Labor Induction: What Pregnant Women Want to Know
Preparing for labor induction to get your baby delivered. Read more
Preparing for labor induction to get your baby delivered. Read more
Pain relief during labor is a huge question that weighs on any expectant mother’s mind. No one likes pain and the mere anticipation of labor pain is a scary thought for most. I make it a point to review all pain relief options with all of my pregnant patients prior to delivery. One of the most common questions that I get is whether to get an epidural or not, and what are the risks and alternatives?
There are two main options available for patients who are in labor. The first is intravenous (IV) pain medications. The second is regional anesthesia usually in the form of an epidural, which is a catheter placed in your back in which medication is infused around the spinal nerves to make your belly and pelvic region numb.
Epidurals, by far, relieve labor pain most effectively. The epidural medications cause you to lose feeling in your belly and pelvic area by blocking nerve signals from the lower spinal nerves. Epidurals are very targeted and block pain directly from nerves that supply the uterus and vagina. IV pain medications, on the other hand, simply cause a decreased perception of pain and don’t necessarily target any specific organs. Their effects often wear off quicker as well.
An epidural block is performed by an anesthesiologist. A small area in your lower back is cleaned and made sterile. A needle is inserted into your back and a catheter is threaded over it into the epidural space (space just outside the spinal cord). Medication is then infused via the catheter, which blocks the targeted nerves. This infusion of medication is set at a constant rate but can be altered using a small pump. Since you will not be able to fully feel your bladder sensations after the epidural is placed, you will have a catheter to drain your bladder.
There aren’t many major side effects of an epidural although some do exist. One possible side effect is low blood pressure. If you experience a drop in blood pressure, there is medication used to raise it to ensure good blood flow to your baby. Epidurals can also cause post-delivery headaches if spinal fluid leaks out. Rarely, a spinal hematoma, which is a blood collection around the spinal cord, can develop however the incidence of this is very rare at less than 1 in 250,000. Other minor side effects include fever, shivering, nausea, or vomiting. One last important side effect is a prolonged second stage of labor (“pushing” stage). This is due to an inability to feel the anything in the vaginal region which then makes pushing less effective. While you may push a little longer, the vast majority of women still deliver vaginally.
No. Studies have shown that epidurals do not increase your risk for C-section.
There are a few rare conditions that preclude a patient from getting an epidural. These include a low platelet count, a coagulopathy (clotting disorder), a space occupying brain lesion, or an allergy to the medications in the epidural.
During labor, the main pain relief options are IV medications or an epidural. The only other options would be a pudendal nerve block or local anesthesia. A pudendal block is a numbing medication that is directly injected around the pudendal nerve through the vagina. This is typically performed as a mother is pushing as its effects are relatively short-lived. Local anesthesia is given as a direct injection of numbing medication into the vaginal tissue to temporarily numb the area. This is typically done after the delivery however, and only used when a vaginal tear has to be repaired.