An Honest Conversation About Epidurals

The first honest truth about labor and childbirth is that it hurts. Obviously. Ask any mama what exactly it feels like, and you’ll get a variety of responses: “like running a marathon” or “the worst period cramps of your life;” the common theme is pain. Labor and contractions are painful, then actual vaginal childbirth is the icing on the pain cake. The good news is that women have been conquering this pain since the beginning of time without epidurals, but now there are a host of options for pain management, both medical and psychological.

Labor neuraxial analgesia, or more commonly “epidurals,” are used in about ¾ of births in the United States making them the most widely used pain management technique available. Epidurals are administered in the hospital by anesthesologists, but unfortunately it’s not just a quick shot like a flu vaccine. An epidural is really more of a procedure, during which a needle is inserted near the spine to make way for a small tube (it’s okay if you shuddered at that). The tube stays in place throughout birth and delivers a steady dose of meds. Once childbirth is over, the tube must be removed. Some women become squeamish at the thought of the procedure… but once those intense contractions hit, that squeamishness often magically disappears!

Relief from an epidural isn’t immediate but can take about 15 minutes to set in, arguably the longest 15 minutes of your life. Depending on the strength of the epidural, you may feel nothing at all, pressure, or numbed sensations. Feeling nothing at all may at first sound like a blissful, dreamy escape from childbirth pain, but that total numbness can be problematic during the pushing stage of labor. It’s hard to determine how to engage the right muscles to push out your baby if it doesn’t even feel like the lower half of your body exists! More and more women are now requesting “walking epidurals” because of this. The name is misleading, as you can’t exactly bounce up and do the electric slide after getting one, but the dose of the medication in a walking epidural allows you to at least feel your legs. This can help make pushing more successful.

As with any procedure, epidurals don’t come without risks. There is always the risk that the epidural may not be administered correctly. In the absolute worst case, that could mean damage to your spinal cord. There can be additional complications if the epidural enters your spinal fluid or is accidentally injected into a vein. If you have an experienced anesthesiologist, the risk of these things happening is very slim. Sometimes though, epidurals don’t pose physical risks but only partially work or wear off at crucial moments of delivery. Women have recalled epidurals “taking” to only one side of the body, so one side may go numb while the other has full feeling. Weird, to say the least. For others, epidurals may nor properly work at all, so the expected pain relief just never comes. Also known as the biggest letdown ever.

Epidurals can also introduce other complications into the delivery room. Having a particularly strong epidural, during which you’re completely numb and unsure how to best push, can substantially slow delivery. Healthcare professionals are still mixed on their conclusions, but some studies have shown that women having epidurals were 2.5 times more likely to have a C-Section. This increase is most likely linked to the epidurals’ prolonging of labor. As the hours stretch on, if things are not progressing, a ceasaran becomes the quickest, easiest option. Finally, some women report after-effects of epidurals like spinal headaches that can last for months, or even years, after giving birth!

For those who do not want to accept the risks of an epidural or simply don’t want one, other less common birth pain management options DO exist: narcotics, nitrous oxide (laughing gas), local anasthetic, meditation, breathing & relaxation practices, birthing in warm water, counterpressure, and distraction techniques. Many epidural-free mamas choose a combination of these other methods. Some options, like meditation, may take weeks of preparation and training, but many women report decidedly pleasant epidural-free births and enjoy the feeling of being “more in control” of their bodies.

All that said, many moms who have had successful epidurals say they could not picture childbirth happening any other way, and they gladly opt for epidurals in their subsequent births. Ultimately, just like every aspect of your birth plan, your chosen pain management route is very personal. It’s something that you, your healthcare provider, and your birth partner (if you have one), should weigh the options of and decide on together. It’s a big decision but remember, once you’re holding your mini-me, the details of how exactly you got to that point–epidural or not–will slowly fade away!