Pregnancy: Top 3 Tips for Labor Epidurals from an Anesthesiologist

Bringing a child into the world is an incredibly transformative and beautiful experience, but it's no secret that it can also be challenging and painful. Fortunately, modern medicine offers various options to help manage pain during childbirth, with one of the most popular choices being the epidural.

An epidural is a form of regional or neuraxial anesthesia using local anesthetics that can provide effective pain relief during labor, delivery, and cesarean sections (C-sections) if necessary.

If you're considering an epidural for your pregnancy, here are three tips from a board-certified anesthesiologist to help navigate the process:

Pro Tip 1: Consider timing and ask for an epidural early, if possible.

Pro Tip 2: Understand differences between epidural vs. combined-spinal-epidural (CSE).

Pro Tip 3: Have a strong support system and practice positioning (think "mad cat" or "cooked shrimp") and push the lower back out.

Read below for more information on each tip listed above.

1.     Consider Timing: While epidurals can be administered at various stages of labor, the timing can impact an epidurals effectiveness and potential side effects.

Some women prefer to wait until they are in active labor before requesting an epidural, while others may opt for earlier administration to manage discomfort during the early stages or other high-risk situations such as previous uterine rupture or hemorrhage.

Pro Tip: This is perhaps the most important out of the three tips! Ask for an epidural early, if possible, because the anesthesiologist may or may not be immediately available at that exact moment due to staffing issues or other emergencies in the hospital.

The epidural procedure itself can take a skilled anesthesiologist 10-20 minutes to complete plus an additional 20-30 minutes for the local anesthetic to “set-up” completely. Total that time up and you might be looking at 1-hour or 60 min time before you are truly comfortable and can relax, so please ask for an epidural early and do not wait until 8-9 cm dilation.

Moreover, the longer you wait, the stronger the contractions will become, making it difficult to sit still during epidural placement and potentially riskier for a post-dural puncture headache due to proximity of the spinal cord.

2. Educate Yourself: Knowledge is power, especially when it comes to making decisions about your healthcare.

Discuss pain management options during pregnancy openly and honestly with your healthcare provider. Take the time to learn about what an epidural entails, the positioning needed during the procedure (think "shrimp" or "mad cat"), how epidurals work, and their potential benefits and risks, including post-dural puncture headaches (occurs in approximately 1 out of 100 epidurals).

If you decide to proceed with an epidural, familiarize yourself with what to expect during the procedure. This typically involves sitting or lying on your side while a healthcare provider inserts a small catheter into your lower back, through which medication is delivered to numb the lower half of your body. While the process is generally well-tolerated, it's normal to feel nervous or apprehensive. Remember to breathe deeply and stay relaxed, and don't hesitate to ask questions or request additional support if needed. Understanding the procedure and its effects will help you make an informed decision that aligns with your preferences and priorities.

Pro Tip: Understand the difference between an epidural vs. combined-spinal epidural (CSE) vs. spinal anesthesia.

A spinal dose or CSE dose will have a more dense “onset” due to closer proximity of the local anesthetic to the spinal cord that wears off over time, leaving just the epidural dose via the epidural catheter. The sudden change or decrease in pain block density often leaves women dissatisfied due to a less dense epidural pain block compared to the spinal or CSE dose. If possible, just ask for an epidural and not the CSE unless time to baby delivery is imminent, then ask for the CSE if the provider allows.

Note: Neither an epidural or CSE will eliminate ALL labor pain due to complexity of neural pathways and dermatome overlap.

3.     Practice Positioning & Have a Support System in Place.

Labor and delivery can be an intense and emotional experience, and having a supportive team by your side can make all the difference. Whether it's your partner, a doula, or a trusted friend or family member, having someone there to advocate for you, offer encouragement, and provide physical and emotional support can help you feel more confident and empowered throughout the childbirth process, including if you choose to have an epidural.

Pro Tip: Have a strong support system and practice positioning

Conclusion:

Ultimately, the decision to have an epidural during pregnancy is a personal one, and there is no right or wrong answer.

As an anesthesiologist, I strongly advocate for epidurals in a majority of labor and delivery patients. What matters most is that you feel informed, supported, and empowered to make the best choice for yourself and your baby.

By educating yourself, communicating openly with your healthcare provider, considering timing, being prepared for the procedure, and having a strong support system in place, you can navigate the process with confidence and peace of mind.