The Epidural Episode: What Nobody Actually Explains Before You’re in the Room | 265

You may have already decided whether or not you want an epidural.

The problem is you may have made that decision before you were actually educated and knew what to expect during labor.

Maybe you found your information from a Facebook group or what your mom did or what your best friend did, or maybe even in haste, you know, you decided to have an epidural based on what your provider said to you after like one rushed appointment where you may not have had time to ask the real questions.

And now you're 30-something weeks pregnant and if someone asked you right now, " Walk me through what actually happens when you get an epidural," You would go quiet, and that is what this episode is for

Welcome back to "The Birth Experience." I'm Trish Ware, or you may know me as Labor Nurse Mama.

I was a labor and delivery nurse for over 16 years, and I'm a mama of seven.

So I have been in the room hundreds of times on the nurse side of the bed while a mama is getting her epidural or even making the decision on exactly what she wants to do.

So today I'm gonna walk you through everything that actually happens from the moment you ask for it to the moment we're pulling it out after delivery.

So this episode is for you if you're interested in knowing exactly what happens during your epidural, and I'm not gonna give you horror stories.

I'm not gonna give you an agenda.

Around at Labor Nurse Mama, we lay it out for you to make the decision, but I want you to know exactly what's happening and my take on it.

All right, so here's the thing about epidural conversations.

Women a lot of times come into three different camps.

One, they come in thinking, " I absolutely want an epidural and I want it the second I get here." The next one comes in saying, you know, " I absolutely do not want an epidural.

I'm going unmedicated.

That's that." And then there's this third camp who comes in and is like, " Eh, I don't know. I'm gonna try and see how I feel." The problem with all three, or I guess not a problem, I wouldn't say a problem, what I suggest for all of you is to be prepared for the pain of labor and have a pain management plan that is outside of an epidural.

Have tools, breathing, movement, and also you need to understand what is happening inside of you and around you so that when you hit, you know, active labor, you're not making a decision out of panic.

Because the women that I see struggle the most in these moments are not the ones who wanted it or didn't want it.

They're the ones that they just don't know what is happening and they don't know what to ask, And they don't know what to expect next.

Because when you're in that kind of pain, and I know there's all this like pain-free, you know, birth talk out there, I am, I'm not a supporter of that.

Let's just say that.

Birth is painful.

I've had six unmedicated.

Is it manageable?

Yes.

Can it be amazing?

Yes.

But I just don't want you to be surprised.

I want you to understand how to handle the pain of labor now.

If you're like, "I'm interested in epidural and I'd like to know all the things, but I don't want to like, not know what's going on," right?

So you still have to know how to manage the pain of labor and hopefully this is making sense.

I'm gonna break down the process of the epidural, but the first thing I want to tell you is that every single one of you will experience the pain of labor at some point, unless you're a scheduled C-section.

That's a different, you know, you're not going to.

But even if you're induced, even if you go in labor at home, whatever the situation, you are going to have to deal with the pain of labor.

And we're gonna talk about reasons why, because just because you want an epidural does not mean you'll get an epidural.

Just because you want an epidural and you're like, "Yes, epidural's gonna be my savior," does not mean that it will work.

It doesn't always work.

So again, I'm not trying to scare you, I'm just saying come in prepared.

For those of you who are like, "I'm 100% going unmedicated," I want you to listen to this episode because things can change.

Now, I always tell my students, "If you wanna go unmedicated, we're gonna marry that decision." You're not gonna be like, "Eh, I'm gonna try it out and see." No.

If you wanna go unmedicated, we have to marry the decision.

I'm gonna break this down very simply from the time you ask for the epidural, when you can ask, and how to go about with that.

So, like what to expect, right?

So I'm just gonna give it to you like I give to my students inside of Calm Labor, and hopefully that's okay.

So deal, we're gonna talk about it.

Okay.

The other thing that I want to say before we get started, and this is semi-totally off the cuff, just so you guys know, we're just like riffing it here, right?

We're just like random, going random.

But I want you to know that if you decide to get an epidural, even if you were like hardcore against it, that is not a failure.

That is a decision.

You're not failing either way, whether you get one or you don't get one.

