So, You Want An Epidural?


It is the Rolls Royce of pain relief for a grueling labour.  The most up to date statistics (here) currently state that, overall in the USA, 61% of women giving birth to a singleton make use of the wondrous epidural.

In the UK, figures (here) reveal that percentage of women to be 33%.

Like many other women, I was all for an epidural at the start of my pregnancy, probably even before I was pregnant when I think about it!  I planned to just show up at hospital and make it my first request!  The more I read about them though, the more nervous I got that i might need one, aside from the needle in the spine, there were some surprising facts floating around that started to change my opinion of what I considered a routine and safe procedure.

So I thought I would take a closer look at some of the facts that I found particularly interesting, and share them with you…

What is an epidural?

Starting with the basics, lets straighten out the types available:

Spinal block is an instant and total numbing that lasts for a short period of maybe a couple of hours.  Medicine is injected into the fluid of the spinal cord, just the once, no catheter is left in place.  Because of its instant and total numbing effects it is good just before a c-section.

Epidural takes 10-20 minutes to have an effect, the anesthetic is injected just outside of the fluid of the spine.  A catheter is taped in place and medication can be administered over a long period of time to provide numbness to the lower half of the body.

Walking epidural is a low dose or combination form of epidural.  The lower dose of anaesthetic is combined with a painkilling opiate like pethidine or morphine, this usually allows the woman to move around with support but don’t expect to be pacing the corridors as you will likely be attached to a drip and baby monitor which can make moving around difficult.

CSE is a combined spinal-epidural.  A one-off dose of painkilling opiate, with or without anaesthetic, is injected into the spinal space, very close to the end of the spinal cord.  Pain relief lasts for around 2 hours, and then if more pain relief is needed, it can be given as an epidural.  The spinal administration is combined with the placement of the epidural catheter into one procedure.

How does an epidural work?

The spinal cord runs through a space in the bones of the spine.  Nerves running from the spine send messages to different parts of the body enabling them to function.  The nerves from the lover section of the the spinal cord control the lower sections of the body.

By injecting anesthetic into the epidural space of the lower back, as seen in the diagram above, the nerves controlling the lower body will be blocked, and feeling will be lost in the legs and the torso from the belly button down.

Can this medication reach baby?

This is the big question that we all want an answer to.  Although injected around the spinal cord, the drugs used will still enter your blood stream.  It is claimed that the amount of medication that does enter the blood stream is very low with an epidural and even lower with a spinal, but it will still cross over to the baby via the placenta.  I am guessing that the longer the epidural is being administered the more medication ends up reaching the baby.

It also takes a couple of hours for feeling to return to your legs after having an epidural, while the medication starts to wear off.  The Royal College Of Anesthesiologists states (here) that while the effects are typically not visible within hours of receiving a general anesthetic, traces can still be found in the body and breast milk for a few days.   That’s not something I fancy floating around in my newborn!

Breast feeding after epidural.

close up of newborn baby near breast

Studies have shown (here) epidurals to have a negative effect on breast-feeding.

That’s a sweeping statement sure to make many mothers angry…after all, we all know that breast feeding is temperamental even in the most ideal of situations.

But one really fascinating study worth looking at (here) showed a deficiency in oxytocin at delivery with epidural analgesia.

This I find interesting…oxytocin is the hormone that stimulates let down and brings milk or colostrum with it.  Low oxytocin…problems breast feeding…makes sense to me!  I have to admit I thought it was maybe down to the anesthetic effect of the drugs on the baby which made it harder for them to latch on, so I really like this scientific stand point, much more compelling.

So what about mum?

Ok, so you managed to handle the big needle in the spine, but what are some of the effects on mum apart from the feeling of total relief from contractions that just started to get the better of you…

Allergic reaction to the anesthesia used
Bleeding around the spinal column (hematoma)
Difficulty urinating
Drop in blood pressure
Infection in your spine (meningitis or abscess)
Nerve damage
Seizures (this is rare)
Severe headache

You can Google the risks of an epidural easily like I have just done for the list above.  No doubt you have done it at some point, so I won’t go into too much detail, as the list is almost endless!

Two particular points that were of interest that I want to look at have a knock on effect on baby are:

  • Low blood pressure (hypotension)
  • Elevated maternal temperature

Low blood pressure has a direct effect on how much blood is pumped into the placenta.  This in turn affects how much oxygen reaches the baby which is obviously not ideal.  To remedy the problem it is likely that you will get hooked up to IV fluids which may restrict how freely you can move into different positions for labour (another reason why your walking epidural might end up less mobile).

