1. As always, know what to expect.
Talk with your care providers, your doula, and/or other women who have birthed in the same place as you. Figure out what their normal routines and procedures are. They vary between hospital to hospital. But, in a general sense, this is what you can expect. When you request the epidural for yourself, your nurse will need to get the anesthesiologist. The anesthesiologist isn't always readily available, so be aware that you may not get the relief of the epidural the moment you ask for it. Sometimes, if you ask your nurses what the anesthesiologist's schedule looks like, they may be able to give you a general idea of when to get the epidural. Something like "Well, she's available right now, but if you want to hold off for a little while, she may not be back for another hour or so since she will be in two more procedures."
First, you'll be hooked up to IV fluids (if you haven't already). Once you get the anesthesiologist in your room, he/she will instruct you to sit perfectly still. I know. You're in labor. That's nearly impossible. But they're pretty good at guiding you through the experience and moving quickly in-between contractions. The best thing you can do is relax, stay perfectly still, and breathe deeply. It may hurt more if you're tense.
Your mid to lower-back will be sterilized with an antiseptic, and you may be given a small local anesthetic to numb the area. You may be asked to lie on your side or to bend over and sometimes bring your knees up to curl your body around your belly. Then, a longer needle will be placed into the epidural space in your spine. The needle is then removed and leaves a thin catheter in place, which is what the drug will be delivered. The catheter is taped to your back so that it doesn't move out of place. Some people describe this as quite painful and others say it wasn't so bad. The key is to relax.
After just a few moments, the nerve endings will begin to numb and most people who experience 100% pain relief will report it by 10-15 minutes. A urinary catheter will likely be placed shortly after the epidural.
2. Decide if you want one early on or later BEFORE you get to the hospital.
The reason why I wouldn't just "wing it" is because you may get too many conflicting opinions when you get there. One nurse may say to go ahead and get your epidural if you know you want one. Your partner may say to hold off as long as you can. And your mother in law might tell you to do whatever the nurse says. You're in labor, so it's really difficult to think critically--and you shouldn't have to! If you have a plan before you go, you can work toward those goals. And if plans need to change, such is life.
When I polled friends, family, and clients about their epidural experiences, I was told by so many people not to wait and to get it right away! And then an equal amount told me that they would either wait as long as possible or not get it again at all! So, you have to decide what is right for you and figure out why you're making those decisions.
3. Learn the risks and benefits.
The benefit seems obvious: pain relief. But it can mean so much more! Believe it or not, this doula won't tell you that the epidural is the devil. If you've been in labor for 3 days, you may need the sleep more than you need the epidural! Or if you're becoming fearful and holding lots of tension in your body and having a difficult time relaxing into your contractions, an epidural may help you relax enough to open up and help your body do this hard work.
Understanding that there are risks is important too, and when I hear from people that they regret their epidurals, it's most often because they experienced some side effect or risk that they either weren't aware of or didn't expect that it would happen to them. This article provides an in-depth look at the evidence of risks for epidurals.
4. Take a quality childbirth education course.
The reality is--even if you want an epidural as soon as you arrive at the hospital, there will be time when you're laboring without one. The admission process itself often takes an hour or so. Sometimes labor moves so quickly that you're rushing out the door, and into a hospital bed, and a baby is ready to be born. Sometimes, the epidural doesn't work. Or it only works on one side of your body.
So, it's best to be as prepared as possible for any scenario. If you're on the Eastern Shore, we offer a class which is designed to give you the tools for moving through labor without an epidural. Women who are planning epidurals or are open to them still gain so much information and tips about what to expect and how to move through labor with or without an epidural in a judgement-free zone.
5. Hire a doula.
Bring someone who is educated on the process of labor, birth, epidurals, and everything in-between. For instance, did you know that you actually CAN still move with an epidural?! It's tricky, but it's possible. And research shows that labors are 50% shorter when the birthing woman alternates between upright and laying positions. A doula is trained to help you move around with all of those tubes and wires. And they're experienced in guiding you into positions that may be helpful for your labor to progress, all while helping to hold you up if you're numb. Knowing what to expect and having someone there to support you no matter what is invaluable. In the meantime, check out this article, which describes some of the common things that people don't expect with an epidural.
If you've had an epidural, do you have anything to add to this list?