12 Things to Know About an EpiduralCeridwen Morris
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1: It's an effective way to cope with pain in labor
When it works — and it most often does — epidural anesthesia is extremely effective at eliminating pain in labor. Sometimes known as the "Cadillac of analgesia, the epidural blocks the transmission of signals through nerves in or near the spinal cord with a combination of anesthesia (which numbs the lower part of the body) and narcotics (which change the perception of pain).
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2: It can decrease the chance of
If a woman is really exhausted and/or has been laboring for over a night (or two) without sleep, her labor may stall. At this point, the pain relief and relaxation from an epidural might get her labor back on track and help her avoid a C-section. Studies have shown that an epidural given after 5 centimeters dilation is less likely to slow down labor and lead to other interventions (such as a C-section) than those given earlier in labor.
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3: It can increase the chance of a C-section
Conversely, studies have shown that an epidural given early in labor — before a woman has dilated 5 centimeters — can sometimes slow down labor and lead to an increased likelihood of medical interventions such as a C-section. However, some studies suggest that the way labor progresses before the epidural has an impact on how the epidural affects labor. Women who hope to avoid risks associated with receiving an epidural early in labor may benefit from staying home until active labor begins and familiarizing themselves with other coping techniques and/or hiring a doula.
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4: There are risks
An epidural slightly increases rates of forceps and vacuum deliveries and vaginal tearing. In some cases it causes a sudden drop in blood pressure, which may or may not affect babys heart rate. (This is typically prevented or stabilized with medications and fluids). In addition, if the epidural is in place for over five hours it can cause a fever in mother and baby. Spinal epidurals are associated with slight increased risks such as difficulty swallowing and shortness of breath. Keep in mind, however, life-threatening consequences only affect around 1 in 4000 women.
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5: There are different kinds
An epidural consists of pain medications delivered to the epidural space (a.k.a. your back) via a catheter. The meds are on a drip so it takes a little while to kick in, but it can be adjusted or removed, if necessary. A spinal is a one-time injection of drugs into the spinal space backed up by a slow drip of meds. The benefit is instant relief; the downside is an inability to adjust or turn off the meds. A walking epidural is usually a lower-dose form of one of the above. The best fit for you will depend on the situation and what the anesthesiologist recommends.
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6: A walking epidural is not what it sounds like
A walking epidural sounds perfect: You get pain relief and you can move, which helps labor progress. But in practice, this form of pain relief — which is either a weak spinal-epidural or an epidural without anesthesia — doesnt usually allow for much walking. Even if a woman has enough sensation to move around, the continuous electronic monitoring, blood pressure cuff and IV — all of which are required when medications are used in labor — limit mobility. Those who can bear some weight (and have a doctors approval) will benefit from getting into gravity-friendly positions such as leaning forward or kneeling.
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7: There are side effects
The most common side effects from an epidural are nausea, itching and shaking. Most women also experience some temporary postpartum numbness and discomfort at the site of the injection (which can make some feel anxious), 10-12% have back pain for weeks or months postpartum, and about 1% suffer from a debilitating headache. The narcotics can also cause constipation, which is no fun postpartum (take stool softeners and stay hydrated).
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8: It can make you feel more (or less) present for the birth
Some women find the epidural makes it possible for them to really feel present at the birth. The elimination of labor pain allows a woman to chat or sleep or otherwise feel more clear-headed and aware of what's going on. However, for others, the disappearance of pain can feel weird or disconcerting. In non-medicated births, women can experience euphoria after the birth due to endorphins and hormones triggered, in part, by the challenges of labor. After a medicated birth, this relief may feel less pronounced.
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9: It's not always ready when you are
Hospitals in the U.S. are pretty efficient when it comes to giving laboring women epidurals, but that doesnt guarantee yours will be administered the second you want it. For this reason, learning about other options for pain relief can be a good idea. Even if you know you want an epidural, you may feel reassured to know there are other ways to ease labor pain before you even get to the hospital — and at each subsequent stage of labor. Many women find its not one thing that helps, but a combination.
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10: The window for getting one depends on where you deliver
In some major hospitals, women can get epidurals pretty much whenever they want, (from very early labor to transition) but anesthesiologists are not always available at a moment's notice. Also, your care-provider may have specific ideas about whether its too soon or late for anesthesia. Talk to your care-provider about his or her opinion on this matter so you can consider your options.
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11: It's common
Its estimated that somewhere between 70-90% of women laboring in U.S. hospitals get epidurals. This can be reassuring if you know you want pain medication in labor, but not so reassuring if youre trying to avoid it. Its really wonderful that pain relief has gotten so good and so safe, but its unfortunate that many hospitals offer little else in the way of non-medical pain relief. Ask your care-provider or hospital-tour leader what options youll have for pain relief in your facility.
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12: It's neither good nor bad
As you can see, weighing the benefits and risks of epidurals gets complicated. The importance of pain relief varies from woman to woman and labor to labor. Similarly, the risks of epidurals are not all static: they can slow down labor or help it progress it, depending on the situation. Learn your birthing options but know that in the end, you are the only one who can make the decision thats right for you.
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