What are Epidurals?

An epidural is a regional anesthesia. It concentrates pain relief in a specific area of the body and blocks the nerve impulses from lower spinal segments. Unlike general anesthetics, which cause a total lack of feeling, epidurals cause decreased sensation in the lower half of the body. When used to control childbirth pain, for example, the mother remains awake but is largely pain-free during delivery. In some cases, women experience complications while giving birth that require a cesarean delivery or C-section. Physicians consider an epidural a medical necessity for C-sections. In the case of twin or multiple births, doctors may insist upon administration of an epidural, due to the prevalence of C-sections in these types of births.

In most cases, an anesthesiologist, obstetrician, or nurse anesthetist administers epidurals. Typically, they will ask the patient to sit up entirely or lay on their left side with their back arched. Research shows that these positions increase the epidural’s effectiveness. A healthcare professional sterilizes the patient's mid-back area near the waistline to prevent infection. Then they administer a local anesthetic into the small area on the back. Once the area is numb, they insert a needle between the bones, through the ligaments, and then through the membrane that surrounds the spinal cord. The physician then threads a small tube or catheter into the epidural space. After this, they remove the needle and tape the catheter into place, ready for the medication. Epidural medication generally uses a combination of a local anesthetic for numbing purposes and a narcotic for pain relief.

There are essentially two types of epidurals. A regular epidural uses a pump or periodic injections to administer the medication. The other type of epidural, a combined spinal-epidural, allows the patient more freedom to move around or change positions. Because of this, some people refer to combined spinal-epidurals as walking epidurals. Many physicians use combined spinal-epidurals during childbirth to allow for more movement. This type of epidural usually offers four to eight hours of pain relief, but requires a smaller amount of medication, so the patient retains some sensation in their legs.

When a disk in the back becomes herniated or starts to bulge, it pushes against the nerves, causing pain. Doctors use epidural injections to treat these painful conditions when other methods of pain relief are ineffective. Historically, some health care professionals to effectively treat sciatica. Epidural pain relief is also popular for colon or rectal surgeries, in addition to a general anesthetic. The epidural allows the patient to stay awake during the procedure, and it also reduces the risk of developing blood clots in a leg vein. Terminal cancer patients receive epidural medication to control severe pain, allowing for decreased amounts of morphine.

Because physicians first numb the epidural insertion site with a local anesthetic, some women report that they feel no pain or discomfort. However, others say they felt a tingling or a quick shooting pain after feeling pressure in the area as the needle enters the spine. Once the epidural is in place, it effectively reduces the pain of the labor. Some women experience back labor resulting from the baby’s head resting against the mother’s spine and causing intense pain. Epidurals may not offer the pain control needed in these cases, and physicians will likely suggest other pain control solutions.

Epidurals may cause a drop in the mother’s blood pressure and a decrease in the heart rate of the unborn child. However, IV fluids help control these issues. Some women report headaches, nausea, or vomiting. The drugs used in the epidural occasionally cause the patient to feel itchy, but other medications can relieve this issue. Although there have been reports of spinal cord injuries, breathing issues, or rapid heartbeat associated with epidurals, these are rare. After the birth, some women who have had an epidural say they experienced a fever or a decrease in bladder sensitivity, but these issues usually resolve themselves within 24 hours. Women who receive anesthesia through an epidural are more likely to require assisted birth techniques, such as forceps.

Whenever doctors administer an epidural to the mother, they also use a fetal monitor to observe the unborn baby. This monitor may restrict the mother’s movements during labor but allows the medical staff to watch both the mother’s contractions and the baby’s heartbeats. Following the birth, some mothers who have had an epidural report that their babies have difficulty latching on or sucking when they attempt to breastfeed. Although a small amount of the epidural medication reaches the baby, it is typically not harmful.

A rare complication of epidurals is nerve damage near the insertion area of the catheter, but this type of damage is usually temporary. Blood clots, infections, an inadequate blood supply, or trauma from the needle or catheter are some of the ways an epidural can cause nerve damage. A 2007 study estimates that spinal cord damage occurs in 1 out of 78,000 procedures and nerve damage occurs in 1 out of 25,000 procedures.

A study of 12,000 women in Britain who received an epidural during labor indicated a higher incidence of severe lower back pain. However, upon further evaluation, the study showed a higher number of women who had not had an epidural reported persistent pain lasting more than a year. While additional studies have shown back pain occurring within three months following the birth, the pain continued for no longer than six weeks. Additionally, women who received combined spinal-epidural analgesia reported fewer headaches and a lower rate of incontinence compared to those who had a high-dose epidural.

A Stanford study focusing on national epidural rates between 2009 and 2014 discovered a high epidural administration rate. Around 71 percent of pregnant women received epidurals during that period. A once common belief was that epidurals slowed down the progression of labor or increased the need for cesarean deliveries. This caused some women and their physicians to avoid the use of epidurals. But a 2017 study disputed those earlier beliefs. Today, women have more control over their birth experiences, and many prefer to avoid the pain associated with labor. With significant progress in recent years ensuring the safety of procedures and equipment, epidurals have become the most popular type of pain control for labor and delivery.