Q: I'm pregnant with my first baby and really scared about delivery. I generally don't do well with pain but I've heard that getting an epidural will slow down my labor and could even lead to getting a c-section. Is that true? Does an epidural have damaging effects?
A: To get or not get an epidural is a conversation I have with my patients daily. This, like many other decisions in pregnancy, is a very personal decision. Some women feel very strongly about not having any medicine for pain, while others say they want their epidural the second they walk through the hospital door. The truth is, these are both viable options and this, like all things obstetric, has to be individualized and discussed between patient and doctor.
What is an Epidural?
An epidural is a catheterization of the epidural space surrounding the spinal cord. The catheter is used to administer doses of analgesics on an intermittent and/or continuous basis throughout labor and delivery. There are many different medications that can be placed in an epidural; every woman has slightly different effects based on how the anesthesiologist has individualized the medication based on the woman's pain.
Unless your doctor is opposed and youve discussed it, you truly can get an epidural when you first walk in the hospital. And likewise, it is almost never too late to get an epidural. Unless the baby is going to be born in the next 10-15 minutes, you can always get an epidural, providing there is an anesthesiologist available. And this timeline only exists because it takes about 10-20 minutes for the pain relief from an epidural to completely set in. Furthermore, once the anesthsiologist places the epidural, the medications can be continously infused for as long as you need it, ie, it will not wear off.
Epidural anesthesia is very safe, though there are some risks (spinal headache, spinal hematoma, hypotension, pruritus, nausea and vomiting and respiratory depression.) Some women wont be able to move their legs at all and some will have full movement and motor capacity. Some can still feel their contractions but much less severe, and some cease feeling them entirely. This varies widely from patient to patient and the desired effect can be discussed with the anesthesiologist placing the epidural.
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Planning for Epidural
Many women spend a great amount of time and conviction mapping out how they want their labor to proceed, with specific attention paid to pain relief. What we all have to remember is that labor is wildly unpredictable, and it's best to enter labor being up for anything, especially if it is a first baby. No one knows how contractions will feel to them. Some women swear up and down that they want an epidural as soon as possible, but then arrive at the hospital and are already seven centimeters dilated and decide that they can and want to finish their labor and birth without pain relief. Likewise, others meticulously plan to not have any medicine for pain, epidural or otherwise, and then when true active labor starts, they completely change their mind. And this is OKAY.
Epidural Won't Change Labor
Contrary to anectodal evidence, there are no studies that prove that an epidural alters the labor curve in anyway or increases the risk of operative or cesarean delivery. And there are virtually no risk factors for a fetus or newborn from a maternal epidural. It really comes down to this: If you are in labor and you are in too much pain, an epidural can help. It truly is as simple as that.