So I just really want you guys to make this decision based on what's best for you, because unmedicated is not for everyone and epidurals are not for everyone.

So again, we're all about you having choices.

The reason I stepped away from the bedside and created Labor Nurse Mama is because I want you to be the driving decision maker in your birth.

I was so tired of seeing women pushed one way or the other.

And so here at Labor Nurse Mama, again, we lay it all out.

We let you pick and choose just like you're at a buffet, okay?

Choose what's best for you based on knowledge.

You don't wanna choose based on fear.

So let's start.

We're gonna start with when can you get the epidural?

So honestly, there's a couple factors in that, right?

My goal for each and every one of my students and for you guys is that you stay at home in labor as long as possible, and that way when you get to the hospital, you're in active labor and you can ask for your epidural.

However, for some of you guys, maybe you, you're induced or what have you, a lot of people will tell you, "Well, you can't get it too early and you can't get it too late." There's honestly no like blanket rules on that, but the short answer is the best time to get it is when you've hit about five to six centimeters and you're actively dilating

now, then you have hospital policy.

Some hospitals and some providers will not let you get it too early.

They're gonna make you wait, and then they won't do it after you hit transition because you can't sit still.

However, I've seen providers do it at two centimeters, and I've seen providers do it after she's complete and, like, ready to push.

The main thing for you and what I tell my patients and now my students is when you start thinking in your head, like, "I, I think I want the epidural," tell your nurse, because there is a process that has to happen.

Number one, you're gonna get put on a list.

So, if there's three other mamas who have asked for an epidural and the anesthesiologist is going down the line, 'cause most of the time we have one that's gonna, you know, do the, the epidurals.

We have a CRNA, and the anesthesiologist may back them up, but if the, if one of them's in surgery, you're out of luck.

So, when you get admitted, we draw your labs, we do your CBC, we get your platelet count, and we also have you sign consent.

So we do that early on, so when you're ready and you ask, we put you on a list, right?

And then we have to do a couple things for you and your body to get you ready for the anesthesiologist or the CRNA to walk into your room.

They're not just gonna rush in your room.

Now, sometimes they will.

So if you're like, "Trish, they did. They actually rushed into my room," sorry, it does happen sometimes.

But let your nurse know, because we can start the process, and I'll tell you what we have to do in a second.

Just say, "Hey, I think I want my epidural."

Let her know so she can get the ball rolling, because first we're gonna have to put you in line, let the anesthesiologist know or the CRNA, and if they're in a C-section, you're gonna be waiting.

If they're doing another epidural, they're, you're gonna be waiting.

But he's gonna want us, most of the time, to bolus you fluids, IV fluids.

You've already got your IV in.

We're gonna give you some extra fluids to help prevent one of the most common side effects, which we're gonna talk about later in the episode.

So you're on the list.

We're bolusing the fluids.

We're gonna get your labs ready.

He's probably already reviewed it if you signed your epidural consents earlier.

If you haven't, we're gonna get those signed.

And the process can be anywhere from 20 minutes to an hour and a half, depending on where you are in the line and where our anesthesiologist is.

So, once they're ready to come to your room, we've got your meds ready, we've got your consents bedside, we've got your labs ready.

So once we've got that ready and I know the anesthesiologist is coming to your room, I'm going to then get you up, we're gonna walk to the bathroom, and we're gonna empty your bladder.

Your bladder creates a roadblock for the baby's head, so we wanna empty it because once the epidural is in place and running, you can no longer empty your bladder your- for yourself, which we're gonna talk about that in just a moment you've gotten your fluids, we've emptied your bladder.

We're gonna bring you back to the bed, and I'm gonna have you sit right on the edge of the bed.

You're gonna get right to the edge with your, the inside your knee pat, I call it your knee pat, right against the bed, okay?

We're gonna lift the bed all the way up.

We're gonna turn all the lights on.

We're gonna bring something in front of the bed.

Sometimes it's garbage cans.

Some facilities have a fancy little thing.

We're gonna put your feet flat on that to give you, like, tension to, and stability.

Or they're gonna give you a pillow, you're gonna grab it, you're gonna hunch over it like a mad black cat.

