What is an epidural?
- 7 hours ago
- 4 min read
Overview
Although the messaging around epidurals can be scary (a giant needle in your spine??), the procedure has been proven very safe and effective since it was first performed almost 150 years ago. Today, epidurals are the most common method of pain relief (also called analgesia) used during labor. In the United States, over two-thirds of women are administered an epidural during labor, including over half of women undergoing a vaginal birth.
What is an epidural and how does it work?
The epidural space is the area between the tough covering of the spinal cord and the spinal bones. Sensory and motor neurons exiting the spinal cord pass through this space. The epidural procedure is the injection of an anesthetic drug into the epidural space. The injected drug stays in the spinal space; it does not enter the blood. The drug then acts upon the nerves in the epidural space, both blocking the sensations of pain and inhibiting movement. Epidurals generally affect the region of the body between the belly button and the upper legs.
During labor, a doctor will first inject women with a local anesthetic in the area where the epidural will enter. After that, the patient may feel pressure when the epidural is inserted, but should not feel pain. The doctor will then insert a catheter, a small flexible tube, into the epidural space, so that controlled amounts of anesthesia can be administered throughout labor, no matter how long it takes.
Epidurals usually take about 15-30 minutes to take effect and, with the catheter in place, are effective for hours.
Today, doctors typically inject lower doses of anesthesia through the epidural than they did in the past. These lower-dose procedures, technically called combined spinal-epidurals (CSEs) and colloquially called “walking” epidurals, allow patients to retain some feeling in their lower body and some ability to move and adjust their position. To maintain full pain relief, steroids or other pain killers are often injected directly into the spinal cord along with the epidural. Lower dose epidurals are generally considered preferable these days and increase the likelihood that the baby will be delivered spontaneously through the vagina without the assistance of extra tools, such as a vacuum or forceps.
What are the benefits of an epidural?
Many women choose an epidural, because it is a safe and effective way to manage pain during labor. An epidural has milder side effects compared to other types of anesthesia and can be given at any point during labor. This flexibility means that if a patient originally declines an epidural, but the pain becomes too severe, she can change her mind up until very close to delivery.
What are the risks of an epidural?
The most common side effect of an epidural is a drop in blood pressure, which is usually managed by administering IV fluids. Other less common side effects include inability to pass urine, itching of the skin, shivering, sedation, nausea and vomiting, and increased body temperature. Although some women complain of back pain after receiving an epidural, that pain is likely caused by labor itself, not the epidural needle.
There is also some evidence that receiving an epidural lowers production of certain hormones associated with labor and birth. The production of both oxytocin and beta-endorphins rises during labor, helping the uterus to contract and the mother to deal with the labor pains. Adrenaline and noradrenaline both surge at the end of labor to facilitate the final push. Epidurals seem to lower the production of these hormones, which may slightly slow the process of labor. However, studies suggest that labor with an epidural likely lasts less than an hour longer on average.
In general, more studies are needed to fully understand the effects of an epidural on the process of labor and delivery.
What are epidurals used for outside of labor?
Beyond labor, epidurals can also be used to treat other kinds of pain. This technique can be used before or after certain surgeries, to treat back pain, and in chronic pain management. When treating chronic or long-term pain, doctors have two main options. A single-injection epidural (as opposed to using a catheter) can be used to deliver steroids that reduce pain and inflammation and lasts for weeks or months. Epidurals with patient-controlled analgesia (PCA) make use of a special catheter that remains in the epidural space after surgery and allows the patient to control release of the drug.
Summary
Although epidurals can sound scary, the procedure is well understood and has been in use for many years. Many laboring women choose to be administered an epidural to help manage pain, and the flexibility of the procedure allows for real-time decision making in the birthing room. Although further studies are needed to fully understand some of the nuanced effects of epidurals, so far, the practice has been used successfully during the birth of many generations of babies.
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