A: I’m glad that you’re thinking about pain management before you enter labor. I realize that choosing a labor epidural can be a hard decision.

As you know, an epidural anesthesia is a means of reducing pain during labor by infusing a medication in the epidural space near your spinal cord. Local anesthetic is delivered through a small plastic catheter to this area in order to numb the nerves of your uterus. This relaxes your pelvic muscles and reduces the intensity of labor pains. Ideally, an epidural will allow you to feel pressure with each contraction and maintain your ability to push during the second stage of labor. Since this is your first baby, it’s hard to predict how you will react to labor. Some women are adamantly opposed to having an epidural and after several hours of labor change their minds. Others plan to request a labor epidural and discover that they have enough support and endurance to tolerate labor without anesthesia. It’s wise to know your options for pain relief before labor begins, and to maintain an open attitude as you approach labor. If you’ve never had a baby before, it’s impossible to know exactly how you will feel throughout labor.

You should also be aware of alternate means of coping with labor. Child preparation classes often teach methods of breathing and moving that can be helpful. Laboring in water, either under a shower or in a bathtub, may make labor more tolerable. Having a supportive person to coach you through can make a world of difference. This could be a labor coach, a doula, your labor and delivery nurse or an experienced friend. Some women learn hypnosis prior to labor or practice meditation techniques to ease labor pains. Many women find massage helpful, while other women prefer not to be touched.

As you mentioned, there are some other cautions about epidurals.

• An epidural must be administered by an anesthesiologist. Find out whether your hospital has an anesthesiologist available to provide labor epidurals.
• Epidural anesthesia causes a drop in blood pressure. For this reason, you will be required to receive ample intravenous fluids before the epidural can be placed. Your blood pressure will be checked frequently once an epidural is placed, and you may receive continuous fetal monitoring.
• Epidurals don’t always provide uniform pain relief. Some women may have intense discomfort in one small area despite having an epidural.
• Rarely, women may have a “spinal block” in which higher than desired doses of anesthesia lead to a temporary loss of all sensation in the lower half of the body.
• After an epidural is placed you may be required to stay in bed throughout the remainder of your labor and delivery.
• You may have trouble urinating after receiving an epidural and require a catheter to empty your bladder.
• Many women who have had epidurals complain of a small area of soreness in their back during the days following the delivery. This feels like a bruise and is the site where the epidural was placed.
• A small percentage of women develop a severe headache in the days after an epidural, which becomes worse when standing up. This can be treated in the hospital with an additional procedure.
• There are some situations that prohibit placement of an epidural. If you have had back surgery, have a blood-clotting disorder or an allergy to anesthetic medication, you should talk with your doctor before your labor. Also, some women have labors that are very rapid, and an epidural may not be able to be placed in time to provide labor and delivery relief.

On another note, studies have not shown that epidurals increase the rate of Caesarean sections. Some women may have slower labors or need assistance with the pushing phase of labor, but many women have faster labors once they are relaxed.

Furthermore, an epidural may help you better enjoy the experience of your birth, allowing you to connect with the events of delivery without exclusively focusing on managing your pain. In my experience, most women who choose epidurals do very well and are extremely grateful that they had this option for their labor.