The nitty-gritty about epidurals.
Now that I've spent two weeks spouting tips for a natural birth, let's give epidurals some equal play. Around 61 percent of you will get an epidural at some point in your labor, so let's answer a few nitty-gritty questions. But first, let's start with some common complaints women have about their epidural experiences:
1. "I was in so much pain but my nurse made me wait a whole hour before I finally got that epidural."
2. "I asked for just a light epidural, but I couldn't even move my legs."
3. "I didn't want to feel a thing, but I still felt pressure and I could tell when the baby was coming out."
4. "I put in my birth plan I didn't want an IV, but I wanted an epidural. My nurse said I couldn't have an epidural without one. She didn't honor my birth plan."
5. "I thought I was going to be able to get up, move around and walk a little, but once I had my epidural, I was a beached."
6. "Nobody told me the epidural needle was going to be that big. I'm a small person and they should have used a smaller needle."
I sympathize with every one of the mothers in these situations. It sucks to wait for relief when you're in pain. It's weird not to feel your legs or be able to move while still feeling other sensations. IVs are a big fear for a lot of women and it's hard to shift gears when you're not expecting a procedure. And, yes, indeed … that epidural needle sure is a big one. Now, let's get real, shall we?
This blog is not the place to describe the entire epidural process, but I can't recommend strongly enough the value of learning all you can about it. I cover it pretty darn thoroughly in this book, complete with pictures to illustrate how and where it's inserted. For now though, let's just tackle the above.
Epidurals are not instantaneous. They're far more complicated than getting a shot in the butt. From the moment you ask for one to the moment you get relief, you might have to wait anywhere from a half-hour to an hour or far longer. The pre-epidural preparations include lab work, getting an IV, having at least a full liter of fluid infused, a consultation with the anesthetist, getting up to pee, signing paperwork and more.
When all that is done, you can get your epidural—but what if the anesthetist is busy putting in another woman's epidural? What if he's needed in the operating room and the stand-by anesthetist has to come to the hospital from home? What if you're only a little bit dilated and in minor pain and another mother is speeding through labor and in serious pain? She goes first, even if you put in your request before she did. While every effort will be made to ensure you get your epidural ASAP, don't expect it to be an instant deal. It takes time, and this is one area where you don't want your doc to take shortcuts.
Epidurals are sometimes called a "blind procedure," meaning once that needle goes past the skin, the anesthetist can't see exactly where it's going. A lot of what he does is done by feel and experience. Every woman's anatomy is unique, and he can't guarantee the results will be identical even though he might put the epidural in with exactly the same technique on every woman.
That's why some women have "windows" of pain where the epidural doesn't work or why some women may need two or three attempts to get the relief they need. In addition, no two women respond to medication exactly the same way. Some women will be completely numb with a small dose of medication while another might still be able to move around and feel stuff. Your anatomy and ability to metabolize and utilize medications are your own unique thing.
Finally, about those needles—your nurse is right—you can't have an epidural without an IV. No way around that. It's how we make sure your blood pressure doesn't plummet. Low blood pressure is a common side effect of epidurals—really low—like low enough to affect your baby. We know that's a factor, so we load you up with IV fluids in advance. If you still bottom out, we give you drugs to bring your blood pressure back up. All of that happens through the IV. No IV, no epidural—no matter what your birth plan says.
And about the size of the epidural needle? Yep, it's a biggie. That's the size they need to be. Sorry about that.
Jeanne Faulkner, R.N., lives in Portland, Oregon with her husband and five children. Got a question for Jeanne? E-mail it to firstname.lastname@example.org.
This Fit Pregnancy blog is intended for educational purposes only. It is not intended to replace medical advice from your physician. Before initiating any exercise program, diet or treatment provided by Fit Pregnancy, you should seek medical advice from your primary caregiver.