Childbirth – from a Mom who knows
If you are pregnant, you are probably already thinking about childbirth too. We know you have been learning lots of new words like trimester and epidural and at first you may wonder what they really mean. Today we will chat with Wendy Monrad who is a mom and a nurse anesthetist who is going to tell us all about epidurals. She will explain both from the perspective of a mom whose had two epidurals herself, and from the point of view of the anesthesia provider. She does an average of three epidurals per shift when she is working and has been working for 21 years. Let’s do the math on that – or maybe not – we can’t count that high! We will just say that she knows what she’s talking about. So let’s get started with the basics!
What is an epidural?
We will start with a definition from the folks at PregnancyBirthBaby.org. “An epidural is a procedure that injects a local anesthetic in to the space around the spinal nerves in your lower back. This anesthetic usually blocks the pain from labor contractions and during the birth very effectively. With an epidural you can usually move and can push your baby out when you need to. An epidural is usually done by an anesthetist.”
Below is a list of several options to manage pain during labor and delivery
- Intravenous pain medications
- Self-administered nitrous oxide by mask
- Many alternative methods of relaxation
Wendy reminds us that “every mom and every labor and delivery is different. It’s good to know your options ahead of time so it is easier to make decisions when you are in labor.” Lots of moms plan to try “natural” childbirth, and Wendy is very supportive of this, but wants her patients to know all of their options so they can choose what works best for their labor.
As an option, Wendy now offers her patients nitrous oxide which is inhaled through a mask during contractions. She encourages all her clients to give it a try and she notes that about 50% of her clients are satisfied with the nitrous oxide. If the nitrous oxide doesn’t work, they can get an epidural. Where she works, patients also have the option of patient controlled epidural anesthesia (PCEA) where you have a button and can give yourself extra epidural medication If you need it (generally close to delivery).
Benefits of epidural anesthesia during labor and deliver
Wendy’s first response – a more pleasant experience! “Epidurals do not take all pain away but do make it considerably better. Moms tend to have better control with pushing and delivery and most are able to rest while progressing through labor. Sometimes it can even speed up the process as moms are able to relax and let contractions change the cervix.”
My personal epidural story: “I was stuck at 4cm for hours. After an epidural was placed, I slept for an hour and was woken up by staff saying it was time to go to the OR and start pushing. 2 hours later I delivered twins!”
Are there risks associated with epidural anesthesia?
Yes. Most of life has risks. For epidurals, Wendy notes that the risks include:
- Infection (anytime we put something inside your body there is a small risk of infection – but everything is kept sterile so the risk is very low)
- Nerve damage (nerves tend to be on the sides and we stay right in the middle so low risk)
- Bleeding inside the back (blood vessels are also on the sides so the risk is low)
- Partial or no relief (also low risk or we wouldn’t offer them all the time)
- Headache (if we accidentally go too far with the needle it can put a hole in fluid filled sack that surrounds spinal cord and nerves and give you a nasty positional headache after delivery – this is the greatest risk but it only happens in < 1% so all risks are very low).
Wendy also notes that sometimes epidurals don’t work on one side or in one spot – this can be caused by a patient’s unique anatomy and it may or may not get better with anesthesia help. Sometimes we offer to replace the epidural.
Are there side effects?
Wendy explains that you will have numb, tingly, heavy legs – this means the epidural is working. You will need a Foley catheter in your bladder as it will be numb also and you won’t feel the need to pee (a full bladder can slow down the birthing process.) You will not be allowed to walk around after it’s placed because of your numb, wobbly legs.
Your nurse will monitor your blood pressure as the epidural “can drop your blood pressure which will require fluids and medications to bring it back up. Baby needs mom to have a good blood pressure to get the blood he or she needs – the first sign of low blood pressure is mom feeling nauseated – bodies are amazing! Vomiting increases moms blood pressure to protect baby!” Let your nurse know if you feel unwell after the epidural is placed. Nausea and vomiting are also common just from the progression of labor.
How to get an epidural while you are having contractions?
Wendy explains “I like to have the support person stand in front of the mom to hold her shoulders and encourage her. The painful part is numbing the skin (pinch and a burn for about 3 seconds then just a strange pressure sensation with the epidural). It is very important she not move while we are working (most common reason for accidental puncture headache). Focus on your breathing through contractions. The support person is really helpful with this. Placing an epidural generally only takes a few minutes. The effect is not instantaneous. It can take up to 10 minutes to notice a real difference once we start putting medicine in.”
“Contractions feel shorter and then like the early contractions before they started to hurt. Some people don’t feel much more than that until delivery. As baby moves down the birth canal, you get a lot more pressure sensations (like you need to poop) – epidurals don’t do much for pressure sensations. But that’s okay because you are getting close to having your baby! It also still hurts a bit as the baby’s head comes out – the head is pretty big compared to you! Once you are all done and the epidural medicine is turned off, it takes a couple of hours for the numbness and heaviness to wear off. Don’t get out of bed until your legs feel normal and have help the first time.”
I’m just loving Wendy’s chatty style and real-life experience! Here are her closing thoughts on epidurals.
“I had an epidural for both pregnancies. My first one worked great! (twin story above). The second one was not as good – I had to have anesthesia put extra medicine in several times. That’s the way it goes – sometimes amazing and sometimes not. Generally, the experience is very good and most patients are pleased and would have another epidural in the future.” “Sometimes moms feel bad deciding to get an epidural when they had planned to go “natural.” I tell them it’s just another way to have the baby – which is the whole point. Everyone’s labor is different and is affected by how well rested you are etc… ”
If you are still researching your options for pain control during childbirth, Wendy recommends taking a tour of the labor and delivery unit, and ask to visit with anesthesia if they are available. Here are links to three local hospitals:
If you would like more information about labor and delivery or pain management, sign up for our Life Lessons classes. These lessons are available for mom and dad!
(We want to send a special Thank you to Wendy Monrad, CRNA, MSN for all her help with this blog post!)