51. Are Epidurals Safe During Labor: Risks and Benefits of an Epidural on Birth, Babies and Breastfeeding

Are you nervous about labor pain and what to learn more about epidurals? Or maybe you’re really wanting to give birth unmedicated, but someone tells you, “You don’t get a trophy for natural birth…” and now you’re questioning it. 

In this episode, we’ll talk all about epidurals and their impact on childbirth including:

• What an epidural is and what to expect during the procedure…
• Understanding the risks and benefits of an epidural…
• How do epidurals affect labor progress or do epidurals slow down labor…
• The effects epidurals can have on newborns and breastfeeding...
• … and so much more!

As you’re deciding whether to choose an epidural during labor or not, it’s important to know the risks and benefits to you and your baby, so you can make an informed decision and plan ahead for your pain management plan.

I encourage you to explore your options, figure out what your values and goals are for your birth, communicate with your healthcare providers, and seek support for whatever it is you decide to choose!

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👋 WHO AM I?

Welcome, friends! I am Beth, a certified nurse midwife, doula, and childbirth educator. My philosophy is rooted in autonomy, informed decision making, and positive mindset to help expecting parents plan for a beautiful, stress-free birth. I am here to provide value to YOU through tips and practical advice, either to guide you through pregnancy or to help you prepare for childbirth, postpartum and beyond. There’s no fluff here - only info that adds to your positive experience and saves you stress and uncertainty.

Transcript

Hello and welcome back to Your Birth Bestie podcast! You are listening to episode 51 all about epidurals where we are going to talk about epidurals in detail, the risks and benefits, the potential effects on labor, and then things to be aware of regarding your newborn and breastfeeding. 

Epidurals are very commonly used today and I’m all for supporting moms when making a choice whether it is a tool they want to use or avoid, that’s up to you… but what I don’t like happening is when mom’s feel guilty or less than for choosing an epidural or plan for an epidural simply because they don’t think they can handle the pain. Getting an epidural seems like the common, standard thing to do in the hospital setting, but I want to empower you with some information and hopefully encourage you to learn more about epidurals and then make the best decision for you.

If you want to avoid an epidural, it’s the “why” that will make it happen. If that why isn’t strong enough and a center value in your birth planning, I think it’s harder to accomplish.

If you want the epidural, 1000% already decided, I still think it’s helpful to listen to this information so you know how to best use the epidural as a tool for your labor and limit any possible risks to you or baby. 

Let’s start by talking about what an epidural is and a little bit about the procedure. So, an epidural is the most common and most effective pain management tool that can be used during childbirth. In the U.S., depending on the study you read, it is estimated that 70-90% of women in the hospital setting use epidurals during labor. If you are familiar with how an IV is placed in your arm, it’s a similar procedure but in your back. A needle is used to locate the area, a small flexible tube or catheter is placed, the needle is removed, and the catheter is taped and secured in place to then be a place for medication administration. 

The epidural space is what the anesthesiologist or certified registered nurse anesthetist, CRNA will be focusing on and where they will place the catheter for the epidural. From the time you request the epidural, to the time the anesthesiologist or CRNA walks into your room can be anywhere from a few minutes to an hour usually. So know this ahead of time when you’re planning your pain management. You will need IV fluids to help maintain your blood pressure during the procedure so many providers will wait for that to be given to you before they start the procedure. And that can take some time to set up. So just a heads up there.

When the provider is finally in your room, the epidural setup takes about 10 minutes and the actual procedure can last about 10 minutes, maybe a little more. Your nurse will help you sit on the edge of the bed, rest your feet on a stool for support, and curl over a pillow or lean on your support person. Having the worst slouching posture of your life and sticking your back out like a cat will help to open up your epidural space and make it a bit easier to place the epidural, so follow cues around that.  

At the same time as you’re getting set up, blood pressure will be placed on your arm with a device on your finger or toe to measure your oxygen levels during the procedure, your doctor will be setting up the epidural supplies, maybe washing off your back to sterilize everything in between contractions. They are really good about communicating what they are doing the whole time because you aren’t able to see what is going on, and then you are able to communicate back to them when you feel a contraction starting to allow them to pause. Your nurse will help with this too.

