Epidurals are the most common pain medication requested and administered during labor. Most non-healthcare people don’t really even know what an epidural is in regards to a labor patient. They call it an epidural because the medication goes into the epidural space of the spinal cord. An anesthesiologist will be the person performing the epidural and it’s done in your labor room. There’s a lot of preparation that needs to be done before this can happen so be mindful when you think you want to ask for it. If someone knows they eventually want it, I’ll start prepping before they ask for it.
A consent form needs to be signed and risks need to be talked about. This is usually difficult to understand or even care about when you’re in active labor and all you can think about is the squeezing pain of your uterus. I remember one mom who couldn’t stop moving from the pain yelling at me, “I don’t care! Just get the doctor here to give me the medicine!” And then she quickly scribbled gibberish on the form where her signature was to be signed.
The thing that takes the longest is getting you an IV and starting IV fluids. IV fluids are given to reduce your risk of low blood pressure, which is one of the risks of an epidural. Depending on the facility, you will get about 500ml-1,000ml of before the epidural can be placed. This process can take 30-60 minutes. You also are not allowed to eat anything after getting an epidural. Depending on the facility some clear fluids are allowed. If your blood pressure does go too low then additional medication will be administered in your IV to help bring it back up.
Sitting for an epidural involves curling your body around your belly to curve your back. This helps to open space in your back to assist the doctor in placing the epidural. This can be done while lying down on your side or sitting up depending on the doctor’s preference.
While you’re waiting for the sweet relief, we will be taking your blood pressure, listening to baby’s heart, and monitoring your oxygen levels and heart rate with a probe that goes on your finger or toe. So there are a lot of things hooked up to you.
Prepping your back before the actual procedure will take a couple of minutes. They wipe down your back with antiseptic and put a drape over your back to keep things sterile. This is a sterile procedure, meaning that it’s free from bacteria and nothing that is not sterile can come in contact with it. We tell you to not put your hands behind your back or touch your shoulders, this also includes your partner that is most likely standing in front of you.
The hardest thing about getting an epidural is when the anesthesiologist is injecting the needle and you have to stay completely still and the more you move the harder it is and the longer it takes. However, this part is usually very short and the only thing getting you through that moment is the fact that you’ll have pain relief very soon. They will put in a needle to find the right space of where to put the medication. This may take another couple of minutes.
Once they are sure they have the needle in the right place they will insert a small flexible plastic tube and take out the needle. They will do an initial test dose all while analyzing the monitors that are spewing out all the numbers.
They will then tape the long plastic tubing to your back to ensure it stays in place. The tube is connected to a pump that will continuously pump the medication into your back to numb you from the waist down.
Then once we get you comfortable the nurse will stay with you for a while to continue to monitor everything to make sure there are no complications.
After some time, a catheter will be inserted into your bladder to empty it. I’ve worked in places that have different policies on this. Some will use a temporary catheter and others will use a catheter that will stay in place until closer to delivery.
Now your bottom limbs have a mind of their own and that mind isn’t yours. It’s a weird feeling, like heaviness and having no control where they go. Some people have complete numbness and can’t move at all. Some people are still able to move their legs and even get into different positions. Everyone is different.
So, at this point you have the tubing from the epidural, IV tubing, monitors on your belly and finger/toe, possibly a tube for the catheter and a blood pressure cuff on your arm. This chaos of tubes and wires are a nurse’s nemesis, but we are happy that our patient is comfortable and we try to make it a functional dance.
Just a reminder, you cannot get out of bed with an epidural unless you plan to army crawl your way to delivery.
Mind Blown Moment
When the anesthesiologist puts the catheter in your spine, they are going in blindly. This means that not all epidurals are perfect. Sometimes an epidural will give complete relief from pain and other times you can still feel pain on one side, you could feel pressure but not pain, or you could have pain relief for a certain amount of time. If the epidural isn’t giving adequate relief, the anesthesiologist can give a bolus (extra dose of medication) or replace the epidural all together.
After all the things are done, we try to get you into a comfortable position and let you rest. Since you have to lay in bed, the baby doesn’t have the movement of the pelvis that it needs to move down. So, we try to put you in different positions. We also will try to what is called a peanut ball between your legs. What did she say? A Peanut ball? Imagine an exercise ball or yoga ball that’s in the shape of a peanut. Google it. I’ll wait….Yep that’s it. Putting this between your legs helps to keep your pelvis open and wide, making a wider road for the baby to drive through. Wide Load Only Lane!
After this we will rotate your position about every hour and you can rest in between position changes until it’s time to push. You will probably feel it when it’s time to push because you will feel the pressure of the baby’s head coming down. It’s also a possibility that you’ll feel some pain with pushing or close to pushing.TMI:I myself, felt no contractions in my uterus with my 2ndbirth but I felt pain in my perineum (cooter, vag, va-jay-jay, hoohaa).
After your baby is born, the epidural pump is stopped and it can take about 30 minutes to 2 hours or more for the medicine to wear off and you can walk like a human again.
Lots of women love epidurals and wouldn’t give birth without one. Lots of women love giving birth naturally and don’t want an epidural. Neither one of these options is right or wrong. What matters is what YOU want. There’s no shame in epidurals, no matter how much you’ve told yourself that natural birth is best for you. If you suddenly decide that you don’t want to feel pain anymore and whoever decided that giving birth naturally was a good idea is insane, that’s ok. If giving birth naturally is what you want and you’ve done it with all 19 of your children, more power to you sister, seriously.
Here’s one opinion that I will give you. This is based on my experiences as a nurse. It’s generally best to wait as long as you can tolerate it to get an epidural (but don’t wait until you’re 10cm and crowning to ask for it). Sometimes an epidural can slow down labor or make contractions less effective. Sometimes with an epidural, Pitocin is needed to make contractions stronger and closer together. Reminder: I’m a nurse and not a doctor or midwife. Talk with your provider about risks vs benefits for your own labor and birth.
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