Epidural: advantages and disadvantages in childbirth | Oh Mama Matrona

The epidural (epidural anesthesia technique) is the most effective method for relieving pain during childbirth. However, this does not mean that it is the best option for all women in labor.

Table of Contents

• What is it? How is it administered? Does it hurt to administer it?
• How long does it take to take effect? Does it wear off?
• When is it administered? Is there a dilation limit?
• Can you move with it?
• Disadvantages and side effects of the epidural
• What are the advantages of getting it?

What is it? How is it administered? Does it hurt to administer it?

The epidural is a regional anesthesia that is administered through an injection in the lumbar area, specifically in the epidural space (located outside the sac that surrounds the spinal cord).

Its main goal is to relieve pain in a localized part of the body (from the navel down). And how does it do this? The epidural works by blocking the nerve endings that exit the spinal cord, numbing the lower part of the body. The main feature of this type of anesthesia is that it allows the woman to be fully conscious during labor while better managing the pain associated with contractions. This is not the case, for example, when general anesthesia is administered.

It is a very common and safe medical procedure, although not without minimal risks and mild side effects.

How long does it take to take effect? Does it wear off?

The effect of the epidural is not immediate; it usually takes a few minutes to achieve its purpose and does not wear off if the anesthetic medication continues to be administered through a catheter.

Keep in mind that this type of anesthesia should relieve your pain but allow for some movement and does not “block” certain necessary sensations for the progression of labor.

When is it administered? Is there a dilation limit?

As we mentioned, it is administered to alleviate the discomfort of labor, so it can be given “when the woman is in pain.” Typically, the onset of more intense pain occurs in the active phase of labor (when the pregnant woman is 3-5 cm dilated). However, there is no dilation limit, and generally, there is “plenty of time” (babies do not just fall out of their mothers' pelvises). It is usually a lengthy process.

If labor is imminent, many women ask us in consultation: is it worth getting it? As midwives, we must evaluate each case at the time of labor.

Similarly, the epidural can be administered if the mother is in significant pain (for example, with poorly positioned babies) even if labor is not progressing. This means that, despite not being in the active phase, it can still be given.

Can you move with it?

Remember that the primary goal of the epidural is to reduce pain, but not mobility, although that line can sometimes be very fine. In other words, getting it should not mean being in bed without any mobility.

The midwife will suggest positions to improve the progress of labor, and you may surprise yourself by being able to maintain a hands-and-knees position even with the epidural.

On the other hand, there is a type of analgesia called walking epidural to retain even more mobility. The technique used is very similar to that of conventional epidural anesthesia; what changes are some of the medications and the dosage administered. The walking epidural allows for more mobility, although this may mean having to “endure” a certain level of pain.

Disadvantages and side effects of the epidural

With the epidural, as with any medical procedure, there are less favorable aspects that should be reviewed to know what can happen under different circumstances.

Does it have risks?

Epidural anesthesia is a very common and safe procedure - like any medical technique - with a good risk-benefit ratio, especially in the case of childbirth.

However, it is not without possible risks and complications:

• Drop in blood pressure.
• Headache (cephalalgia) or pain at the injection site.
• Fever and tachycardia (increased heart rate).
• Mobility blockage (which can complicate the pushing stage).

The cascade of interventions and techniques that sometimes accompany the epidural can medicalize childbirth, such as artificial rupture of membranes or the use of synthetic oxytocin (and these techniques per se have their own risks).

In this regard, when mobility is limited and pushing becomes more demanding, pelvic floor counseling before and after childbirth can help prepare the muscles, improve body awareness, and facilitate a more functional recovery.

For your peace of mind, you should know that anesthetists are monitoring both the mother and the baby at all times.

What if it doesn’t work?

Sometimes the epidural fails or does not have the desired effect. There are women who find that one part of their body is more numb than the other, for example.

In some cases, the technique can be repeated if, for example, only the right side has gone numb; the anesthetist might consider turning the woman so that the medications flow to the other side; but in other cases, one must adapt to giving birth without it.

When is its use not recommended?

• If there is suspicion or certainty of having an allergy to any of the medications used during the process and if there are no alternatives.
• When there is some type of coagulation disorder (when platelets are very low, for example), this anesthetic technique is discouraged. Also, if you are under anticoagulant treatment (if you are on heparin, a prudent time must be waited before administering the epidural).

What are the advantages of getting it?

It is the most effective method for reducing pain during labor, widely recognized by scientific evidence.

• It allows you to maintain consciousness, be present, and actively participate in the birth.
• Promotes relaxation: it can help the woman rest, especially in long labors or when there is significant physical and emotional exhaustion.
• Useful in case of interventions: if an instrumental delivery or an emergency cesarean is necessary.
• For women with great fear of pain or previous traumatic experiences, knowing they can count on this resource can provide security and peace of mind.

What if I don’t want to get the epidural?

If there is no medical reason that specifically requires its use, such as having a scheduled cesarean, for example, you can choose not to get the epidural if you wish, as long as you have discussed it with your midwife and/or it is reflected in your birth plan.

I didn’t get it, but…

I was very clear that if at any point I needed it, I would ask for it. Without any remorse, inferiority, or guilt. What matters is not whether to give birth with or without it, but how the woman feels during that process.

The epidural is a valid resource, but it is not the only option for managing pain during childbirth.

Did you use it in your labor? How was it, would you do it again? What alternatives did you use instead? Did you have any complications mentioned in the post or others?

Surely other mothers would benefit from reading your experience and concerns about it… Look for our carousel on Social Media and participate in this interesting debate about the epidural.