So, you are considering getting an epidural when you’re in labor. Awesome! Our doulas are experienced in supporting women choosing an epidural (in addition to supporting “unmedicated” deliveries). We think epidurals can be a fantastic tool to help you feel more comfortable and enable you to get the rest that you need. After discussing common misconceptions about epidurals, we felt it important to put together a list of the top four “What I Wish I Knew Before Getting My Epidural” points to help you prepare for your epidural.

What I Wish I Knew Before Getting my Epidural

Sometimes it doesn’t work

Say what? No, that’s not a typo. Sometimes epidurals don’t work or don’t work fully. It’s definitely important to know this is a possibility. But why? Well, your anesthesiologist places the epidural catheter by assessing landmarks on your body and by feel of the tissues; they are not able to visualize the pathway from your skin to the epidural space of your spinal column. It is possible that the initial placement of the catheter may be a little “off”. What do we mean by that? Well it could be a little off center or not as deep as one would like. This doesn’t mean the anesthesiologist didn’t know what he was doing – the anatomy of your neuraxial space may have a slight deviation, as just one example. It is also possible for the catheter to migrate after it is placed.

After you get your epidural your anesthesiologist will want you to lie flat (not on either side) to allow the medication the opportunity to evenly distribute to both sides. The vast majority of the time this happens as intended. But sometimes it doesn’t and you may be more numb on one side than on the other.

Epidurals can cause your blood pressure to drop

Anesthesiologists expect this when placing an epidural as it is the body’s normal response to epidural anesthesia. Before your anesthesiologist will administer your epidural they will insist you receive at least one liter of IV fluid. This prophylactic measure helps increase your blood volume, counteracting the expected drop in blood pressure.

But why do anesthesiologists expect your blood pressure to drop? Epidurals block the sympathetic nervous system (SNS) (which is how they prevent you from feeling pain). Blocking the SNS causes your arteries and veins to dilate or expand. When this happens you have a functional drop in blood volume (meaning that your normal blood volume now takes up less space in the arteries and veins and does not exert the same pressure on these vessels it usually would).

You may get a severe headache

Post dural puncture headaches usually present within 48-72 hours after administration of the epidural and effect roughly 1 in every 200 individuals. These headaches are caused by too much fluid leaking into the dura, resulting in a decrease in the pressure of the fluid around the brain. How will you know you have an “epidural headache”? Well, it will get worse when you’re sitting or standing and will drastically improve when you lay flat. The good news is there is a very effective cure – a blood patch. This procedure involves taking your own blood and inserting it into the same space where the epidural was originally placed.

You won’t be able to get out of bed

Once your epidural is places you will loose most of the feeling in your legs. Because of this you will not be able to get out of bed. In a way this is good because it forces you to rest so you have more energy when it is time to push. But it can also be very boring or make you feel like you’re not “doing anything”. When our clients get epidurals, after they are cleared to move around in bed, we help them to shift onto one side and get comfortable. This usually involves putting pillows or a peanut ball between your legs to help keep your pelvis open. Why? What this does is helps your body make progress. Opening your pelvic outlet puts baby lower down, meaning baby can make better contact with your cervix during contractions. Better contact means more dilation and effacement with each contraction. We will help you rotate every 30-45ish minutes.

Because you cannot get out of bed, it is not uncommon that a foley catheter may be placed so you can void your bladder. You won’t feel the urge to urinate once you’ve received your epidural so this is important not only for your comfort and to prevent you from wetting the bed, but it also allows more room in your lower pelvis for baby to descend.

We hope this blog was helpful. What did you wish you knew before getting your epidural? Let us know in the comments.

Additional Resources/Readings

Why Epidurals Do Not Always Work
Epidural Anesthesia, Hypotension, and Changes in Intravascular Volume
Headache after an epidural or spinal anaesthetic
Epidural Blood Patch

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