Epidural administration

What are the pros and cons of an epidural?

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• published: 18 Oct 2013
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Getting an epidural is a personal choice you should make with education you receive from your doctor. Pain is subjective. Everyone experiences it differently. It's going to hurt more during labor than you might think, especially if it's your first baby. You don't know what to expect. Labor is usually the most significant pain a woman has felt. We ask patients to rate their pain from 0-10. First time moms may say their pain is a 10, even when they're 1 centimeter. They just don't know how bad it's going to get. Some women deliver without using any form of analgesia, whether that be IV pain medication or an epidural. They make it through. There are pros and cons to getting an epidural and it depends on the situation you want. A pro is controlled pain. A common misconception about epidurals is they relieve all sensation. A good epidural is one where you can feel pressure. You may know you're having a contraction and this helps with pushing. Women who don't want to feel anything are disappointed they still feel pressure when they're contracting. But it doesn't hurt; it takes away the pain. But epidurals aren't perfect. Sometimes you have to be re-dosed during labor and receive just a little bit more medication to keep you on top of the pain. We keep you on one side during labor; that's best for the baby. It doesn't have to do with an epidural. The side that's down will be more numb. The side that's up may hurt more, so we flip you over and give you more medication. One possible downside to having an epidural is you can't move. You can't walk around. You may have a little control over your legs to shift yourself in the bed, but you can't get up and walk. Some see that as a con. You need to have a catheter to drain your bladder but it goes and out when you're numb. There are also benefits to having an epidural. Many studies show that epidurals slow the progress of labor, which they can if you get it too soon. But, they can also speed up labor because if you can't control your pain and breathe properly-- in fact, if you don't breathe properly and take in enough oxygen and blow off the proper amount of carbon dioxide, it messes up the carbon dioxide and oxygen balance in your blood and that affects all of your organs including the uterus and circulation to your baby. It's very important to breathe properly. Make sure you're in control. If you're not in control, it's a good time to start thinking about an epidural because it can halt your progress. I've taken care of patients who have been 7 centimeters for 4 hours until they get an epidural and then 20 minutes later, they're 10 centimeters and ready to push and have their baby. There are instances where it can speed it up. Sometimes it slows it down if you get it too soon. Some doctors feel another benefit to an epidural is when it comes time to push the baby out, you're able to do controlled pushes instead of when you don't have an epidural, that instinct causes you to push as hard as you can with all your might and often times, that increases your chances of tearing. Recovery might be a little bit better after having an epidural. Now, as with any procedure, there's always risks. The biggest risks are infection and bleeding but many things are done to reduce this risk and we know that a possible side effect of an epidural is having your blood pressure drop. In efforts to decrease that effect, we give you a lot of fluid beforehand through your IV. This increases your blood pressure so when it drops from the effects of the epidural, it keeps it even. If it drops a little bit lower than we expect, there's easy ways to bring it back up and it's usually inconsequential to you and the baby. Possible risks of getting an epidural. One of the biggest ones is a spinal headache and this happens 1% of the time where afterwards, you could have one of the worst headaches you've ever had in your life. But, it's not permanent and there are easy fixes to it. There are also other risks that can be associated with the placement of it. The medication can go into a blood vessel that's in your back and the anesthesiologist is likely to ask you after they've finished with the procedure, do you have any ringing in your ears, funny tastes in your mouth, dizziness, those sorts of things. Those can be indications it's gone into a blood vessel instead of into the epidural space. The anesthesiologist would just try it again, place it in the proper place, and get you comfortable. In very rare circumstances, it can cause a little persistent numbness and tingling after the time period where your epidural should have worn off. This is about 1 in 10,000. It's rare. If you have more questions, ask your OB provider, the nurses, and anesthesiologist at the hospital. They'll answer your questions and assist you. If you have any other questions for me,ask them on our Facebook page at facebook.com/intermountainmoms and recommend us to your friends and family, too.