Welcome to another episode designed specifically for all the expecting moms out there. Today, we're diving deep into a topic that's often shrouded in myths and misconceptions: Epidurals.
With the help of my long time experience as a labor and delivery nurse, I aim to arm you with all the information you need to make empowered choices for your birthing experience.
What's Inside this Episode:
- What is an Epidural?: Understand the medical science behind epidurals and how they can impact your labor.
- The Best Timing for an Epidural: Get the lowdown on when you should consider getting an epidural for a seamless labor experience.
- The Epidural Placement Process: Know what to expect during the actual procedure and pick up some relaxation techniques to ease the process.
- Types of Epidurals: From ‘walking epidurals' to standard ones, explore the options that best suit your labor goals.
- Pros and Cons of Epidurals: Navigate the benefits and risks, and learn how to discuss them effectively with your healthcare provider.
Resources & Extras
- Epidural Empowerment Kit: Comment ‘#Epidural' on our latest Instagram post to get your hands on this invaluable resource filled with FAQs, checklists, and practical tips. or click this link:
- Questions to Ask Your Provider: Don't miss our bonus list in our toolkit where we share essential questions to discuss with your healthcare provider, ensuring you make an informed choice.
Making decisions about your birth plan can be daunting, but knowledge is power. This episode is designed to provide comprehensive insights into epidurals, helping you take control of your labor and birthing experience.
Connect with Us
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Connect w/ Trish:
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Next Steps with LNM:
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Remember, my advice is not medical advice. Always discuss what you learn with your team. See my Disclaimer here! Also, We make a small commission from some of the links (you don’t pay any more for using our links); however some of the recommendations, we do not earn anything; we love ’em and want you to know about them.
Trish: [00:00:00] My name is Trish Ware and I am obsessed with all things pregnancy and birth and helping you to navigate with the practical and the magical seasons of this journey called motherhood. I'm an all day coffee sippin mama of seven. I've had the amazing privilege of delivering many babies. And my 15 plus year career as a labor and delivery nurse, and as a mama of seven, I'm here to help you take the guesswork out of childbirth so you can make the choices that are right for you and your baby.
Quick note, this podcast is for educational purposes only and does not replace your medical advice. Check out our full disclaimer at the bottom.
Hello everyone! I am so sorry I'm so [00:01:00] late. Sorry, my morning went insane. I had a doctor's appointment. Just so y'all know, I am a huge baby when it comes to getting a shot, which is funny because I have tattoos, but it's not the same thing. I had a rough morning. I had to like work on my mindset. I don't like getting injections or shots or...
Any of that. Anyway. Okay, you guys, so we're gonna talk about epidurals. Are you guys, excited? Someone say hello. Tell me how far along you are. Tell me what number, baby. All the things. Let me see who's out there. So we are going to talk about epidurals and then I want to tell you that we have a sweet little guide for you guys.
I want to make sure it's ready. We have a guide for you guys that is called our epidural guide. It's a prep essentials [00:02:00] kit. Hi, I see someone that said she is 24 weeks, 36 weeks with four days. Hello. Is it painful? We're going to talk about that. Just a minute. 39 weeks and 5 days. First baby. Love it.
First baby, 19 weeks. Congratulations. Hello. Seven months, baby number two. So excited. Let me make sure that I have Everything ready. I do. If you reply to a story or comment on a post, hashtag Epidural, you're going to get our Epidural Essentials Prep Toolkit. That is a Mouthful. And it's got a lot of third trimester things in there.
Our hospital checklist, our birth plan template, which is now customizable, and a couple other little goodies for you guys. So hashtag Epidural and you'll get that for free. Okay, so what we're going to talk about today is [00:03:00] Just the whole situation, what exactly is an epidural, I had some tubing and stuff to show you and I completely cannot find it.
So an epidural is a procedure that numbs the lower half of your body during labor. Obviously, it is anesthesia, so you will be considered to have anesthesia on board, and it is administered through a catheter into your spine, into the epidural space. Now, the difference between an epidural and spinal is that an epidural is going to be continually pumped in.
It's on a pump. One of the questions I get a lot is, will my epidural wear off? So two parts, two answers here. It shouldn't. We will have to replace the medication bag for the epidural so that if the bag empties you have a new bag. However, your, [00:04:00] your medication, the numbness should not wear off. And we're going to talk about occasions where epidurals don't work so great in just a minute.
The plan that I would have and part of your free little toolkit that we made for you guys are questions to discuss with your provider ahead of time. So you want to be discussing the option of an epidural with your healthcare provider before your due date. So that you can chat with them and ask him all your pressing questions.
