Epidural! Stat!

Not so fast: The facts and more.


Let's talk about epidurals. These guys are popular. In fact, some patients want them before they're even in labor. Some women come in so painful they grip their nurse's arm and growl, "I want my epidural NOW! Do you hear me?" You bet, honey, loud and clear. However, epidurals aren't as simple as throwing a dart at your back. It's a process. It's anesthesia. It's your spine. No matter how painful, surly or desperate you are, we're methodical about epidurals.

Believe me when I say, you don't want us to botch your epidural.

For that one woman out there who doesn't know what an epidural is, here's your definition: epidurals are God's gift to laboring women who don't want an un-medicated birth. It's numbing medicine that virtually eliminates labor pain. Labor continues, just without the gut-wrenching pain. A small tube (catheter) is placed in the epidural space outside your spinal cord, attached to a medication pump and a continuous dose of glorious, pain-numbing medication is supplied until shortly after the baby is born. Whoever thought this up is a flippin' saint.

Certain procedures have to be complete before we can actually "do" your epidural. First, you have to be admitted to the hospital (a bunch of computer and paperwork). Then we start an IV and dump in at least one liter of IV fluid. We run blood tests to make sure an epidural is safe for you. If all systems run smoothly, we can get you ready quickly. We're motivated—we don't want you to be in pain and we do want you to quit growling. The trick is, our patient has to cooperate (easier said than done when they're in big pain and freaked out); the IV has to go in smoothly and the lab has to run your lab work ASAP. Believe it or not, these things usually go off without a hitch.

The next step is getting the anesthetist or anesthesiologist involved. If they're already in the hospital, you're lucky. Most big hospitals have at least one on their maternity unit at all times. They'll review the prenatal records, start their own paperwork and interview the patient to make sure she's healthy enough for an epidural. Then it's show time. It takes anywhere from 10 to 30 minutes (on average) to place an epidural catheter. It's a "blind" procedure—the anesthetist can't see what's under the skin. He/she has to find the exact space by feel. He/she's going to be careful with that spine and take his/her time, no matter how painful the patient is. Once the catheter is in, the anesthetist injects numbing medicines (the same family of drugs used at the dentist) and in 10 to 15 minutes, the pain is gone. Women still feel pressure but a good epidural eliminates most pain.

Here are a few things about epidurals that most women either didn't read about or weren't paying attention to during class.

1. The worst part about getting an epidural is the shot the anesthetist gives to make the skin numb. It's like when you go to the dentist and you get a shot of novacaine. Same concept. The anesthetist gives a lidocaine injection into the skin and surrounding areas before he/she places the catheter. It stings for 10 seconds then the rest of the procedure doesn't really hurt. It feels weird but almost everybody finds getting the epidural is way easier than they thought it would be.

2. Epidurals lower your blood pressure (BP) so we dump in lots of IV fluid to avoid it. Some patients still drop their BP, making them feel dizzy, nauseous, and crappy. If that happens, the nurse turns mom on her side, dumps in more IV fluid and might give Mom some oxygen. Mom might barf. Oh well, it happens all the time. Occasionally, BP drops low enough that Mom needs medicine to temporarily elevate it until enough IV fluid can get in to fix the problem. Sometimes, baby's heart rate is affected by the low BP and slows down dramatically. Most of the time, mom and baby recover quickly.

3. You can't pee when you have an epidural. This one always catches Moms by surprise. Your legs are numb so you can't walk to the bathroom. Your bladder is numb so you can't tell when it's full. The sphincter that keeps you from wetting your pants is numb so you can't voluntarily release pee. Every few hours, your nurse will slip a catheter (yet another tube) into your bladder, empty the urine and voila, you've peed. Does it hurt? Nope, you're numb.

4. Epidurals work with gravity. If you spend your whole labor lying on your left, more medicine drips down your left side, making it number than your right. If you sit straight up for a long time, your butt gets numb and the rest of your abdomen gets less medication. Your nurse will help you change positions occasionally.

5. Epidurals aren't perfect. Remember the part about "blind" procedures. We can't see that every nerve ending is getting bathed with medicine. Sometimes there's a "window" of pain—an area that doesn't get numb. If it's intolerable, you can have the epidural redone.

Some babies won't wait for an epidural. Remember, it's not a dart in the back. We know you're in pain. We're sorry. The good news: your baby will be here in no time—then the pain's over. And the good times begin.

Got a question for Jeanne? E-mail it to labornurse@fitpregnancy.com and it may be answered in a future blog post.

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.