Epidural in childbirth — 5 things you must know before
What an epidural actually is, how it's placed, how much it hurts, who can't have one, and what the risks are — 5 things every expectant mother should know before going into labor.
Chapters
Frequently asked questions
What exactly is an epidural?
In the spinal cord there are tracts made of bundles of nerve fibers that carry electrical signals — that's how information about pain travels from the body to your brain to tell you something isn't quite okay and, basically, to make you do something about it (like… ask for an epidural).
Around the spinal cord there's spinal fluid, and around that there's another sheath called the dura.
When we inject local anesthetic outside the dura (or "epi-durally" in Latin) we manage to block the transmission of that electrical signal, and that reduces the sensation of pain.
I know — it really does sound like voodoo magic.
##
How an epidural is placed — step by step
First of all, who's going to actually place it? Only an anesthesiologist — a physician. And by the way, please don't call us "epiduralists." Epidurals are a tiny part of what we do.
Where is the epidural placed? Only in the delivery room. Not in the ER, not in the ward, not in the corridor, not at home, not in the jacuzzi… we good?
It's a sterile procedure — which means the doctor performing it washes their hands, puts on a sterile gown and gloves, and cleans the puncture area with alcohol three times, all to prevent infection.
The puncture itself is done in your lower spine, in the lumbar area. We go in with a needle in the space between two vertebrae, inject local anesthetic there (similar to what the dentist uses), and then thread in a very, very thin catheter so you can keep getting medication throughout the labor. At the end of the procedure we pull the needle out and leave only the catheter, which you really won't feel.
How can you make this go as smoothly as possible? The most important thing is to cooperate and be in the right position — the anesthesiologist will ask you to be in a "banana" or "angry cat" pose, basically a rounded-back position that opens up the space between the vertebrae as much as possible.
The procedure itself can take a few good minutes, and during that time it's critical to hold the position and not move at all — otherwise the needle could end up in the wrong place. We really don't want that.
"But I'm having contractions," you say? Don't worry — studies have shown this is a very common trait among women who come in to give birth. It can genuinely be scary, but like everyone else you'll get through it: breathe deep through the contraction, ride it out, and remind yourself that this might be one of the last painful ones you'll have.
What will you actually feel during the procedure? Cold on your back from the alcohol, a little sting on the skin from the local anesthetic, some pressure from the epidural needle itself, and then a small zing when the catheter goes in (sounds like a recipe).
##
What happens after the epidural is in
It'll take about fifteen minutes for the medication to start working — but every contraction will feel easier than the last.
Right after the epidural we'll lay you on your back to take blood pressure a few times and monitor you. After that, in most hospitals, you won't be allowed out of bed because of fall risk.
But you can be in any position you want in the bed — you definitely don't have to stay on your back the whole time. You'll be hooked up to a pump that keeps delivering the anesthetic continuously throughout labor, and you'll also have a button you can press for an extra dose.
The epidural is very, very effective at preventing the pain of contractions, and you may not feel them at all — you might even fall asleep. But here's what to know: it's less effective at preventing the pressure pain during the pushing phase, so you might feel some of that. It'll still hurt much less than without the epidural.
What you should NOT feel: the epidural shouldn't completely numb your legs. There's some variation between women — some move their legs freely, some feel them a bit heavy, and both are normal — but it really shouldn't paralyze your legs. If that happens, call us so we can check.
And can an epidural fail to work? Yes, unfortunately that does happen and we don't always have an explanation. Usually we'll try giving you an extra dose, wait a bit, and see if it helps. Sometimes we need to redo the epidural, but that's relatively rare.
##
Does an epidural have complications?
Let's start with this: it's a very, very safe procedure — but in medicine there's no 100%. The most common side effects are a drop in blood pressure, nausea, or itching. They're usually mild or pass on their own.
In up to 1% of cases there can be headaches that aren't life-threatening but can be very bothersome, and sometimes they require a procedure called a blood patch — basically a repeat epidural to improve the symptoms.
Truly life-threatening side effects or ones that cause significant neurological damage are very, very rare — mainly from bleeding or local infection at the puncture site pressing on the nerves. That's exactly why epidurals are done sterilely and why we don't do them on women with clotting disorders or bleeding tendencies.
##
Who can't get an epidural?
Lucky for us, there are very few women who can't get an epidural — but let's go through them. If you're on the list, write to me in the comments and I'll explain other options for pain control during labor.
Who can't get an epidural?
- Women with a clotting disorder that causes bleeding
- Women on certain blood thinners who didn't stop them in time before labor (depending on the drug; aspirin doesn't count — there's no problem doing an epidural on aspirin)
- Extensive infection at the puncture site
- And… if you don't want an epidural. Then we're not really supposed to do one. Yes, shocking.
##
Frequently asked questions
- Women with scoliosis can almost always get an epidural, but in severe scoliosis it might be more technically challenging. And if you've had corrective surgery for scoliosis, bring your imaging discs, orthopedic consultation, and any relevant medical info so we can find the right spot in the back to do it.
- Women with a tattoo on the lower back can also get an epidural — we just won't puncture directly through the tattoo itself; we'll find another gap without ink. We're anesthesiologists — we think outside the box.
That's it. I hope you enjoyed the video. If you have more burning questions about anesthesia or medicine in general, write to me below. And of course, hit subscribe so I can keep bringing you content.
See you in the next video, and have an easy birth.