So we, inside of your epidural toolkit, we have questions like, What is your experience? What is your feelings? What are the hospital policies? So on and so on. And they just can break it down in more detail and you'll get them to sit down and actually talk to you for a little bit. Anyway, you are inside that epidural toolkit is that list of questions.
You can print it, take it with you, and you have it ready for your provider. So the next thing that people [00:05:00] ask me is, what about, when do I get it? What is the timing for my epidural? So the best time Is during active labor now, that being said, not everybody waits until active labor now, if you're one of my mama's inside of our birth classes or our community, then, we're going to encourage you guys to stay at home as long as possible.
And if you follow our labor rules that we teach you inside of call mama, confident birth, or the V back lab, then typically. Our students get to the hospital. Now, our unmedicated students, on average, get to the hospital at eight centimeters. But our mamas that are wanting epidurals usually get to the hospital between six and seven centimeters, which is a fantastic time to get your epidural.
Now, ACOG states that you're not in active labor until around six centimeters, or you're making very rapid cervical change. If you [00:06:00] get to the hospital following our labor rules, Then guess what? You can ask for your epidural. You can roll on in the door and say, I'm ready for my epidural and we will get you prepped.
Now, the thing about the epidural timing, and this is what I tell my patients in person is if you're planning on an epidural and you start thinking, holy smokes, I need my epidural I need it. It's time. Tell your nurse, because it takes us a little bit of time to get you prepped and ready. Most facilities require that we bolus in a whole bag of IV fluids.
We have to make sure all your labs are back. We need your platelet, all platelet count your blood type, all of this stuff needs to be back. So if you roll in real quick, we've got to get you ready and get everything in line. So once you tell your labor and delivery nurse that you're ready for your epidural, then she's going to bolus a bag of fluids.
She's going to alert [00:07:00] the anesthesia team, the anesthesiologist or the CRNA and tell them, my mama's ready for her epidural. And then that usually takes about 20, 25 minutes. So this is why I tell my students, if you're really losing it, Or I tell my patients, if you really are thinking, Oh my God, I need it now, tell your nurse so she can start that process.
Now, once the anesthesiologist has your labs, they gather their car, your nurse will get some stuff and you have your fluids in, we also usually have you get up and go and empty your bladder. Your bladder can act. Like a roadblock for baby to move down into the pelvis. So we want to get it empty because once the epidural is in effect, you can't empty it yourself, which is why we put in a Foley catheter.
But we'll talk about that in a second. So the placement process. Typically, now I have worked, so I've worked as a high risk labor and delivery nurse that travels, so I've worked at a lot of [00:08:00] facilities, and two facilities I worked at, they would lay the mamas down on their side. I personally loved that. But not many providers do that.
So the placement process is usually we'll get you up, go to the bathroom. When you come back, I've got your bed padded, everything ready, especially if your water's broken. And I will have you sit on the edge of the bed with the back of your calves hitting the bed. So you're right on the edge, but you're secure.
And then what I personally do is I will pull up the big garbage can that has the flip top lid. I will put a blanket on it so you don't touch it and a chucks pad and I have my mamas put their feet on that. So I lift the bed up, she puts her feet on the garbage can and that just gives a little more security for when you get into position.
Because when we get you into position, you're going to curl over that baby. Like you're doing a stomach crunch. [00:09:00] So we call it like the mad cats. You're going to arch your back out. You're going to relax those shoulders and you're going to keep your head still. Now, one of the tips that I've given to my patients over my many years, because I've been a labor and delivery nurse for 16 years.
is we want you to keep your spine still. So when you move your head, you move your spine. When you're talking, you tend to move your head. So the most that I want you doing is chin to your chest, shoulders relaxed, and I want you just to be doing your deep breathing. That usually will keep you from moving.
Typically, If you have a good anesthesiologist or a CRNA, then it's, you're going to go through about three to six, seven contractions during the placement process. Now, once your provider has you sitting in position, they're going to clean your back. It's scratchy. [00:10:00] It is a sterile procedure, so you want to make sure that you're not reaching back there.
We usually, some hospitals don't let your partner stay in the room, but I would combat that. You have a right to have someone with you, and they can stay on the side where I'm at. I'm not sterile. If I'm not sterile, they don't need to be. So it is a sterile procedure, so you can't reach behind you. I always tell my patients, don't touch anything that's blue, because that's sterile.
ThEy clean your back, it feels nice and scratchy, and then they're going to inject the nummy medicine, the lidocaine. What I've been told, because I started this little teaching saying, I am scared to death of needles. So my very first baby, I did not have an epidural because I was scared of the needle, but then I loved unmedicated birth.
