epiduralAn epidural is one of many ways women use to manage labor pain. It's not necessarily for everyone, but the vast majority of us rely on an epidural to ease the agony. Unlike other forms of pain relief, an epidural doesn't go directly into your bloodstream, which makes it safer for your baby. But how does an epidural work, and what are the possible risks and reactions?

I talked with Kristin Mallon of Mindful Midwifery about epidurals -- just about every question you'd want to ask. Mallon is a board certified nurse midwife and mom of three. She's also worked as a labor and deliver nurse and as a D.O.N.A. trained doula. Here's what you need to know about epidurals to make an informed decision.

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What drugs are in an epidural? Each anesthesiologist comes up with their own "recipe" for an epidural. Most commonly there's local anesthetic like lidocaine or bupivacaine, maybe a pain reliever like fentanyl, and something that boosts the effectiveness of those drugs, like epinephrine.

How is it inserted? Does it hurt? The anesthesiologist will usually inject the insertion area to numb it before inserting the epidural. Then they will insert a needle into your lower back, thread a catheter through the needle into your back, remove the needle, and leave the catheter in place. Medication is continuously pumped into the area until you no longer need it.

How long before the pain stops? Sometimes (not usually) it can take an hour just for the anesthesiologist to arrive in your delivery room once you've requested an epidural. You may need extra time to take in fluid from an IV, first (this prevents your blood pressure from dropping.) An experienced anesthesiologist can take just five minutes to insert the epidural; a less experienced doctor could take up to 40 minutes. Once the epidural is in, the doctor does a lighter "test" dose that takes effect after about 10 minutes. You should feel the full effect of the epidural after 20 minutes.

Can I move around with an epidural? You won't be able to walk around. Thanks to the somewhat lighter doses used nowadays, though, you should be able to move your position. For example, you should be able to sit up or squat.

What's a "walking epidural"? This is an extremely low-dose epidural sometimes used in the Midwest but uncommon elsewhere. Mallon says they're infrequently used because the dosage is so low, you could get the same effect via an IV. In other words, it's kind of not worth the trouble of going through an epidural. 

What about possible side-effects? You may get what one mom describes as "that tingly, cold waterfall feeling" if the catheter happens to brush a certain nerve that runs down through your leg. You may get a random spike in your temperature and doctors aren't quite sure what exactly causes that. This is not the same as a fever, however. If you (or your baby) spike a fever it could be attributed to chorioamniontitis.

You can get a spinal headache if your lumbar is punctured and spinal fluid leaks. An anesthesiologist will know if that happens right away, and should deal with it. Headaches are common after labor for a multitude of reasons. You'll know if it's a spinal headache (if your anesthesiologist didn't already tell you) if the pain is in the back of your neck, is accompanied with nausea and vomiting, and can't be relieved with Motrin or Tylenol. Usually lying flat on your back will offer a great deal of relief for a spinal headache.

Are there any risks to an epidural? About 1 percent of women who get an epidural experience a drop in their blood pressure. You'll be monitored, so this can be immediately (and easily) treated by giving you more fluids. In extremely rare cases, a poorly inserted epidural could become infected. Paralysis or long-term disability due to an epidural are extremely rare and there are several safety measures that will prevent that from happening. As with every other aspect of pregnancy and childbirth, any health issues you have could complicate your experience with an epidural. You should discuss this with your doctor or midwife.

Mallon recommends that you inform yourself about the possible risks and reactions before you go into labor. When you take your hospital tour, see if you can meet with the anesthesiologist, or at least get a copy of the hospital's consent form, which will describe the risks. Read that before you're blind with pain, ladies!

Does an epidural increase your chances of having a C-section? This is a claim often made in favor of unmedicated labor. Mallon says there has been an epidemic of C-sections, but it's not related to epidural use: Correlation is not causation. 

Can an epidural slow down your labor? Mallon says yes -- IF it's given too early, before labor has really begun. An epidural reduces your mobility, which in turn can slow down your labor. On the other hand, for women in labor an epidural can relax your pelvic muscles so you dilate more quickly. (This was the case with me -- after about 8 hours I was in so much pain my labor stalled, and getting an epidural helped get me going again.)

Do you have any other questions about the epidural?

 

Image via Roderick Chen/First Light/Corbis