Full transcript
Show full transcript
What is an epidural? How does it work? How much does it hurt? Who can't get one? What are the risks? In this video I'll explain in 5 minutes the 5 things you have to know about an epidural before you come in to give birth.
## What exactly is an epidural?
In the spinal cord there are tracts made of bundles of nerve fibers that carry electrical signals — that's how information about pain travels from the body to your brain to tell you something isn't quite okay and, basically, to make you do something about it (like… ask for an epidural).
Around the spinal cord there's spinal fluid, and around that there's another sheath called the dura.
When we inject local anesthetic outside the dura (or "epi-durally" in Latin) we manage to block the transmission of that electrical signal, and that reduces the sensation of pain.
I know — it really does sound like voodoo magic.
## How an epidural is placed — step by step
First of all, who's going to actually place it? Only an anesthesiologist — a physician. And by the way, please don't call us "epiduralists." Epidurals are a tiny part of what we do.
Where is the epidural placed? Only in the delivery room. Not in the ER, not in the ward, not in the corridor, not at home, not in the jacuzzi… we good?
It's a sterile procedure — which means the doctor performing it washes their hands, puts on a sterile gown and gloves, and cleans the puncture area with alcohol three times, all to prevent infection.
The puncture itself is done in your lower spine, in the lumbar area. We go in with a needle in the space between two vertebrae, inject local anesthetic there (similar to what the dentist uses), and then thread in a very, very thin catheter so you can keep getting medication throughout the labor. At the end of the procedure we pull the needle out and leave only the catheter, which you really won't feel.
How can you make this go as smoothly as possible? The most important thing is to cooperate and be in the right position — the anesthesiologist will ask you to be in a "banana" or "angry cat" pose, basically a rounded-back position that opens up the space between the vertebrae as much as possible.
The procedure itself can take a few good minutes, and during that time it's critical to hold the position and not move at all — otherwise the needle could end up in the wrong place. We really don't want that.
"But I'm having contractions," you say? Don't worry — studies have shown this is a very common trait among women who come in to give birth. It can genuinely be scary, but like everyone else you'll get through it: breathe deep through the contraction, ride it out, and remind yourself that this might be one of the last painful ones you'll have.
What will you actually feel during the procedure? Cold on your back from the alcohol, a little sting on the skin from the local anesthetic, some pressure from the epidural needle itself, and then a small zing when the catheter goes in (sounds like a recipe).
## What happens after the epidural is in
It'll take about fifteen minutes for the medication to start working — but every contraction will feel easier than the last.
Right after the epidural we'll lay you on your back to take blood pressure a few times and monitor you. After that, in most hospitals, you won't be allowed out of bed because of fall risk.
But you can be in any position you want in the bed — you definitely don't have to stay on your back the whole time. You'll be hooked up to a pump that keeps delivering the anesthetic continuously throughout labor, and you'll also have a button you can press for an extra dose.
The epidural is very, very effective at preventing the pain of contractions, and you may not feel them at all — you might even fall asleep. But here's what to know: it's less effective at preventing the pressure pain during the pushing phase, so you might feel some of that. It'll still hurt much less than without the epidural.
What you should NOT feel: the epidural shouldn't completely numb your legs. There's some variation between women — some move their legs freely, some feel them a bit heavy, and both are normal — but it really shouldn't paralyze your legs. If that happens, call us so we can check.
And can an epidural fail to work? Yes, unfortunately that does happen and we don't always have an explanation. Usually we'll try giving you an extra dose, wait a bit, and see if it helps. Sometimes we need to redo the epidural, but that's relatively rare.
## Does an epidural have complications?
Let's start with this: it's a very, very safe procedure — but in medicine there's no 100%. The most common side effects are a drop in blood pressure, nausea, or itching. They're usually mild or pass on their own.
In up to 1% of cases there can be headaches that aren't life-threatening but can be very bothersome, and sometimes they require a procedure called a blood patch — basically a repeat epidural to improve the symptoms.
Truly life-threatening side effects or ones that cause significant neurological damage are very, very rare — mainly from bleeding or local infection at the puncture site pressing on the nerves. That's exactly why epidurals are done sterilely and why we don't do them on women with clotting disorders or bleeding tendencies.
## Who can't get an epidural?
Lucky for us, there are very few women who can't get an epidural — but let's go through them. If you're on the list, write to me in the comments and I'll explain other options for pain control during labor.
Who can't get an epidural? - Women with a clotting disorder that causes bleeding - Women on certain blood thinners who didn't stop them in time before labor (depending on the drug; aspirin doesn't count — there's no problem doing an epidural on aspirin) - Extensive infection at the puncture site - And… if you don't want an epidural. Then we're not really supposed to do one. Yes, shocking.
## Frequently asked questions
- Women with scoliosis can almost always get an epidural, but in severe scoliosis it might be more technically challenging. And if you've had corrective surgery for scoliosis, bring your imaging discs, orthopedic consultation, and any relevant medical info so we can find the right spot in the back to do it. - Women with a tattoo on the lower back can also get an epidural — we just won't puncture directly through the tattoo itself; we'll find another gap without ink. We're anesthesiologists — we think outside the box.
That's it. I hope you enjoyed the video. If you have more burning questions about anesthesia or medicine in general, write to me below. And of course, hit subscribe so I can keep bringing you content.
See you in the next video, and have an easy birth.
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