Then you’ll feel a bee sting like pain for about 10 seconds which is the lidocaine to numb part of your back up so you don’t feel pain from the needle poke. When the lidocaine is effective, the needle will be inserted for the epidural procedure and that small flexible catheter tubing I was talking about is threaded through, and the needle is taken out. The catheter stays in your back until after delivery so you are able to have a continuous flow of medication throughout your labor, as long as you want. The medication is typically a mix of local anesthesia and opioids, which work together to block pain signals from reaching your brain and is very effective at providing very good pain relief in as little as 10 minutes or so.

As far as when you’re “allowed” to get an epidural, that is up to you honestly. I’ll briefly mention that I have been in situations where midwives “don’t let” their patient get an epidural until active labor aka dilated to 6cm, so they are in a good labor pattern… and even though I can see the good intention here of wanting to limit intervention and help labor progress, only you can know when it’s the right time to make this choice.

To give you the full spectrum of when to request an epidural… some women choose to get an epidural before their induction is started and they are 0cm dilated and some women are 10 cm and have been pushing and decide they would like the epidural. As long as you can sit still for the procedure and aren’t actively delivering your baby, it is usually still possible to get you an epidural. In the case of needing shorter pain management coverage, it would be a spinal epidural where an injection of medication is given into your back, rather than a catheter with a continuous flow of medication, but I won’t go into the different types of epidurals, you can ask your provider though what your options are if you’re curious!

Let’s next talk about the risks and benefits of labor epidurals.

Epidurals are the most effective form of pain relief, which is why they are so popular, because women can often have a labor experience without feeling their contraction pain. It can also be used as a tool for exhausted mothers to rest and is a safer alternative to IV pain medication for baby, because even though a small amount of medication might reach the baby from the epidural, it is much less. Many moms enjoy the comfort and feeling of control in the situation of labor and birth, rather than surrendering to the out of body experience that can be childbirth as well. Everyone experiences it differently.

As far as risks, there is a bit of a list I can talk about. Think about with an epidural you will be laying on your back or at least in the bed with limited movement right? This can lead to a longer pushing stage, often the use of pitocin to speed labor progress, increased risk of forceps or vacuum at delivery, and increased perineal tearing. The medication that is given through the epidural can also lower your blood pressure causing nausea and lightheadedness, which leads to more IV fluids and potentially other meds to help manage what is going on. The drop in blood pressure can also limit oxygen going to the baby and cause fetal distress. Other side effects are the loss of bladder control, so it’s standard to place a urinary catheter for that, maternal fever is common, itchy skin, and nausea are the more common ones. More rarely women can get a spinal headache requiring treatment, slowed breathing and sleepiness, infection where the needle was inserted, sore back, and nerve damage.

You can see that medical cascade of intervention begins as soon as you request the epidural. So many things are going on at the same time, you’re being attached to a blood pressure cuff, continuous oxygen monitoring, continuous monitors on baby, IV fluids, pitocin, urinary catheter, increased instrumental delivery and tearing… just can be one thing after another.

And when I say “can”, it doesn’t have to be this way. There are ways to support moms with epidurals to limit intervention, but you have to be prepared ahead of time to make it happen!

Next, let’s talk about how epidurals can affect your labor progress, like slowing labor down you might have heard.

And to answer this, I think it’s really important to understand that epidurals definitely affect labor and the dynamics of your hormonal response and ability to move, they typically do not make the first stage of labor longer, and that is remember the phase where your cervix is dilating from 0 to 10 centimeters. Regardless if someone wants an epidural or not, this first stage is usually pretty consistent.

But, the difference can be seen in the second stage of labor, particularly the pushing phase, after you are completely dilated at 10 centimeters. It has been shown that the second stage of labor tends to be longer for women who get an epidural compared to women who haven’t. On average, the second stage is about 13 minutes longer with an epidural, and can be due to a few different things including a decrease in the effectiveness of your contractions, leading to less coordinated or effective pushing efforts. Epidurals can also relax the pelvic floor muscles and change the way the baby is able to descend or move down through the birth canal and rotate for delivery.

And the difference isn’t harmful in itself, but prolonged pushing can come with additional risks such as infections, severe perineal tearing, postpartum hemorrhage, and the need for assistance at delivery like forceps or vacuum extraction, or a c-section.

