Today we’re getting really into it. We’re talking labor pain & epidurals with my friend, & anesthesiologist, Nicole.
Nicole & I met at Delicias in Rancho Santa Fe when I was a bartender. Her brother Alex was one of my friends & a regular at the bar. Nicole joined him one day & I liked her immediately. What I really liked was how smart she was. Smart, sharp, focused & even though she was young at the time, I knew she was going to do big things.
So here we are. Obviously I have a bun in the oven, so I thought it would be fitting for her to come on & spew some realness. Today on The Skinny Confidential Nicole is sharing everything she knows about labor pain & epidurals. Yikes.
Without further ado, let’s welcome Nicole Andonian.
Hey Babes! I’m stoked to be on the blog today. Lauryn & I go way back from growing up in San Diego. Lauryn is a true hustler – I remember so many nights where my brother & I would go sit at the bar Lauryn bartended at, & she would pour us each a nice, heavy-handed pour of Cab Sauv, & we would just shoot the shit on life. The Skinny Confidential was just a little idea at that time. Fast-forward tenish years… Lauryn & Michael are killing it.
I went to medical school & am now an anesthesiology resident at UCLA. Since Lauryn has a bun in the oven, & I know tons of you are expecting or will be over the next few years, I wanted to share some common questions I get asked about epidurals & pain during labor.
♡ What should I expect from labor?
There are three stages of labor. The first starts with regular uterine contractions & ends when your cervix is fully dilated, at ten centimeters. The first stage is separated into latent & active phase as your contractions get closer together & stronger. The second stage starts when you are fully dilated & ends with delivery of the baby. This stage is where you feel a lot of pelvic pressure & the urge to push.
The third & final stage involves delivery of the placenta. There is a wide variety of how each one of us will perceive pain associated with labor. We all have seen the Kardashians episode where Kourtney is just chilling & pulls out her baby. Sorry babes, but that is not the norm! But she did look awfully comfortable & my guess is that is due to a good epidural.
♡ What is an epidural?
An epidural is when a trained doctor locates the space in your back, just outside the spinal cord, & places a catheter to give you medications that help with pain. Placement of an epidural catheter with a continuous infusion of medication usually results in minimal to moderate pain until after delivery. It is normal & expected to feel pressure, especially as the baby’s head gets lower in your pelvis & you feel the urge to push the baby out. The data is unclear if getting an epidural alone increases the amount of time in labor, but getting an epidural does not increase chances of needing a C-section.
♡ I’m scared! What are the risks of getting an epidural?
The side effects of epidurals include: a headache from something we call a dural puncture, low blood pressure, itching, nausea/vomiting, & shivering. Other relatively uncommon risks include being in the wrong space ( blood vessel, spinal cord ), infection, bleeding complications, nerve damage ( often reversible with time ), breathing problems, & abnormal heart rhythms. If your anesthesiologist thinks you aren’t a good candidate ( if you have bleeding problems or a history of surgery on your spine for example), the anesthesiologist will talk to you & offer you safer options.
♡ What can I expect during epidural placement? Will it hurt?
During the epidural, your nurse & doctor will monitor both you & the baby. You will also get some fluids via your IV. You will be sitting up, with your back curved into a C shape ( think of the shape of a shrimp ). The anesthesiologist will clean your back with a sterile solution. Next, we use lidocaine or a similar medication to numb your skin & back. Most women say this is the worst part & feels like a little bee sting, similar to getting dental work done. After that, you will feel pressure until the anesthesiologist finds the exact right space in your back. The catheter will be threaded into your back and taped into place. Don’t worry, no needle will be left in your back and you can & should lie on your back!
♡ What can I expect after the epidural is placed?
You lay pretty flat for the first fifteen minutes after placement of the epidural to allow the medicine to spread evenly. The nurse will be taking blood pressures often during this time. Gradually, your legs will feel heavy & numb but you should still be able to move them. Think of the feeling when your legs go to sleep. Most often, although there are exceptions, you will not be able to walk around or get out of bed until after delivery & the epidural is turned off. This also means the nurse will likely insert a Foley catheter to help drain your bladder ( sounds miz I know, but fortunately you will be nice & numb down there & shouldn’t feel much ).
♡ What is this walking epidural thing I hear about?
“Walking” epidural is an option if you think you want to stay mobile during delivery. A lower concentration of medicine is used, which can result in a more painful labor. Although this is talked about a lot, I don’t see it used much!
♡ What effects does the epidural have on the baby?
Usually none at all! There is a very, very small chance that the baby’s heart rate will be slower during labor & the baby will be slower to breathe after delivery but most of the time the epidural medications are very safe & have minimal to no adverse effect on the baby.
♡ When is the best time to get my epidural?
Technically, the “ideal” time to ask for your epidural is when your cervix is 4-5 cm dilated. But getting it earlier does not necessarily increase complication rates with delivery! Many moms receive a medicine called oxytocin ( or Pitocin ) that causes an increase in contractions that are more painful & may make you want an epidural earlier.
♡ How about if I wait too long to get an epidural?
The only time that is “too late” to get an epidural is if you are on the brink of delivering that new bundle of joy. When that baby is coming, there is no stopping the little guy/girl. But typically, as long as you can sit still through contractions, a trained anesthesiologist should be able to get you an epidural. The only caveat is that between placing & activating the epidural, it can take up to 20 minutes to kick in, which if you are too close to delivery won’t be helpful for you. This is especially true if this isn’t your first baby since labor moves MUCH faster!
♡ What if I am in a lot of pain even after I get the epidural?
Sorry babes, that is never fun but it does happen on occasion. It could be that the epidural is in the wrong place, moved, or you aren’t getting enough medicine. Sometimes the baby can be facing in a certain direction that can cause some pressure that an epidural can’t help with.
Always let your nurse know what you are feeling & they can call the anesthesiologist for you to troubleshoot. If we think it’s not working at all, there is always the option to take it out & replace it completely.
♡ What are some non-pharmaceutical options to help me get through the pain?
There are always options other than medicine! These include nitrous oxide, use of IV pain medications, massage, use of heat or cold, hydrotherapy, acupuncture, relaxation training ( Lamanze classes ), etc.
♡ How long will it take for the epidural to wear off?
The epidural is usually turned off right after you deliver ( & after any potential tears or lacerations are repaired ). It wears off gradually. Usually in about 2-4 hours you should start feeling back to normal.
I hope this was helpful for all you mamas-to-be! You got this, women have been doing this for years & years. Women are bad-ass. We are tougher than men, which is why we were picked to do this! If you ladies have any other questions at all, I am here for you. XOXO
Hope you guys found some value in this post. I sure did. What am I in for ???
+ scope how to get a pregnancy glow without the pregnancy.
++ check out Dr. Michelle Braude’s tips for healthy eating here.