this can take anywhere from 15 minutes to 30 minutes.
Why do I need IV fluid for an epidural?
- First off, we anticipate that your blood pressure is going to drop a bit after receiving an epidural. Getting some extra fluid through your IV can help prevent that from happening
- Second, having a bit more fluid circulating helps to open up the spaces in your spine. It makes placing your epidural a bit easier for the anesthesiologist. And, the easier it is for him/her, the quicker you get pain relief!
Lastly, I need to collect some routine items needed for the procedure. This doesn’t take very long to do. It’s worth mentioning though, as I will be running in and out of your room a few times.
2. Paging anesthesia
Once you’ve got all your fluid, and I’ve checked to see that your platelet count is a certain number, this is when anesthesia gets paged to come place your epidural.
Depending on what hospital you deliver at, the anesthesiologist may have to be called from home. Sometimes hospitals only have one or two anesthesiologists on call, and they may be busy doing other surgeries around the hospital.
This would be the only delay here.
3. Anesthesia is on the way
At this point, I would sit you up, put a blood pressure cuff on your arm and pulse oximeter on your finger.
Usually the anesthesiologist likes you to sit up in a certain position, and while we are waiting on him/her to arrive, I like to practice this position.
- Shoulders slumped
- Head curled down to your chest
- Arms in front of you
- Feet dangling
Your back should be curved, and you should be curled around your baby. Basically I want you to curve your back so you look like a boiled shrimp or a scared cat.
4. The anesthesiologist is here!
Alright it’s game time! You are about 15 minutes from starting to feel better!
The anesthesiologist will do a preliminary assessment on you when he enters the room, ask you a few questions, and have you sign a consent for the procedure. After we’ve got all our ducks in a row, we can begin.
While the anesthesiologist is opening a sterile table and some medications that he needs for the procedure, I’ll have dad (or whomever your support person is) come around and sit in front of you on a chair.
5. Placing the epidural
- He begins by cleaning your back with a COLD sterile solution.
- After this is dry, he places a drape on your back, and gives you some numbing medication in the area of your back where he will place the epidural catheter. This is the worst part.
- The numbing medication stings, and you may have heard people describe it like a bee sting in your back.
- The medication takes about a minute to numb your back
- Once you are numb, this is when the anesthesiologist will use a different needle to attempt to find a teeny tiny space in your back where he can deliver the medication. This second needle should just feel like pressure.
- It can take some time for him to find just the right space, and the most important thing you should focus on is staying still and breathing through any contractions that you have during this part.
- It can be difficult to stay still if you have a contraction in the middle of the procedure, however IT’S VERY IMPORTANT.
- Sometimes this part takes less than a minute, sometimes the placement can be very difficult and take 5-10 minutes.
- Trust me, we both know YOU ARE DYING FROM THOSE CONTRACTIONS and I promise he is working as quickly as he can.
- Once he has found the right spot, he takes the needle out of your back. Then he slides a flexible catheter into your back that will stay there until after delivery.
- Before taping it down, he first gives a bit of medicine through the line to make sure it truly is in the right place in your back.
- Once he is certain it’s in the right place, he places a huge piece of tape on your back and gives the medication that will eventually start numbing your legs and make the contractions go away.
From this point on, your contractions should start to become a little less intense, and feel a bit shorter, eventually going away all together. It takes approximately 15-20 minutes for this medication to fully set in, and for you to be pain-free.
WITH THAT SAID, the pain you were feeling from your contractions should completely go away. However, you will still feel the pressure of the baby’s head. Most women report this as uncomfortable, especially as you get closer and closer to delivery.
Also, epidurals aren’t perfect, and there is a small fraction of women who receive them and they either are one-sided or don’t work at all. If this is the case, let your nurse know and there are a few things we can do to try and make you as comfortable as possible!
Well, there you have it! That’s the entire epidural process from start to finish. I hope you’ve taken some info from this post. Even if you aren’t planning on an epidural during labor, it’s certainly always helpful to be informed!
If you KNOW you want an epidural, I created an online birth course just for my epidural mamas! It’s helped thousands of other mamas, and I know you’ll be better prepared. The best part? It’s super affordable. Go check it out!
For more info and advice check out:
Happy Laboring! 🙂