Everything You Need to Know About Epidurals & Pain Management in Labour

The experience of pain in labor can be influenced by a variety of factors such as previous experiences, and individual emotional, physical, motivational, cognitive, social, and cultural circumstances. Strategies for dealing with the pain can be medicinal and non-medicinal, both of which Drs. Alicia and Sarah outline today, with a particular emphasis on epidurals as we get frequent questions about them! As always, having a good understanding of your options is crucial in making decisions that feel right for you, even when sometimes things don’t go according to plan. This is also why we’ve assembled this free hand out about the Risks and Benefits of Epidurals and How to Support your Partner in Labour as well as these other great associated episodes on Hypnobirthing and Waterbirths!

And if you would like a more in-depth understanding of your options, a reminder that there is a module on Pain Management in Labour in our Pregnancy to Parenthood Online Prenatal Masterclass which includes a video from Stephanie Curran on Acupressure in Pregnancy and Labour!

Non-Medicinal Strategies

Acupressure: Acupressure can be really beneficial. A Cochrane Review in 2011 concluded that acupuncture and acupressure may have a role in reducing pain and increasing satisfaction with pain management, as well as the reduced use of pharmacological management. A reminder that there is a module on Pain Management in Labour in our Pregnancy to Parenthood Online Prenatal Masterclass which includes a video from Stephanie Curran on Acupressure in Pregnancy and Labour!

Breathing Techniques: Also sometimes referred to as Hypnobirthing, essentially this involves practicing proper breathing and mindfulness in labor to help with pain management. Check our our episode on Hypnobirthing here!

Water: Water can be a really amazing way for some people to help decrease the sense of pain during labor, allowing them to feel more in control and have more ease of movement into positions that can be more comfortable. You can also choose to give birth in water, as we discuss in our episode on Waterbirth, but a couple of tips to ensure the safety of the mother and baby in water include:

• A healthy pregnancy, being at least 37 weeks gestation or later
• Being in a warm but not hot bath
• Getting out of water every hour or so to empty the bowels and bladder
• Staying hydrated, and;
• Not having strong medications which may cause you to fall asleep

Medicinal Strategies: Epidurals

What is an epidural? An epidural is medication placed around the spinal cord to help decrease pain sensation. They are placed by anesthesiologists or family doctors with extra training and anesthetics, in some smaller communities, and are the most effective form of pain management that we have in labor. The procedure involves a physician discussing the risks and benefits to you, and you must give consent.

Once you’ve given consent and the procedure goes forward, you'll be asked to sit up in your bed and lean forward, often hugging a pillow to round out the lower back and make more room in between the bony vertebrae. The back is wiped with a cleansing solution (which can be a little bit cold!) and some freezing is placed in the skin and underlying tissue. This often feels like a bit of a pinch or a burning sensation when the needle goes in. This usually takes a couple of minutes and it is important to do your best to stay still even though contractions are continuing throughout this time. The anesthesiologist will try to time doing all of this in between contractions. 

Next, a needle is used to locate the epidural space, and a plastic tube is inserted close to the nerve roots. After the epidural is placed, it usually takes about 15 minutes to take full effect. Medication is administered continuously throughout labor, delivery of the placenta, and any additional postpartum procedures needed, such as suturing.

Benefits & Risks

An epidural greatly reduces and sometimes even eliminates contraction pains, at times entirely, but sometimes pressure and discomfort can still be felt during the delivery. Once an epidural is in place, walking is limited to small distances like the washroom, but you will not be able to walk the halls. It can change your sense of balance and affect the strength in your legs while it's in place, which is another reason long walks are not recommended.

One potential risk is epidurals not working well and requiring replacement. A spinal headache can occur in about 1% of cases, and there is a very rare risk of nerve injury, infection, or bleeding in the epidural space that can lead to permanent nerve damage - but this is exceedingly rare. Lowering of blood pressure is a common side effect that can be addressed by giving extra fluids in the form of an IV. Epidurals can also cause shivering or itching. 

A spinal procedure, which is different from an epidural, is a one-off medication dose that lasts for about an hour and a half and does not require a catheter (the small plastic tube in your back) to be left in place. It is often used for shorter procedures such as C-Sections or forcep deliveries. If you're having a scheduled C-Section, then a spinal anesthetic would be administered beforehand, not an epidural. If you've been laboring with an epidural and need an unplanned C-Section, often the epidural that's already in place can be used to administer extra medication. 

We hope this gives you a bit more of an idea what to expect from Epidurals and Pain Management in Labour! Be sure to tune into the episode where we also answer our most common questions around epidurals such as “is getting an epidural ‘weak’ as our bodies are meant to withstand childbirth” and “do epidurals prolong labour”?