Epidurals for Labor Pain Relief

Epidurals for Labor Pain Relief

If you have been researching the pros and cons of pain relief during labor, you have probably read about using epidurals for labor pain relief, a common method of pain relief administered during labor. You may be wanting to have as natural a birth experience as possible, i.e using non- medicated comfort measures, but you may still be interested in the option of an epidural.

There are two different kinds of pain relief medications: anesthesia and analgesia.  The medical definitions are:

Anesthesia: loss of feeling in all or part of the body with or without loss of                  consciousness through the administration of one or more agents that block the passage of pain impulses along nerve pathways to the brain

       Analgesia:  the loss of the ability to feel pain while conscious

Epidurals are administered as an anesthesia that include analgesia.  When using an epidural for relief, it’s important to know your options.  Hospitals usually offer different choices:

•  The procedure referred to as an”epidural”- a needle is inserted into the space outside the dura, the space where your spinal chord  and nerves are housed.  A catheter is then inserted through the needle and left in place instead of the needle to provide the drugs.
•  A combined spinal epidural- CSE. With a CSE you will have a needle inserted deeper into the cerebrospinal fluid space, but less medication is used than with a single epidural.
• A “walking epidural” This is typically  a combination of analgesics and anesthetics. They are a lighter dose of medication but unlike their name implies, they often fail to allow you mobility.
• An EPI-LITE is a low dose of narcotics administered through an epidural. Women will have sensation with some pain relief. This may be a good choice for women seeking a lite dose of medication to take the edge off their pain.
• A spinal block is a single shot of a narcotic and anesthetic  into the cerebrospinal fluid. A catheter is not left in place with this procedure hence the difference between a spinal block and spinal epidural. It provides pain relief for 2 hours. It is not administered as often with vaginal birth but tends to be more common with a c-section.
• Patient controlled epidural anesthesia PCEA allows a woman to control the amount of medication she receives through administering the medication with the control of a button.

Here is a video about Epidural pain relief during labor:

As with any medication, there are concerns with epidurals.  Epidurals are associated with the following:

• A decrease in maternal blood pressure.
•  maternal fever
• The inability of the mother to feel she fully participated in her labor and birth.
• A 5% chance of newborn fever which would require additional testing for infection.
•  The installation of a bladder catheter.
•  continuous fetal monitoring
• Intravenous fluids  to prevent a severe drop in blood pressure.
• Some women  report feeling only partial or no pain relief after receiving an epidural.
• If you are planning on breastfeeding,  epidurals have been shown to minimize the baby’s interest in taking the breast after birth.

Here is a link to an example of one epidural package insert.

When you plan to receive an epidural during labor, timing could mean the difference between a further cascade of interventions and achieving a satisfying birth with minimal interference.

An epidural is best administered during active labor, 5-6 centimeters dilation. Receiving an epidural earlier than this window of time could hinder your ability to move when necessary as well as provide no relief simply because it was given too early.  Administering an epidural too late is associated with difficulty feeling the urge to push and knowing how to push your baby out.  It is also helpful to know that from the time you request an epidural to the actual time it is administered is usually around 30 min. Timing is key.

Knowing you have tools to assist your labor and being educated about them is very empowering. The more you learn, the better prepared you will be to have a satisfying birth experience.