Vaginal birth

• Most women give birth through the vagina (birth canal).
• Labor occurs in three stages and feels unique to everyone.
• If you’re healthy, wait for labor to begin on its own.

When it comes to managing labor pain, some expecting moms prefer to deal with the pain of childbirth naturally, using breathing and relaxation techniques. Others decide to use pain medication to help manage labor pain. One option for pain medication during labor is an epidural block (or epidural). It's among the most effective methods of pain relief during labor.

How it works

• An epidural can be given during active labor or just before a cesarean section.
• The woman is given an injection in the lower back, which numbs her lower body.
• The medication blocks pain from contractions while the woman is awake and alert.

How it's given

• Before giving you the injection, the health provider numbs your lower back with a local anesthetic.
• While you are sitting or lying on your side with your back curved outward, the health provider inserts the needle for the epidural.
• The health provider then passes a small flexible tube (catheter) through the needle.
• You will probably feel some pressure as the needle is inserted, but it usually isn't painful.
• The needle is then removed. The tube remains in place so you can receive more medication as needed.

How it affects you

• An epidural takes about 20 minutes to be given and another 20 minutes to take effect.
• Although an epidural block makes you more comfortable, you may still be aware of contractions. You also may feel your health provider's examinations as labor progresses.
• Depending on how much pain relief you need, the epidural can block pain in your lower body or just change your awareness of the pain.
• The epidural may cause temporary numbness or heaviness or weakness in the legs. So you probably won't be able to walk around once the epidural takes effect.
• You can also get a "walking epidural." This provides pain relief, but leaves you with enough strength in your leg muscles to walk during labor.

Pros

• The epidural blocks pain in the lower body without significantly slowing labor.
• It can be used throughout labor and for several hours.
• You remain awake and alert.
• You can receive a walking epidural, so you can walk around during labor.
• An epidural usually has little or no effect on the baby.

Cons

• An epidural may provide uneven pain relief, affecting one side of the body more than the other.
• Your blood pressure can drop during an epidural. This may affect your baby's heartbeat. To prevent this, you’ll receive extra fluids through an intravenous (IV) tube. Lying on your side can improve blood flow.
• You may feel some soreness from the epidural injection after delivery. It may last a few days. But an epidural should not cause long-term back pain.
• If too much medication is given, it can affect your chest muscles. You may temporarily have trouble breathing. This happens rarely.
• In very rare instances, you may get a bad headache. If not treated, this "spinal headache" may last for days.

Changing your mind about pain medication
Labor pain affects each woman differently. Some women have mild discomfort. Others experience intense pain.

If you try natural childbirth, you may think about using medication for pain after your labor has begun. It's okay to change your mind. Don't feel like you gave up or let your baby down. Only you know how strong the pain feels. It's okay to talk with your provider about medication and to do what you think is best.

October 2009