The World of Pregnancy

When Is It too Late to Get an Epidural?

Epidural anesthesia is the most common method of pain relief during labor. More than 50% of women require epidural before birth.When Is It too Late to Get an Epidural

If childbirth approaches, it`s best to know as much as possible about what pain relief options you may have to be prepared and take the best possible decisions regarding labor and delivery.

Understanding the different types of epidurals, how they`re managed, the risks and benefits can help you make the best decisions during labor and birth.

What Does an Epidural Do?

Epidural anesthesia is an anesthesia that blocks pain in certain areas of the body. Its purpose is to relive pain or block it, rather than anesthetizing a specific area – a situation that leads to a total lack of sensation.

Epidural blocks nerve impulses from the lower segments of the spine. The drugs involved in epidurals fall into a class of medication known as local anesthetics, like bupivacaine, chloroprocaine or lidocaine.

These are often administered in combination with opioids or narcotics with the purpose of reducing the required dosage of local anesthetic. This way, the pain is relieved and the consequences are minimal.

These drugs can be used in combination with epinephrine, fentanyl, morphine and clonidine to prolong the effect of epidural anesthesia or to stabilize the mother`s blood pressure.

How Do They Give You an Epidural?

Before the onset of labor, the mother should be given fluids intravenously, and before the procedure is started, she`ll have the epidural installed. During labor and birth, the pregnant woman will receive 1 – 2 liters of liquids intravenously.

An anesthetist, obstetrician or nurse will administer the epidural. You`ll be asked to sit on a bed and to curl up on one side. This position is critical to preventing problems and increasing the epidural effectiveness.

An antiseptic will be used to clean the back of the waist and minimize the risk of infection. Then a small area on your back will be numbed with a local anesthetic. The doctor will introduce a needle into the numbed area round the spinal cord on the lower back. – Read more!

The needle will be inserted through a tube or catheter into the epidural space. Then, the needle is carefully removed, leaving the catheter in place in order to deliver various drugs through it.

Most of the times, the procedure shouldn`t hurt because there be a tiny needle that will numb that specific area before the epidural needle will be inserted. Most women won`t mind the tiny needle, but they`ll feel the numbing drugs which are injected with the needle. It may sting for a few seconds.

When Is It too Late to Get an Epidural?

Most obstetricians will want for you to be in active labor before beginning the procedure of epidural anesthesia, meaning for you to wait until you are around 4 – 5 cm dilated and having regular uterine contractions. The main concern may be that the epidural anesthesia may slow down the uterine contractions.

Types of Epidural

Currently, there are 2 essential types of epidurals used. The doses and combinations of drugs may be different from one hospital to another. You can ask the doctor how will perform the epidural about all this:

  • Regular epidural: after the catheter is fixed, a combination of narcotic and anesthetic will be administered by anesthesia with periodic injections into the epidural space. A narcotic, such as fentanyl or morphine, will be administered to replace the high dose of bupivacaine, chloroprocaine or lidocaine. This way, any possible side effects of anesthesia will be reduced.
  • Combined spinal epidural: an initial dose of narcotic, anesthetic or a combination of the 2 is injected in the outer membrane that covers the spinal cord. The anesthetist will insert the needle into the epidural space through a small catheter, then withdraws the needle locally, but leaves the catheter.

This allows the possibility of making different types of movements for hours as well as a greater ability of the patient to change positions with professional assistance. When the catheter remains in the same position, the epidural can be performed in any moment, if the initial intrathecal injection is inadequate.

You should ask the physicians if you can move, drink or eat after the epidural was placed. After the drugs for the anesthesia were used, the muscle force, balance and responsiveness are reduced. Spinal epidural anesthesia should relieve pain for 4 – 8 hours.

Benefits of Epidural Anesthesia

  • Epidural anesthesia will allow you to rest if your labor is prolonged.
  • By reducing the discomfort caused by birth, the birth experience becomes more positive.
  • Normally, epidural anesthesia won`t put you to sleep and you can actively take part to the delivery.
  • If you give birth through Caesarean delivery, epidural anesthesia will allow you to not fall asleep and the pain will be acceptable during recovery.
  • When other types of mechanisms of improvement are no longer helpful, epidural can be quite useful in case the mother sense exhaustion, irritability or fatigue.
  • An epidural can help pregnant women to rest, relax, focus and will also provide strength to move forward as an active participant in the entire birth process.

Disadvantages of Epidural

  • Epidurals may cause a drop in blood pressure. Therefore, the blood pressure will be monitored to confirm that the mother and child get an adequate flow of blood. If there`s a sudden drop in blood pressure, it may be necessary to administer intravenous fluids, drugs and oxygen.
  • It might appear severe headache caused by cerebrospinal fluid leaking. This side effect is seen in more than 1% of women.
  • After the epidural is placed, the pregnant woman must alternate sides while lying down and fetal heartbeat will continuously be monitored. By positioning on one side or another, the labor may be slowed down or even stop.
  • The following side effects may be experienced: chills, tinnitus, back pain, pain when the needle is inserted, nausea or difficulty urinating.
  • In the case of epidural, other interventions may be required during delivery: the use of oxytocin (pitocin), forceps, vacuum extractor or Caesarean delivery.
  • A few hours after birth, the inferior part of the woman`s body may be numbed and she may require assistance to walk.
  • In rare cases, permanent damage to nerves may occur in the area where the catheter was inserted.

Although research is ambiguous, most studies suggest that some children of mothers who give birth with an epidural will suffer a blockage which will lead to difficulties in breastfeeding.

Other studies assume that babies may experience respiratory depression, inadequate fetal position and fetal heart rate variability will occur, a situation that requires the need of using forceps, vacuum extractors births, caesarean section and episiotomy.

How Could the Child Be affected by this Procedure?

  • If there`s a drop in blood pressure, it might have affected the flow of oxygen to the fetus. In this case, you`ll need to insert an intravenous cannula in the hand or arm, in case blood pressure drop suddenly.

A lower blood pressure can be treated by drinking fluids introduced through the cannula to increase of blood volume.

  • Epidural solutions contain opioids, like fentanyl or other similar drugs, which may pass through the placenta. In high doses (more than 100 mcg), there medications may affect the baby`s breathing or it might make him drowsy.

Useful Advice

Epidural is only performed in maternities by an anesthetist under the direction of an obstetrician, not at home. Even maternity kits cannot provide an epidural 24/24. Therefore, it`s recommended for the mother to get such a kit from a pharmacy, according to the recommendations of obstetricians, to be ready when labor triggers.

Try to remain calm when the anesthetist mounts the epidural. You`ll stay in a squatting position on one side, so you can open the space between the bones of the spine. Try to focus on your breathing: inhale slowly through your nose and exhale through your mouth. Try to keep eye contact with your partner, if he`s present.

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