Not That You Need Another Reason To Be Frightened Of Childbirth, But We Just Learned How An Epidural Is Administered, And It's A Lot More Than Just A Shot
TikTok user @z00mie recently caught the attention of over 17 million people after she shared a TikTok stating that she just discovered that an epidural is not a shot administered by a long needle as some may have seen depicted. In fact, it's a small, flexible catheter that is threaded down into the space where the initial needle made contact and the needle is then removed.
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Right away, it was apparent that lots of people did not know this information.
And why would they? I mean, it's not like the school system (or a lot of our doctors ??) is teaching us these things.
So today, let's go over what an epidural actually is and how exactly it is administered, with helpful information provided by Dr. Mary Jane Minkin, who is a clinical professor of obstetrics, gynecology, and reproductive sciences at Yale University School of Medicine and founder of MadameOvary.com.
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Dr. Minkin has also delivered hundreds of babies throughout her career.
First of all, an epidural is an injection in your back to stop you from feeling pain in part of your body. And even though epidurals are most commonly used during childbirth, they can also be given during orthopedic surgery of any lower extremity and/or to help with managing chronic pain.
For the purposes of this article, however, we are just going to refer to epidurals used during childbirth. "We can administer the epidural right away, as long as the person is in good labor and contracting well. If they're not in solid labor, an epidural can slow things down, so they might have to wait," Minkin said.
When you're ready to receive your epidural, your healthcare provider will have you either sit forward, arching your back and hugging your knees, or they will have you roll over on your side, lying in a fetal position.
Next, the skin on your lower back will be numbed and a needle will be inserted — this is where the needle idea comes from, because a needle IS involved, but promptly removed. The needle goes into the space around your spine and once the needle is in that space, a small, flexible catheter is threaded down into it and the needle is removed. The catheter is hooked up to a pump that constantly gives you a very small amount of anesthetic to keep you numb from the waist down.
"Labor epidurals take away the pain fibers that come in toward your spine and up to your head without blocking the motor activity and contractions in the uterus. Basically, the nerves from the whole body go out from the spinal cord. But there is an area around the spinal cord, which are membranes that contain fluid — spinal fluid. The nerves pass through this space, which is the epidural space. So, in an epidural, you are introducing a catheter, which is like an IV in a sense, that you'll inject medicine through which will hit those nerves that are going out from the spine. You're trying to bathe those nerves in an anesthetic agent to make them numb," Minkin explained.
One thing Minkin said most people are nervous about when it comes to epidurals is thinking a needle is going into their spine. But the needle is not going directly into your spine, it is going into the fluid around your spine and it is also removed. I'm not going to lie and tell you the needle is small, though, because it's not. It's usually three and a half to five inches long.
If there aren't any complications, the whole process of getting an epidural should take less than 15 minutes. It kicks in fairly quickly and you may feel pressure from it, but not intense pain. Minkin said labor pains after getting an epidural will typically go from about an 8 or 9 to a 1 on the pain scale!
However, after an epidural, some people may get so numb that they have trouble pushing. "Sometimes, we let an epidural lighten up so the woman can feel more to push better. We don't let it wear off altogether, but we let it wear off a bit so she can feel where she's pushing because she may not be pushing effectively."
The epidural usually wears off after a couple of hours, but because you won't be able to stand or use the restroom while you're numb, some people need a urinary catheter. Minkin said those are given on a case-by-case basis, and if you do need one, you won't feel it being inserted because you'll be numb (thanks to the epidural).
The actual epidural catheter is typically removed shortly after you deliver the baby, and the urinary catheter will be removed when you regain feeling again.
Now, if you're in labor and have an epidural but need an emergency C-section, Minkin said the procedure can be done under the epidural and the person usually doesn't need another anesthetic. However, if someone is coming in with a scheduled C-section, they will likely get a spinal block instead of an epidural. "A spinal anesthetic actually works a little more quickly and gives the person a denser block, which provides more pain relief in their belly," Minkin said.
You can read more about how a spinal block is different from an epidural here.
Overall, an epidural is a pretty safe procedure, but it does have some risks. "The major medical problem we see with epidurals is blood pressure falling. Epidurals relax a lot of stuff — and that's a good thing — but they can also relax your blood vessels, so we have to pay attention to your blood pressure. One precautionary thing we do is always have an intravenous (IV fluids) to minimize the chances of the person's blood pressure going down," she said.
"Another major risk is if the epidural gets into the space directly next to the spinal cord. If this happens, you might, unfortunately, develop a leak of some of that fluid, which causes headaches for several days. The instance of paralysis is extraordinarily rare. I've never seen a case or heard of a case, but it could happen," Minkin concluded.