The anesthesiologist is gonna come in and with their cart, and they're gonna introduce themselves.

They've probably already met you earlier in the shift, but sometimes not if you're going fast.

They're going to go to the backside of the bed behind you.

Me and your partner are standing in front of you.

Now, there are some antiquated facilities that want your partner to leave the room, because notoriously, during an epidural placement is when a lot of partners pass out.

So what we do is we normally will have them sit down right in front of you so that they're right there, they're with you.

I'm gonna have a blood pressure cuff on you and a O2 sat monitor, 'cause I'm gonna be watching your vital signs.

We're gonna do it very often.

The anesthesiologist is gonna come behind you.

They're gonna open your gown, and they're gonna clean off your back.

It's wet, it's cold, it's scratchy.

Then they're gonna use a numbing medicine to numb the spot.

A lot of my patients, 'cause I've never had an epidural, I've gone unmedicated, they've told me that that feels like a really, like a bee sting or like a flu shot, and it's a little painful.

So that's gonna be the most pain that you're gonna feel during this procedure.

That's the most pain you should feel during the procedure.

Then once it's nice and numb, they're gonna put in the epidural needle with a catheter.

They remove the needle, and they leave the catheter in.

So that is the next question that I get a lot of times is like: " Wait, do I get a shot over and over again?"

No.

We're actually going to put the catheter, hook it to a pump, and it's titrated into you for the rest of your labor.

We turn it off right before baby comes out or right after the placenta comes out.

It just depends on your provider.

Some of them do it different.

One of the things to note and let your partner know is that this is a sterile procedure, so anything blue, partner cannot touch.

You're not gonna put your hands behind you.

They're gonna be in front of you because it's a sterile environment, so we wanna keep it clean.

So now your epidural is in place, and we will lay you back on the, the bed actually more flat than you've probably laid since second trimester, and we're gonna put a pillow under one side of you so you're kind of tilted.

The reason we lay you that way for a period of time is because the medication is based on like gravity.

So if I put you all the way on your left side, your left side's gonna get really numb, but your right side, you'll still feel pain.

So we're gonna put you kind of flat on your back with a tilt, a pillow tilted so that baby still gets a good blood supply and all of that.

we're gonna be monitoring your vital signs, and your nurse should be at bedside during what we call recovery.

That's anywhere from 30 to 45 minutes.

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Now, I told you before that we give you the bolus of fluid for a reason, and that is because of one of the most common side effects is that your blood pressure will tank.

And so when that happens, it inadvertently causes the baby's heart rate to drop.

So that's why we're doing your vital signs and we're taking your blood pressure like a madman, okay?

Like over and over again, very, like, soon.

So we're doing that because we wanna watch those vital signs to make sure you're stable.

Once we know that you're stable, then we go to every 15 minutes, but until then, we're doing it more often.

I always tell my patients and my students that you're gonna feel it in your head first.

A lot of times a mom will just say, " I'm feeling weird," like, "I'm feeling weird." And that usually precedes the blood pressure showing a drop on the, monitor.

I'm losing my words right now.

On the monitor.

And so a lot of times if my patient will say like, "I'm starting to feel funny," like, "I'm feeling funny," I'll tap that thing and take a blood pressure right then and there.

And usually what will happen is if it is dropping, we'll call the anesthesiologist back in and they're gonna give you a medication to bring it back up.

We may have to put oxygen on you.

It just depends if it's affecting the baby.

So, you have it in place, we're recovering you.

At the end of that recovery, we're gonna check and see if you're actually numb, and we use like a, a cold alcohol swab and we rub it on your waist and your hip and all that.

Once you're actually numb, then your nurse is going to place your Foley catheter.

A lot of moms are okay with their partner being in the room.

I always ask the mom because we're gonna bring your knees, if you're watching the video, you're gonna see me, we're gonna bring your b- knees up and open up and you're like, your girl parts are gonna be right in my spotlight.

So, if you're shy and you don't want, they can either turn around or step out of the room.

You're gonna be feeling better, so this might be the time for them to go and get a snack or a meal or something.

