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Hey Mamas! There’s a lot of controversy out there about epidurals, and epidural side effects. “Do I get one?” “Is it safe for baby?” “What’s the deal with that needle?” Some women are very pro-epidural (GIMME THE DRUGS!!), while others go the all-natural route. Some women go into labor thinking they don’t want an epidural, and then change their minds down the road. Whichever route you end up taking during your labor, the important detail that we need to take away from the debate is that it’s ALWAYS helpful to be informed!
So, as a gal who’s been through many epidurals, I thought I would share with you a few tidbits you may not know about “the e-word”.
*I’ve also written a post going into detail about the entire procedure of actually getting an epidural, so if you’re interested in how it all works, head on over here!*
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THEY CAN CHANGE YOUR BLOOD PRESSURE
One of the most common side effects of receiving an epidural is a decrease in your blood pressure. It’s usually mild when this happens, but sometimes it can be dangerous for you, and especially dangerous for baby.
During pregnancy, baby relies on his or her blood supply from your placenta. When your blood pressure drops, one of the first things your body does is shunt blood flow away from your placenta and redirect it towards your vital organs (your heart, your brain, your lungs etc.).
Your body is basically saying “uh oh, there’s not enough blood flow in here for everything, I need to save the important stuff!”. Unfortunately, your placenta doesn’t count as a vital organ according to your body.
No worries though, there are many easy ways we can get your blood pressure back up!
THEY AREN’T ALWAYS PERFECT
Occasionally when your epidural is placed, the tip of the catheter that stays in your back is pointed to one side, instead of facing the middle. This can cause a dreaded “one sided” epidural. Since this medication is gravity based, commonly what is done to fix this problem is a change in position. Occasionally the anesthesiologist must come back to your room and reassess the placement, but usually a position change is all you need.
Sometimes you can also have “hot spots” that form after getting relief with your epidural. A “hot spot” is when a bit of your contraction pain comes back, frequently in one small spot on one side of your body. Everyone’s anatomy is different, and sometimes the medication that was originally given doesn’t go everywhere it needs to. This is also an easy fix, and most likely all you need is a bit more medication to be infused through your catheter, along with a position change.
YOU CAN HAVE LONG TERM BACK PAIN
Okay, this is one of those that your doctor might tell you is a rare complication. All too frequently, what I’ve seen is that many women report discomfort in the site where their epidural was placed. Sometimes going on for YEARS!
I’m not saying it’s debilitating. Actually, what I’ve heard is that it’s described as more “uncomfortable” rather than painful. In my opinion, it’s worth bringing up!
THEY DON’T TAKE AWAY ALL OF YOUR DISCOMFORT
As you get closer to delivery, your baby gets lower and lower into your pelvis. This comes with a great amount of vaginal PRESSURE. And, unfortunately epidurals don’t do much to relieve any of this pressure.
YOU CAN’T GET OUT OF BED (BUT YOU CAN MOVE AROUND)
Along with getting pain relief from an epidural, you’ll also have some numbness in the lower half of your body. And when your legs don’t work, we don’t want you to be getting out of bed trying to walk around, because you might fall! So, after getting an epidural, your only place of residence until you deliver is in your bed.
With that said, it’s very important not only to move around in the bed, but move around frequently! Movement fosters labor progression. Ideally you want to be changing positions about every 30-45 minutes. Your nurse can help with this!
YOU MAY HAVE A BAD HEADACHE AFTER DELIVERY
This is called a SPINAL HEADACHE. While extremely rare, I have seen a few in my practice and it’s worth mentioning. When you are signing a consent form for the anesthesiologist to place your epidural, this “Spinal Headache” is listed as a rare complication that you may face as a result of the procedure. It’s always brought up pre-procedure, but I notice sometimes it gets glazed over. When you are huffing and puffing through those contractions, it’s hard to hear what ANYONE is saying, especially some doctor you’ve never met spewing out medical jargon.
A spinal headache usually develops within a few days to a week of receiving your epidural. It usually comes on slow, commonly in the front part of your head. The way we tell it’s a spinal headache, versus just a normal headache is that a) It’s debilitating, so bad you can barely take care of your baby, and b) the pain subsides when you lie flat.
Your spinal cord is surrounded by fluid, which is also surrounded by a small membrane called a “dura”. When you receive an epidural, your anesthesiologist inserts a small needle right outside this dura membrane. This is called the “epidural space”. A small tube is inserted into this space to give you the necessary medication to ease your contractions. On rare occasion (less than 1 in 100) the needle punctures that dura membrane, a tiny hole forms, and some of that spinal fluid leaks out of the hole. This can causes pressure changes in the fluid surrounding your brain if enough fluid leaks out. This, in turn, gives you a really bad headache.
