The use of an epidural is a common method for managing pain during childbirth, offering significant relief for birthing people. Despite its effectiveness in blocking painful sensations, a frequent question remains about what a person will still feel during the actual delivery. The goal of an epidural is not to eliminate all sensation, but rather to intercept intense pain signals, allowing for a more comfortable and controlled delivery experience. Understanding the mechanism helps to clarify the sensations that persist through the final stages of labor.
How Epidurals Target Labor Pain
An epidural works by delivering pain-relieving medication directly into the epidural space, a small area just outside the membrane that surrounds the spinal cord. A thin, flexible catheter is placed in the lower back, and through this tube, a mixture of local anesthetic and often a small dose of opioid is continuously administered. This combination targets the nerve roots as they exit the spinal cord, specifically those that transmit pain signals from the uterus, cervix, and lower pelvis.
The medication reduces the transmission of pain signals before they can reach the brain, providing analgesia to the lower half of the body. Local anesthetic components, such as bupivacaine or ropivacaine, block the nerve impulses responsible for sensation. The opioid component helps to blunt the pain without significantly impacting the ability to move. This targeted approach aims to provide effective pain relief while maintaining some motor function. Modern techniques often use more dilute concentrations of medication, which further minimizes the motor block.
What Sensations Are Blocked During Delivery
The primary goal of the epidural is to eliminate the sharp, intense pain associated with uterine contractions and the baby’s descent. The medication effectively blocks nociceptive signals, meaning acute pain and cramping are significantly reduced or vanish entirely. This relief is especially noticeable during the transition phase and the second stage of labor, which involves the most forceful contractions.
The epidural also typically prevents the intense burning or stinging sensation often referred to as the “ring of fire,” which occurs as the baby’s head stretches the perineal tissue. This sharp, somatic pain is usually covered by the effective spread of the epidural medication. A well-placed epidural ensures that the experience of pain is replaced with a manageable level of pressure or simply the feeling of contractions without the associated agony.
The Pressure and Movement You May Still Feel
Even with an effective epidural, the birthing person will still experience profound physical sensations, most notably the feeling of deep, unrelenting pressure. This pressure sensation is distinct from pain and is caused by the baby’s head moving down and pressing intensely on the pelvic floor and the rectum. This deep, visceral pressure is often described as feeling like the need to have a bowel movement, and it is a positive sign of the baby’s progression.
This sensation of pressure is transmitted by different nerve fibers than those that carry pain signals, and these fibers are less susceptible to the effects of the local anesthetic. The descending baby also causes a noticeable feeling of movement and stretching within the pelvis and vagina. While the sharp pain is gone, the physical displacement and stretching of tissues create a strong, dull pushing sensation that provides important feedback.
The involuntary, reflexive urge to push, which is triggered by the baby’s head pressing on the nerves and muscles of the pelvic floor, often remains intact. This natural impulse is helpful for guiding the birthing person’s efforts during the pushing stage. Feeling this deep pressure helps a person effectively direct their energy, making the pushing more productive and controlled.
Managing Epidural Levels During Pushing
The level of medication delivered through the epidural catheter is strategically managed by the anesthesiology team as the birthing person enters the second stage of labor. A common approach involves aiming for a “lighter” block during the pushing phase to allow enough sensory feedback for effective bearing down. This balance is achieved by using lower concentrations of the local anesthetic, often combined with an opioid, which provides pain relief while preserving some motor and sensory function.
This adjustment helps ensure that the birthing person can feel the necessary pressure cues without experiencing a return of significant pain. Many modern systems use Patient-Controlled Epidural Analgesia (PCEA), which allows the patient to administer a small, controlled bolus of medication when needed. The medical team continuously monitors the effectiveness of the block and can adjust the continuous infusion rate or the concentration of the medication to optimize the experience.