Using an Epidural in Labor - What Does the Evidence Say?
Average Read Time: 4-5 Minutes
Epidurals are the most commonly used medical pain management tool in childbirth. I be surprised if you DON’T know someone who had an epidural to support their labor! Yale Medicine estimates that 70-75% of all pregnant people use an epidural in their childbirth experience.
Are you debating using an epidural to help you navigate the sensations of labor? I’ve broken down the information using EBRAINS (want more info, see my blog here!).
Explanation:
An epidural is a catheter that is inserted into your spine by an anesthesiologist at any point during your labor.
This catheter allows for a stream of medication into your body to stop the pain of contractions.
The medications that are used depend on each hospital, but may include opioids (ex: fentanyl) and anesthetics (ex: lidocaine).
The catheter is taped to your back very securely so that it won’t move around!
If the medication starts to wear off, some hospitals give you a button to press to administer a bolus (a small boost of medication). You can’t over-do this bolus, the machine won’t let you press the button more than once every 15 minutes. At other hospitals, the nursing staff have to press the button for you, but you still can request a bolus at any time!
Benefits:
You will not feel the intense sensations of contractions any longer.
It can give you a chance to rest, or even sleep, in order to prepare for the later stages of labor and delivery.
If a cesarean becomes necessary, many anesthesiologists will use the same epidural for the procedure.
Risks:
You can no longer get out of bed, and will require assistance to move your body into different positions (remember, motion is lotion for labor - to quote the amazing Britta Bushnell).
There is an increased risk of hypotension (low blood pressure), so the blood pressure cuff will take a reading every 15-30 minutes.
There is an increased risk of fever. This epidural fever can’t be distinguished from an infection, so medical staff will treat you with antibiotics.
Alternatives:
Non-medical comfort measures, such as counterpressure, hydrotherapy, acupressure, and more!
Intuition:
While you can compile all the information and knowledge about an epidural before the day of your birth, checking in with your intuition throughout your childbirth journey is going to be the final deciding factor when you make your decision.
You may have planned for an epidural, but then find that other comfort measures are working well and that you’re coping in the way you wanted. Or, vice versa, you may have planned for an unmedicated birth but decide to get an epidural when you realize your pain has turned into suffering.
Before you get an epidural, I always recommend asking for a cervical check, if that feels safe to you, and depending on how long it’s been since you had one. It may help your decision-making to know how dilated and effaced your cervix is!
Nothing:
The “what happens if you do nothing” question for an epidural means… you won’t have an epidural!
The question here is more for the instances where an epidural is recommended to you. If a nurse or provider asks if you’d like an epidural, you can always respond by saying, “I would like to labor for a bit longer, but I’ll let you know if and when I’m ready!”
Side effects:
You will have a catheter inserted into your bladder to assist you with peeing for the duration of your labor. This typically comes out before or during the pushing stage!
Epidurals require continuous fetal monitoring to make sure that you’re contracting well and that baby is doing OK! If possible, ask your hospital for wireless monitors, so that you can move around without worrying about wires.
Another requirement of an epidural is a saline IV drip. This is to support blood pressure drops, which are common with an epidural.
There is a chance with an epidural of labor slowing down, especially if you get an epidural earlier in the laboring process. This may increase the change that your provider will recommend pitocin to stimulate your body to continue to have contractions and progress through labor.
Some people report that there’s a feeling of pins and needles that lasts in the legs and feet for days, weeks or sometimes months afterward.
Remember, you get to choose how you navigate your labor! The purpose of this blog is to help you make an informed decision for your body, your baby and your family. Want help navigating the choices you have during labor? Reach out to me here :)
Citations:
Yale Medicine - Epidurals During Childbirth: What Women Should Know
Evidence Based Birth - Epidural during Labor for Pain Management - Evidence Based Birth®
Henci Goer, Optimal Care in Childbirth (Classic Day Publishing: 2012), p. 267-301.
Sue Gottschall and Rebecca Nguyen, The Power of Birth: Birthing with Awareness, (Self-published: 2022), p. 67-68.
American College of Obstetrics and Gynecologists -Medications for Pain Relief During Labor and Delivery