And actually about c-sections, I did want to mention another concern about epidurals which is the association with an increased risk of c-section. There used to be a thought that the overall rate of c-sections is similar for women who receive epidurals compared to those who don’t, but the chance of needing those interventions like vacuum or forceps is increased as well as the incidence of c-section. 

interventions during delivery, such as the use of forceps or vacuum extraction, does tend to be higher among women who have received epidurals. This distinction is essential for expectant mothers to understand when making informed decisions about pain management options during labor.

The last thing I want to talk about today is the effects of an epidural on your baby and breastfeeding if you choose.

It’s important to understand that yes, epidurals are considered safe and babies born to mothers who have gotten an epidural typically have equal APGAR scores compared to those who are born to mothers without epidurals. And if you aren’t familiar with an APGAR score, this is a quick assessment that is done at 1 and 5 minutes after birth as an evaluation to how well your baby is doing transitioning to being born, looking at heart rate, breathing, muscle tone, reflexes, and skin color. So this in itself is very reassuring.

There are some other things to consider too though about how an epidural might impact your newborn, particularly regarding breastfeeding. Epidural medication can cross the placenta and enter the newborn’s circulation, possibly affecting their ability to latch and suck effectively. Also, maternal fever, which can sometimes be a side effect of epidurals, has been linked to lower APGAR scores in newborns.

Another way epidurals impact birth and newborns is influencing hormonal responses during labor, including your natural oxytocin levels. We’ve talked about oxytocin before, but it is a hormone that your body makes that is important in labor progress and stimulating contractions, but also for breastfeeding. And when oxytocin is affected or limited with the use of an epidural, you may notice decreased milk production initially. So something to be aware of for sure, and maybe even a reason to consider collecting colostrum during pregnancy, starting at about 36 weeks if it’s safe for you to do so, so you have a backup method of feeding baby if it takes some time for your milk to come in. 

And then a few other things to mention that many people don’t consider being related to epidurals, is that with the higher risk of forceps or vacuum use, this can lead to longer repair times that can then delay skin-to-skin contact and that initiation of breastfeeding. With this being known though, I didn’t also want you to know that you can have skin-to-skin with your baby while you are being repaired if it’s comfortable for you and you feel safe holding baby. Or maybe baby is skin-to-skin with you as your partner helps support baby as well. I know for me, I had a repair with my first that took over an hour and nobody offered for me to see or hold my baby, and I didn’t even think to ask which is heartbreaking for me to look back on now. So please know that as long as baby is well and you are well and able to hold baby, you should absolutely be able to do so.

And the last part I wanted to mention about breastfeeding and epidurals is that when you get an epidural, you will be given additional IV fluids, which we talked about before, but there's a few things to know here. IV fluids can lead to painful engorgement of the breasts postpartum, potentially impacting breastfeeding initiation in those first few days. The additional fluids in labor can also result in an initial increase in baby’s first weight, and they may seem heavier due to fluid retention, but then when they are weighed later on in the hospital they will have greater weight loss that what is typically expected because of that skewed first weight due to the fluids. With a greater weight loss, there may be a recommendation from the pediatrician to supplement with formula, which isn’t always necessary, it is sometimes just a precaution, which would then could interfere with your breastfeeding goals. So know this ahead of time, I even encourage moms to meet prenatally with a lactation consultant, and formulate a feeding plan and goals that work for you and your family.

Thank you so much for tuning in to Your Birth Bestie today, and I hope it helped you understand a bit more about epidurals. The most important thing is that you are informed and prepared going into your birth and have a pain management plan you are comfortable with. If you are really not wanting an epidural, but aren’t sure how to go about preparing for that, I would first suggest you find reasons why you do not want an epidural and have a really strong “why” to reflect on during your pregnancy and then come back to during labor to keep you moving forward in this goal. I also think it’s beneficial to have a doula and/or solid birth support team to guide you through your unmedicated birth. 

Regardless of your pain management plan, I would love to share my resources with you rooted in informed decision making, mindset, and autonomy, so you feel 100% prepared going into the hospital to have your baby and your support person feels confident supporting you as well. 

You can find me on instagram @bethconnors_cnm and shoot me a message with additional questions or comments, and if you’re looking for more information about pregnancy and childbirth preparation, I invite you to check out my online birth course, Fearless Birth Academy, at bethconnors.com/birthcourse. Thank you again for being here and I will see you back here next Tuesday, bye everyone!