So what worked out in my favor... I've not had one, but most of my patients say this, the epidural the IV hurts worse than the [00:11:00] epidural. The lidocaine is going to be the most painful part of your epidural. Typically, there's always that one whack a doodle case that things are different, but typically the nummy medicine is going to be the thing that hurts you, that stings like a big bee sting.
It's not going to be horrible. But you got to decide, do I want labor pain or do I want this numbing pain? So the place, then they're going to insert a catheter, they're going to insert a catheter, thread, or they're going to insert a needle and thread the catheter through that cannula, and then they're going to pull out the part, the one part, and leave the catheter.
It's very thin and very flexible. So you do not have a needle in your back the whole time. A lot of people have a misconception of thinking that they have this needle in their back, but they don't. It's a very thin, flexible tube. So your tube is gonna, then they're going to tape it on your [00:12:00] back. Now, most of the time, once they put that catheter in, they're going to give you a bolus.
And they're going to ask you some questions and just to make sure it's in the right spot and all things are, kosher. So once we get your catheter running, we're going to tape it up over your back, hook it to the pump, and then we're going to lay you down. So you're going to lay down and on a tilt, tilted to one side.
Now, obviously that's because we don't want you laying flat on your back. And the reason that we don't want you sitting up is because the medicine flows and works on gravity. So whatever is the dependent part of your body, so if you're sitting up, that's going to be your bum, all the medication is going there, and you don't want a numb bum, you want a numb abdomen.
and perineum. So you want to make sure that you're not sitting up directly after. We usually will not let you. We're going to have you tilted and we're going to sit with you. Usually your labor and delivery nurse will sit with you for the first 30 [00:13:00] minutes. Again, you have anesthesia on board. So we have to watch you.
We're going to be doing your vital signs. So your vital signs, we're going to be doing your blood pressure, your pulse, and we're going to be checking that every five minutes for the first 30 minutes or so. And then it'll be every 15 minutes. Depending on your facility, but you do have anesthesia on board.
So we have to watch. How are you reacting to that? So during that initial process, I'm also going to be making sure the reason I'm watching your blood pressure is because one of the most common Problems per se is a block or a drop in mama's When your blood pressure drops, then the baby's going to most likely have a reaction as well, which is usually a fetal deceleration.
So what we do is we watch your blood pressure, but here's what I always tell my patients. The first sign. of that blood pressure dropping is [00:14:00] you feeling not right. So if you start feeling just a little off, a little dizzy, a little nauseous, let your nurse know right away. So let's say you're in between that every five minutes of a blood pressure, she can hit the button, get a blood pressure and see if you're trending down and call anesthesia back in.
And they're going to give you some medicine to. up that blood pressure. So usually around 30 to 40 minutes after we place it, we're going to put in a Foley catheter. So I told you before, the reason we use a Foley catheter is because you cannot empty your bladder and we need it to be emptied. Some people have an epidural for up to 12 18 hours.
or more. So we obviously don't want your bladder just fill and filling because that's going to cause problems, but it's also a full bladder is a roadblock for baby to move down into the pelvis during the, that 30 minutes or so I'm in the room with you, I'm bothering [00:15:00] you, I'm checking you.
But once you're stable, here's my big pro tip. Once you're stable. Take a nap. This is not when you invite all the family in, your Aunt Mary, and your cousin Kathy, and all the people to come in and hang out with you, because remember, you got some sleepless nights coming, and you've been laboring, which is hard work.
So I want you to take a rest. Now, during that rest time, And it might be the best rest you ever had in your entire life. But during that rest time, we're still going to be rotating you at least every hour and mocking natural movements. This is where the magical peanut ball comes in. We love the peanut ball.
Now, as old school nurses, as old ladies, used to use our bedside table and do the exact same thing with the peanut ball, but Lord have mercy, the peanut ball is way more [00:16:00] comfortable for a mama. But we used to do it with a bedside table. So if you've had to do that, you know what I'm talking about. So if you don't, if you're planning an epidural, here's my insider tip.
And your hospital doesn't have peanut balls. Take one. Now, most of them are moving towards having them because it's just obvious that it is such an incredible, non invasive tool to get the baby in the right position and to speed up the labor process. If they don't have one, bring one with you. Get one that's easy to inflate.
Your partner can inflate it once you get into your labor room. The way that you can find that out, here's my tip to find out anything you want to know about labor and delivery. Call the hospital, ask to be transferred to the labor and delivery station, and then ask whoever answers, Hey, do you have wireless monitoring?
