EP 11: Will an Epidural Slow my Labor?


WHAT IS AN EPIDURAL: An epidural is a small catheter placed into your back that continuously infuses pain medication into the epidural space around the spinal cord. This causes a numbing sensation from your belly button down, allowing you to stay awake throughout labor yet get relief from pain.


The procedure: Anesthesia numbs up your back, a needle is used to guide a small plastic catheter into the epidural space in your lower back. Medications are given through that small plastic catheter that can help with pain during labor. Now, after they get the plastic tube in your back, they remove the needle so it’s just the thin plastic tube in your epidural space. An epidural takes about 10 minutes to set up and takes about 10 minutes to start working. It doesn’t always work well at first and sometimes your medications may need to be adjusted so that you get the pain relief during labor you’re looking for. Rotating sides, giving a bolus of medication, or getting your epidural redone are ways to troubleshoot an epidural that is not working.


More drugs or stronger drugs can also be given through the catheter if you end up needing a cesarean birth. EPIDURALS DO NOT RUN OUT, this is a common misconception that after they're placed they only work for a certain amount of time. The medication in the epidural is constantly infusing. As labor progress you may feel more pressure or breakthrough pain, but this does not indicate that your epidural is wearing off! It just means labor is progressing!


More than 60% of people giving birth in the US have either an epidural or a spinal block during labor.

SPINAL BLOCK: like a one time epidural, lasts an hour or two.

BENEFITS:


1. PAIN MANAGEMENT: Cochrane review published in 2018 that looked at 40 different studies, with over 11,000 participants. They compared people receiving epidurals, spinals, and combined spinal epidurals to those who were either receiving no pain medication or were receiving injections opioids in their arm of temporary pain medications.

  1. epidural lowered pain on average 2-3 points

  2. people using epidurals had “excellent or very good" pain relief

  3. People with epidurals experienced less nausea

  4. There were no differences in newborn intensive care unit admission and Apgar score less than 7 .

2. REST: able to sleep, especially if it is your first baby or long induction. Sometimes patients who labor naturally do get very exhausted.


3. ABILITY TO RELAX: relaxing can be what you need to dilate. When you are tense and fighting contractions dilation can be slowed.


4. PUSHING: this works both ways, for some people an epidural may slow labor/pushing because they may be too numb to feel. For other people it can speed up labor since they don't feel the pain, so they're able to push with all their strength and not have fear.

RISKS:

1. People with epidurals were more likely to experience low blood pressure, a fever, or urinary retention from a foley catheter (a catheter is inserted into your bladder to drain your urine throughout labor).

2. Can get a heavy motor-blockade. That means that your legs might become so heavy and difficult to move that you can’t really move the lower part of your body at all.

3. LONGER PUSHING: Epidurals could potentially decrease the birthing persons pushing efforts by reducing the strength of uterine contractions.

4. People with epidurals may have a longer labor and be more likely to have oxytocin augmentation. In a study by Zhang in 2010 they found that the average length of the pushing was 1 hour and 6 minutes for first time mothers with an epidural and 36 minutes for first-time mothers without an epidural.

A California Study showed epidural use added about 73 minutes to pushing for first-time moms.

People in the epidural group were more likely to have a forceps/vacuum assisted delivery- used to help the baby come out at the end of the pushing phase.


There was no difference in Cesarean rates


5. Epidurals and breastfeeding: These medications have been found in breast milk.

- the medications cross the placenta and could affect the newborn’s ability to suck and latch.

- epidurals could lead to the mother developing a fever during labor. Fevers in the mother are linked to lower Apgar scores in the baby.

- getting an epidural could influence the maternal hormones. Especially due to pitocin augmentation and fluid bolus dilution, this could effect breast milk production and breast feeding.

- epidurals are linked to higher rates of vacuum and forceps delivery, which could impact breastfeeding due to increased risk for maternal tear and newborn complications.


TIPS FOR AN UNMEDICATED BIRTH:

  1. HIRE A DOULA. hello, I'm Jenn!

  2. Relax during contactions- melt into your bed or your partner or the floor. Any surface. Focus on relaxing your face and your hands. Dont squeeze a grip.

  3. Veiw contractions as waves, surges or power, pain with a purpose of dilation and getting to meet your baby. Dont fight it.

  4. Focus on deep low sounds, not high pitch. Moan the baby out.

  5. Push like you're going under water or blowing out a candle. Relax your face when you push, push into your bottom not your face or feet.

  6. Pushing often will give you relief. Push into the contractions and don't fear it.


resources:

https://evidencebasedbirth.com/prolonged-second-stage-of-labor/

https://pubmed.ncbi.nlm.nih.gov/22161362/

https://pubmed.ncbi.nlm.nih.gov/29016499/

https://evidencebasedbirth.com/effects-of-epidurals-on-the-second-stage-of-labor/