An epidural is a form of regional anesthetic commonly used during labor to manage pain. This procedure involves placing a thin, flexible tube, called a catheter, into the epidural space in the lower back, the area surrounding the spinal nerves. Pain-relieving medications, typically a combination of a local anesthetic and an opioid, are continuously delivered through this catheter to block nerve impulses from the lower spinal segments. The goal is effective pain relief from contractions and delivery, allowing the birthing person to remain awake and alert.
Administering the Epidural and Initial Sensation
The process begins with the patient sitting up or lying on their side for the anesthesiologist to access the lower back. The area is cleaned with an antiseptic solution before a small injection of local anesthetic is given to numb the skin. This initial injection is often described as a momentary, sharp sting or burning sensation, similar to getting an intravenous (IV) line started.
Once the skin is numb, a needle is inserted into the epidural space, through which the catheter is threaded. Patients typically feel pressure during this deep insertion rather than pain, and remaining still is important for proper placement. After the catheter is secured and the needle is removed, the medication begins to flow, and the full effect of pain relief sets in within 10 to 20 minutes.
Understanding Labor Sensations With an Epidural
An epidural is highly effective, reducing labor pain scores significantly, frequently from a 10 out of 10 down to a 0 or 2. However, the goal is pain relief, not total numbness, meaning some sensation remains. The sharp, debilitating pain of contractions is typically eliminated, but a feeling of intense pressure, tightening, or dull aching may persist.
This remaining sensation is the feeling of the baby descending through the birth canal, especially during the second stage of labor. Many modern epidurals use lower concentrations of medication, sometimes referred to as a “walking epidural,” which aim to blunt the pain while preserving some motor function and the ability to feel the pressure needed for effective pushing. Feeling this pressure can be helpful for the birthing person to coordinate their efforts, though the urge to push may be muted compared to an unmedicated birth.
Non-Contraction Related Discomforts
While the epidural relieves labor pain, it can introduce other physical discomforts or side effects. A common consequence is a drop in blood pressure, known as hypotension, which requires intravenous fluids to be started before the procedure. The medications used, particularly the opioids, can also cause itching (pruritus) or shivering and chills.
Because the epidural numbs the lower body, it can interfere with the sensation of needing to urinate, necessitating the placement of a urinary catheter for the duration of the block. Some individuals may experience back pain or soreness concentrated at the injection site, which typically resolves within a few days. Rarely, a complication known as a post-dural puncture headache (PDPH) can occur if the needle punctures the dura mater, causing a cerebrospinal fluid leak.
Immediate Postpartum Pain and Recovery
After delivery, the continuous infusion of medication is stopped, and the catheter is removed. The pain relief does not stop instantly but wears off gradually over a few hours as the remaining medication is metabolized by the body. During this transition, the severe pain of labor does not return.
As sensation returns, the patient will begin to feel postpartum discomforts. This includes uterine cramping, the sensation of the uterus contracting to return to its pre-pregnancy size (involution). Perineal pain and soreness from the birth or any necessary repairs also become noticeable as the numbing effect fades. This pain is typically managed with standard oral pain relievers, such as ibuprofen or acetaminophen, rather than requiring the epidural to be re-started.