Hey, do you have peanut balls? Do you have birth balls? All the things you want to know. Do you have a birthing tub? Any of those things you can call and ask us and we will be happy to let you know what we have. Okay. So let me [00:17:00] see. I have some notes because y'all know I get off track. Okay. So a lot of people ask me about the walking epidural.
I Know sure as heck when I say that it's not common, I will get tons of DMs and comments saying we do them or we have them, but I have worked at some of the top facilities in the U. S. as a travel nurse, and I have never once had an anesthesiologist allow a patient to get up and actually walk. What a walking epidural typically means is it is one that you have really good movement.
But again, you have an epidural on board. It's anesthesia, which makes you a fall risk. And I can tell you 100 percent hospitals are all about preventing fall risks. So they're not going to let you walk around typically. Now, I'm sure I'll get some DMs, but that's okay. So just talk to your provider about these.
And this [00:18:00] is also in your provider questionnaire so you can get the lowdown on your particular birth place. Now we're going to talk about some of the things people don't like to talk about when it comes to an epidural. So epidurals. Number one. You might not be a candidate. So there are some mamas who have some congenital spine deformities or situations that they are not a candidate.
So again, talk to your provider early, get the low down early so you're not like thrown out of the loop when you get to the hospital. If you have low platelets, sometimes if you have some sort of infection or something going on, untoward, you want to talk to your provider. So always ask for A consultation and talk to them.
So some of the questions that we put in your guide to ask your provider is, the hospital prov policies and [00:19:00] procedures. Another really common question that I get here on Labor Nurse Mama and inside of my student community is this, when is it too late to get an epidural? So if you were thinking that hit the heart or something.
Here's the thing. Every anesthesiologist is different. Some have different policies. It also depends on how many babies you've had. So someone like me, who's had a million babies, who's birthed six babies, I'm not necessarily going to be able to get an epidural when I'm 8 or 9 centimeters because I'll probably be 8 or 9 centimeters for like less than a minute.
But a first time mom, a lot of facilities will let you get an epidural up until 8, 9, 10 centimeters. It just really depends on a couple things. How many centimeters are you? What station is the baby at? And, all the things that are going on, but a lot of hospitals do have a rule that after [00:20:00] around seven centimeters, they're not going to do it.
So keep that in mind. And that's another question to ask your provider. Another thing that I want to talk about is what happens when your epidural doesn't work. This actually happens. I want you to keep in mind that sometimes your epidural will not work at all. It just doesn't work for you. Other times, you have what we call a hot spot, and that is a section usually on your abdomen where you feel the pain of those labor contractions, and that seems to drive women insane.
Now, there's other times where it might be working for a while, then it doesn't work anymore. Here's what I teach my girls inside of Calm Mama Confident Birth, or Calm Labor, Confident Birth. I teach them to have coping tools in their tool bag that is not related to medication. [00:21:00] Because there are times you either maybe were too busy.
Maybe the anesthesiologist has six mamas ahead of you, and we don't have time to get you one. Or maybe it's too late, and you can't get one. So I want you to practice the coping tools that we teach inside of our classes, inside of our community, because you need to have a plethora of tools. The other obvious reason is I want you laboring at home as long as possible.
So if you're laboring at home, you're going to need some tools to use. So don't negate the fact that you're getting an epidural. You don't need to know the breathing techniques. You don't need to know the coping tools. You do. Okay. Keep that in your head. You do. You do. So another thing that mamas want to know from me is after you get your epidural, Typically, it wears off in about an hour ish.
When I have you immediately after delivery, I'm going to be checking how you move your legs, if you can feel things. [00:22:00] Once you're able to put your body weight on your legs, we're going to do what I call the epidural shuffle and go to the bathroom. Okay, you guys, so I hope this helped. When you get the essential toolkit for epidurals, you're also gonna have a couple positive epidurals birth stories to read from my students.
And you're gonna have that questionnaire to print out, and you're gonna have a inside the toolkit, you're gonna have my birth plan template, that's customizable. You're gonna have the hospital checklist, the third trimester prep guide that we put together where we talk. We have a prep. Calendar for you, daily to do list, and we talk about all the ways you can prep your body and your mind for birth.
Remember, birth is 90 percent mental.
Hey mama, I hope you enjoyed this episode all about the epidural. If you're interested in grabbing our epidural [00:23:00] toolkit, which is a epidural labor birth toolkit. That's a mouthful. Then click the link in the show notes as always hit subscribe, leave us a review and we'll see you again next Friday. Bye for now.