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Having an Epidural to Manage the Pain of Labor
To put it mildly, labor is a challenging experience. Hours of contractions and their associated discomfort can wear you down both physically and mentally. When it comes to preparing for the discomfort associated with labor, I urge my patients to have an open mind: you just don’t know how you will react to labor or how long your labor will last. For those fortunate enough to have a fast labor, pain management may not be an issue. But many of my patients are not that fortunate and may need to control their discomfort.

A major advance in pain management during labor came about with the development of epidural anesthesia—suddenly, we had a new technique that could alleviate the pain without impeding labor!

An epidural involves putting a small plastic tube into the back, just outside of the spine; it is placed by an anesthesiologist or nurse anesthetist. Through this tube, local anesthesia is injected to numb the nerves from the uterus. An intravenous drip of the medication insures that it is effective until the baby is born. The epidural also diminishes sensation and muscle strength from the legs while it is working.

Once the epidural is in place and working, my patients swear by them … the pain of labor is gone! They can take a nap, read a book or just enjoy the labor experience while the cervix continues to dilate and the baby moves down the birth canal. There are a few side effects associated with an epidural, and the most common include: headaches, dizziness, soreness at the site of insertion and a transient lowering of the blood pressure. But these side effects pale in comparison to the benefits.

Still, there are many misconceptions surrounding epidurals:

Epidurals slow down labor: If an epidural is given early in labor, contractions may spread out. If this happens, we can give you a medication called Pitocin® through your IV line to get your contractions going again. In contrast, I have also found that giving an epidural can speed some labors, and that pain can actually disrupt labor contractions. There have been numerous times when I have witnessed a patient rapidly going on to complete dilatation once she has been given an epidural.

Epidurals can only be given once good labor is established. Although the textbooks suggest waiting until the patient is 4-5 centimeters dilated to prevent contractions from spacing out, in practice, I find this recommendation to be ridiculous. Why should my laboring patient wait for hours, in pain, to receive an epidural? I gladly give her an epidural and Pitocin as needed.

Epidurals prevent a patient from pushing. The urge to push the baby out is diminished with an epidural. However, there is a sense of pressure once the baby moves deep into the pelvis. Some patients find this to be quite uncomfortable. With a good coach and nurse, you will push the baby down the birth canal and help him/her make their grand entrance. Because the strong urge to push is reduced, there is a slight increase in the use of vacuums and forceps in patients who’ve had an epidural.

Epidurals increase cesarean section. Early studies seemed to suggest an increased cesarean section rate. However, these have been refuted by more careful analysis. In my practice, epidurals help me to reduce the cesarean section rate because I can wait longer for a patient to dilate as long as she is comfortable. As you can imagine, it is very hard to watch a woman huff and puff for two hours without making progress; she wants results and is more impatient when labor hasn’t moved along.

A further advantage of an epidural is that once it’s inserted, it can be used as anesthesia for a cesarean section. This will require a stronger dose of medication inserted into the epidural, but it provides excellent comfort throughout the procedure.

It is important to speak with you obstetrical provider regarding their policy and the hospital’s availability of this type of anesthesia during labor. For more information, read my article on this web site titled, “Where will your baby be delivered? Important considerations for choosing a hospital.”

Deciding if an epidural is right for you is a personal decision. Pressure from friends, neighbors or even your spouse should not influence your decision. In the end, it is your experience and nobody will really care how you delivered your beautiful baby.

Craig L. Bissinger M.D.