Elevated maternal temperature has the potential to spark a whole cascade of meddling, not least because a temperature can be a sign of infection but also because it may lead to a faster heart rate in the baby.  Fast heart rate can be a sign of a baby in distress and may lead to a c-section.  Baby may need tests to rule out infection and may require treatment with antibiotics after the birth, interfering with those precious first moments of skin to skin contact, breast feeding and bonding.  That right there is a good enough reason for me to try and stay away from the epidural!

Does an epidural really slow down labour and lead to a higher chance of c-section?

This isn’t just something they say to scare you away from an epidural, it’s not just hear say from the natural childbirth advocates, there is a simple reason why this is the case.

Plain and simply put, epidural anesthesia is indiscriminate, it freezes up the pelvic floor muscle which are crucial to guiding and delivering a baby safely and steadily.  This once active muscle that was guiding baby out so nicely, becomes a little bit too relaxed giving baby the opportunity to turn around in the birth canal.  This is where forceps may be needed to reposition baby, episiotomy cuts may be needed to allow forceps access, or c-section may be required if labour is too obstructed to deliver vaginally.

Will an epidural be so high on your birth plan now?

The epidural will always have a place on the delivery ward, it is essential at times, every labour is so different and who knows how yours will turn out.  What I think is important is to really study for a birth, prepare with as many natural aids as possible, yoga, meditation, hypno birthing, aromatherapy, TENS, massage…the more prepared you are in the earlier stages, the further you may get into your labour naturally, that might be all the incentive you need to go that final leg alone!!

How did you handle the pain of childbirth?  How did you find the epidural if you went down that route?  Would you make the same choices for the next time?  Let me know, leave a message below…

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12 thoughts on “So, You Want An Epidural?

      1. wildandwisdom Post author

        Oh yes, I love a bit of royal baby reporting, so that one caught my eye combined with the factual bits in the post. Great stuff. I’m interested now, I shall be having a proper rummage through your blog!!

  1. moshe rafael and eliyafa

    I was hoping you might write something about epidurals. Please please look into the effects epidural has on the babies ability to breast feed. This is not very well known but is a very real problem that many newborns struggle to latch on if their mothers had an epidural. I unfortunately experienced this firsthand with my last birth and although I am an experienced breastfeeder of several children, I almost lost hope while I watch my poor little baby struggling to eat for the first week of his life. Women need to know about this as a potentially bad side effect.
    Here is a nice post someone did about the topic

    1. wildandwisdom Post author

      There is definitely a two pronged attack on breastfeeding. It makes sense that a baby drowsy with the remnants of anesthetic may struggle to latch on, but what I found really interesting was the potential interference with the release of oxytocin. At that point, even if baby has latched well, the let down of milk may be compromised, a side effect which has long reaching consequences. I hope you enjoyed the article, I will check out the link you added now…thank you!

  2. mummyflyingsolo

    What a great post! I had an epidural and it didn’t work! It numbed some parts of my body but not others and definitely not the critical area (this wasn’t due to their incompetence but rather a spinal injury I had when I was young – I always knew it was a risk). I do believe though that my birth would have been much different if I’d been better at applying the principals I’d learned in my Calm Birth course. Next baby I will definitely be doing more of that. The only thing I would say to others though is don’t be afraid of going down that path if it really is hard for you to experience in any other way. You shouldn’t feel like you have failed if you choose the epidural, just that you chose it being aware of all possibilities. Oh and my milk took awhile to come in (mainly as I was induced I think) but my son didn’t have any trouble feeding once it did. Thanks for sharing!

  3. Pingback: One Lovely Blog Award + An Update | mummy flying solo

  4. wildandwisdom Post author

    Hey, glad you enjoyed reading it. Sounds like quite the birth experience you had! Interesting also about your milk being affected by the induction. I think it’s great to prepare for any eventuality, and to use any tool at your disposal to deal with any decision that comes along. Forewarned is forearmed I think the saying goes! The epidural is a great thing, there is no denying it, and as you say, delivering baby safely is the only thing that matters and it should be guilt free.

  5. Rose

    Oh I actually had to hide my eyes for some of this post… I knew from day 1 no one was coming near me with an epidural no matter how bad it was. I had a few puffs of gas and air for no.1 and nothing for no.2 – I was miles too scared of weird medication to let them do anything to me!!

    1. wildandwisdom Post author

      Snap, I was so paranoid about the drugs too, and what sort of effects it would all have on baby. Thanks for stopping by and checking out my post. You can open your eyes now!!!!

  6. Pingback: Why are we so afraid of birth? | Adrienne Loves Babies

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