An epidural is a common and effective method used for pain management during labor, providing significant relief from the intense pain of uterine contractions. A frequent concern for individuals considering this option is whether they will still be able to sense the contractions, even if the pain is gone. The primary goal of an epidural is to remove the painful sensation while allowing the body’s natural processes of labor to continue.
How Epidurals Block Contraction Pain
The epidural procedure involves inserting a fine, flexible catheter into the epidural space in the lower back. This space lies just outside the membrane surrounding the spinal cord and the nerves that branch off it. A continuous flow of medication, typically a combination of a local anesthetic and an opioid, is delivered through this catheter.
The local anesthetic blocks the transmission of electrical signals through the nerve fibers that carry pain messages from the contracting uterus and dilating cervix. By bathing the spinal nerve roots in this medication, the epidural effectively interrupts the pain pathway. This targeted delivery blunts pain sensation across the abdomen and pelvis without causing a complete loss of consciousness.
Differentiating Pressure from Pain
While the sharp, severe pain associated with contractions is usually eliminated, the physical sensation of the uterus tightening often remains. The epidural blocks the smaller nerve fibers responsible for transmitting pain signals, but may leave the larger nerve fibers that transmit sensations like pressure, touch, and movement relatively unaffected.
This remaining sensation is often described as a strong feeling of pressure or tightness across the abdomen, pelvis, or rectum. This pressure results from the uterine muscle physically contracting and the baby descending down the birth canal. Feeling this pressure provides awareness of the contraction’s peak and duration, which aids in timing pushing efforts later in labor.
Reasons for Unexpected Sensation
Even when an epidural is working correctly, some individuals may experience a stronger-than-expected sensation, often called breakthrough pain. One common cause is an incomplete or “patchy” block, where the medication does not spread evenly across all the necessary nerve roots. This can lead to feeling pain on only one side of the body or in a specific area, such as the back or hip.
Another factor is the subtle movement or migration of the epidural catheter from its optimal position. If the catheter shifts, the medication may be delivered less effectively, resulting in reduced pain relief. Certain patient characteristics, such as being a first-time mother or having a heavier fetal weight, are also associated with a higher likelihood of breakthrough pain. In these situations, the care team can often adjust the medication dosage or reposition the catheter to restore adequate relief.
Managing Labor and Pushing
The altered sensation caused by the epidural means the intense, natural urge to push, often triggered by the baby’s head pressing on the pelvic floor, may be significantly dulled or absent. Healthcare providers account for this by using different strategies during the second stage of labor to ensure effective pushing efforts without strong sensory cues.
One common approach is “laboring down,” or delayed pushing, where the mother rests after reaching full dilation, allowing contractions to passively move the baby further down the birth canal. When it is time to push, the medical team provides directed coaching, guiding the mother to push during a contraction based on external monitoring of the uterus. They may also rely on any remaining pressure or fullness the mother feels, using it as feedback to coordinate her efforts.