Ok, I know that sounded really scary! It is. But the likelihood of actually having one of these spinal headaches is relatively low. And, there are things that can be done to fix it! Sometimes they do resolve on their own, spontaneously in a few days, but most commonly what is done is a procedure called a “blood patch”. This is a very simple, short procedure that is done by an anesthesiologist. Basically what he does is draw a bit of your blood, and insert it back into that space where the hole had formed, creating a “patch”. Once the blood clots around the hole, your headache goes away almost immediately.
THEY AREN’T IMMEDIATE
If you’ve read my post about receiving an epidural, you may already know this one! Unlike a medication that can be easily inserted into your IV to help with pain, epidurals are kind of a lengthy process. It involves a lot of pre-procedure prep, and sometimes a lot of waiting. Most often, once you’ve asked your labor nurse for an epidural, you’ll actually feel relief from it in about an hours’ time. Unfortunately, no one has invented an “epidural button” yet, but if you guys hear of one, let me know ok?? 😊
SOME WOMEN CAN’T RECEIVE THEM
Just like ANY procedure, there are certain contraindications to receiving an epidural. First off, you must be able to stay STILL during the procedure. If you can’t sit relatively still for a few minutes during placement, your anesthesiologist will not be able to place your epidural. It’s very dangerous to be moving around with a needle in your back near your spinal cord!
Secondly, you need to have a certain number of platelets circulating in your bloodstream. In order to for your body to form a clot when there’s been blood vessel injury (aka, getting a needle stuck in your back!), your platelet count needs to be over a certain threshold. Generally if you have no medical problems during pregnancy, your platelet level should be at or above the adequate threshold. However, severe preeclampsia or certain blood diseases can cause this level to drop. Occasionally I will have a patient who randomly has a low platelet level, and is unable to receive an epidural during labor, but this is RARE.
Finally, if you’ve had spinal surgery (such as a correction for scoliosis), you may not be able to receive an epidural in labor. In my experience, anesthesiologists will not place an epidural catheter in someone that has not had a previous consult with their team. This means if you’ve had any sort of back surgery before, you are pregnant and you’d like to receive an epidural during labor it’s important to bring this up to your OBGYN. You will need to schedule a consult with the hospital’s anesthesia team, and they will evaluate you further to determine if placement is an option.
SOMETIMES THEY SLOW DOWN YOUR LABOR
Unfortunately for many women, epidurals get a bad rap for slowing down labor. This is commonly due to receiving one too early in the game (before the active stage of labor). It’s totally fine to receive an epidural at this point in your labor, in fact many women do receive them before they are truly active. Just be aware that it has a higher likelihood of slowing things down.
SOMETIMES THEY SPEED THINGS UP
On a positive note, sometimes epidurals actually speed things up! All too commonly, laboring women wait to get epidurals until they just can’t stand it anymore. They are stressed from labor, grimacing, and tensing every muscle in their bodies to try and deal with the pain. Once they receive their epidural, they RELAX for the first time in hours, and BAM they are 10 centimeters dilated, after probably being stalled at 4-5 centimeters for hours. THIS IS SO COMMON GUYS! I see it all the time.
YOU’LL HAVE TO GET A CATHETER PLACED IN YOUR BLADDER
Don’t freak out, this is done AFTER you get your epidural, so most women do not even really feel discomfort from the placement.
A catheter is placed after you’ve received an epidural for two reasons. First off, along with numbness in your lower body, comes numbness in your bladder. This means even if your bladder fills up with urine, you won’t be able to feel the need to urinate. Secondly…well your legs don’t really work too well anymore, so you can’t get out of bed to get to the bathroom! No worries though, your catheter is taken out right before you start pushing.
SOMETIMES YOU SHIVER, SOMETIMES YOU ITCH
Sometimes epidurals can cause a brief impairment in the way your body regulates your core temperature, and in turn, can cause your body to shiver uncontrollably. It’s temporary though, and once your epidural wears off post-delivery, it will subside.
Itching is a common side effect with any ingestion of opiate-based drugs (which is most likely what part of your epidural is composed of). This is also temporary and will resolve post-delivery.
THEY ARE SAFE!
Even though I’ve gone through some scary side effects and complications, I’m going to end this post on a positive note. From a medical standpoint, receiving an epidural is considered a VERY safe option for pain control during labor. Hundreds of thousands of women receive them annually, and let’s just say they would NOT be as popular if they were deemed unsafe. Yes, there are some complications that can arise, but most of these are rare. With that said, it’s YOUR choice to decide whether an epidural is for you or not!
Whew, that was a lot of info! I’m curious to know if any of you have experienced these side effects I’ve brought up. How did your epidural ultimately impact your labor experience? Leave me a comment!
Not so crazy about epidurals? I hear you, I went the all natural route, and opted out of getting one myself. Check out this article for some alternative methods of pain control that I recommend during labor.
Happy Laboring! 🙂
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