Labor Pain: Should I Get an Epidural?

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?

What pain relief options are available?

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.

Which method is the best?

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.

How is an epidural placed?

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.

What are the “side effects” of an epidural?

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.

Will an epidural increase my chances of a C-section?

No. Studies have shown that epidurals do not increase your risk for C-section.

Is there any reason why I can’t get an epidural?

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.

What if I don’t want an epidural or pain meds? Are there any other options?

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.

Menopause: Am I Crazy?

As you approach menopause, has this question crossed your mind? Many patients feel that they may be going crazy as their hormones become unbalanced or as the common phrase says “out of whack”. It may be you or your husband or other family members that notice it first, but at some point you may ask yourself this question.

As women age and approach 50 years old, which is about the age of menopause, they began having symptoms which include night sweats, hot flashes, mood swings, vaginal dryness, skin dryness, painful intercourse, and just feeling like they are in a fog all day long. Symptoms of menopause can occur as much as 10 years prior to the actual event, which is usually at age 51. You may have only one or two symptoms, or you may have a group of symptoms, all related to hormone imbalance. Your kids may not want to be around you much, and your husband may look at you and say “honey, I think you need to go to the doctor. You are acting really weird! Are you OK?” And of course, that is when you ask yourself “am I crazy?”

The answer to that question is obviously a resounding “NO!” But, you still feel like it. The good news is that there is help for this problem. There are at least six different hormones that can affect you physically, emotionally, psychologically, and physiologically. These include: estrogen, progesterone, DHEA, testosterone, and the two components of your thyroid, T3 and T4. All it takes is coming to the office and having blood drawn, which takes about a week to get the results back. We then sit down together and go over your symptoms, and the test results. I can then tell you exactly what your deficiencies are in the hormone range, and prescribe exactly what you need. It takes about two weeks for the hormones to get into your bloodstream and began working, as your tissues have been without these hormones for some time. Once you start feeling better, your family will like you again and you will actually like your family again. The key to this is to follow-up in three months with lab work drawn again to make sure that your levels are getting close to normal.

There is no reason to put up with this any longer when natural, bio identical hormones are available from local compounding pharmacies. All it takes is your first step, which is coming to the office. There is help available, and you don’t have to think that you are crazy.