What’s an epidural? How does an epidural during labor 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. I’ve been through hundreds of epidurals, so if you’re curious how it all goes down, you’ve come to the right place!
When should I 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 should be having painful contractions
- You should be changing your cervix
- 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.
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Alright, I want one! What’s next?
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.
I do need to complete some pre-procedure tasks before you are able to see the anesthesiologist. Let’s go over those preliminary steps:
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- 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.
- You need some IV fluid. After I’ve started your IV, and 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.
You need IV fluid before we get your epidural for a couple of reasons. 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!
- 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.
K, I’m prepped, and I really want an epidural in labor now!
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.
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, and 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.
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.
Let’s get to it…
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, and 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.
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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 whom 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 procedure 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!
And, if you’re interested in learning MORE about epidurals, head over to THIS POST!
Happy Laboring! 🙂
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