I know what you may be thinking, “Aren’t doulas against epidurals? Don’t you want your clients to go natural?” While this may true elsewhere, that’s not the agenda here.
I’m going to assume that if you’re looking to birth with pain relief, you already know at least the epidural anesthesia basics. So let’s get down to brass tacks and talk about how to make the best of your birth choices.
If you know you are planning on getting an epidural, it’s best to make sure your care provider knows this during your pregnancy so it can be placed in your file. This can help fast track your way into getting relief that much quicker. In labor already? Let the staff know as soon as you arrive.
Unfortunately, getting from contractions to epidural bliss isn’t always as simple as the movies make it out to be. Before you can even get prepped for anesthesia, you’ll be talking with triage staff to get your preliminary information and vitals taken. You’ll then need to get an IV line inserted. You must receive at least one bag of IV fluids in order to make sure that you are adequately hydrated to receive medication. Your care provider will want to run blood work to check for things such as your platelet count to make sure spinal meds will be a safe option. You’ll then be placed on the anesthesiologist and nurse anesthetist’s list to receive your pain meds. If there is, say, an emergency cesarean elsewhere that takes place as soon as you are ready for your epidural, there’s a chance you’ll be waitlisted if your hospital does not have a large anesthesia team. There are other medical and non-medical pain relief options if that’s the case.
You may not have to wait until active labor to receive an epidural. The American Congress of Obstetricians and Gynecologists defines active labor as someone who is 6 centimeters or more dilated. Previous belief suggested that those who received epidural analgesia earlier in labor were at a higher risk of more childbirth intervention, such as instrumental delivery (vacuum, forceps) or a cesarean section. The newest evidence, however, doesn’t show this to be the case.
Just got the epidural? Get some sleep.
Whether you’ve been in labor for two hours or two days, you will have already put in a ton of hard work. While we’d love to tell you that pain medication is a one-way ticket to an easy birth, there still may still be quite a ways to go. So save your energy and savor the break!
What will it feel like to have the epidural?
How you experience the pain relief of an epidural can be rather up in the air. It can depend on what mix of anesthetics you receive, the skill level of your anesthesia team and sometimes, your body’s composition. In the Capital District, St. Peter’s Hospital tends to offer a version of the epidural that contains Bupivicaine, a commonly used numbing agent, with a nurse anesthetist reported pain relief of around 80 percent. At Burdett Care Center, a subsidiary of Samaritan Hospital, epidurals may either be administered with a numbing agent or a synthetic opioid such as Fentanyl, as well as the option of a spinal epidural which combines both spinal and epidural anesthesia for potentially faster relief.
When you get the medication, you may experience itching, a “drippy” feeling in your extremities, nausea and extensive numbing throughout the lower half of your body.
What about if I can’t get an epidural or my epidural doesn’t work?
Sadly, there are some situations in which an epidural may no longer be a viable option, such as cases of low platelet blood count, spinal fusion or if your epidural medication does not “take” and further attempts are not successful. There’s also the time between when you ask for meds and when you get them, in which some of the following ideas may be worth their weight in gold.
Take the time to learn more about the benefits and risks of childbirth interventions such as the epidural before diving headfirst into a decision. As an expectant parent, the choice to give birth on your terms is a very personal one. Make sure you are asking your care provider for honest and straightforward answers so they can best assist you in writing up a labor day game plan.
Cara Del Favero is a Capital District mother of two, placenta encapsulation specialist and a birth and postpartum doula providing holistic, nonjudgmental support for all childbirth options. To contact her, visit thealbanydoula.net.