Because once you have your epidural, you're no longer allowed to have food, only ice chips, so keep that in mind, and clear liquids.

Once your epidural's in place, you're now considered, you know, you've got anesthesia on board, so you can only have ice chips.

So we are not letting your partner eat in your room, okay?

Not allowed to eat in front of you.

So, we've got the recovery going on.

Let's fast-forward, and what are you gonna feel?

Ideally, you should feel that your legs feel heavy, but you can still move them.

If you can't move them or feel them at all, then we call this like a heavy epidural, and that's not a good thing because we need you to be able to feel and move and feel pressure so that you can feel where and how to push.

So if that's the case and it's like you feel like a dead weight, like I had a patient one time, you guys, that she was like, "Trish," she called me in the room, she's like, "There's something in my bed." And I looked, I'm like, "No, I don't see anything." I went out.

She called me back.

It turns out it was her legs.

They felt so foreign to her.

She didn't even know that was what was in her bed.

We had quite the laugh, which brings me to another side effect that you may not be happy about, but it can cause a lot of laughs, is you're not gonna be able to control your gas.

So a lot of women, including this patient, she started laughing, then she had gas, then she laughed and had more gas.

We were all dying, dying.

It was so much fun.

I love births where we get to laugh together.

Now, one thing that I forgot to tell you is that the medication turns on kind of like a dimmer switch.

So it's not like, boom, you're numb.

It's like, it's like a dimmer switch where it gets stronger and stronger.

On the flip side, when you are done pushing baby, and depending on your provider, sometimes we turn it off right when baby comes out, sometimes we do it when placenta comes out, we're gonna turn off the epidural pump.

Let's go back a little bit.

On the epidural pump, you're getting an amount every hour.

We also have a little button on some of them that if you start to have some breakthrough pain, that you can push it and it will help you.

It will not let you give too much, so you don't have to worry about that.

The other thing to note is that some epidurals do not work as good as others, so sometimes you might have a hot spot, like on your left side, and you're feeling pain, so we're gonna turn you to the side that you're feeling, get the medicine to run that way, and sometimes the provider needs to come in and redo your epidural.

Okay, so the other thing that I want you to hear me, and this is probably one of the most important things that I'm gonna tell you today.

A lot of times when a mama gets an epidural, she's exhausted.

Maybe she's been laboring for a couple days, she hasn't slept, and neither has her partner.

Once your epidural's in place and working, this is not the time to invite nana and all your cousins in.

What I recommend you do is we turn off the lights, he gets comfortable or your partner gets comfortable, you get comfortable, your birth team, whoever's in the room, your doula, your mom, whoever, everybody takes a rest.

' Cause you don't know h- if you might be up all night tonight laboring and tomorrow night with a newborn.

I know it's a little bit hard, but I promise once you calm your mind down, do some deep breathing, this is gonna be the last solid sleep you get for maybe a year.

So, don't get on your phone, don't watch TV, and don't invite people into your room.

This is when you need to rest.

So hear me, rest time after epidural.

The other thing that people ask me is like, "How will I push?" You should feel pressure down there.

So a lot of times what I'll tell my patients is that when you start to feel like an massive increase in pressure, let me know, 'cause that's usually a sign that you are complete.

I do believe in laboring down, so we do have an episode on that.

I won't go into that, but laboring down is magical for epidurals.

Okay, you've pushed the baby out, you've pushed your placenta out, we've turned off your epidural.

It's gonna wear off, again, like a dimmer switch.

After that, we are gonna wait until you can actually put weight onto your legs to bring you to the bathroom.

But before we do that, we're gonna actually remove the epidural, and I always tell my patients it's like you get a free wax job.

We're gonna pull all that tape off, we're gonna pull out the epidural, inspect it, make sure it looks good.

Then we're gonna put a little Band-Aid on the spot, and then we're gonna waddle to the bathroom, and you're gonna go to the bathroom.

So hopefully this answered a lot of your questions about epidurals.

If you want more information, we do have a third trimester checklist.

It's a freebie.

It's our birth prep guide for third trimester.

If you go to any post on Instagram at labor.nurse.mama and comment the word third, #third, you're gonna get it.

Or you can go to labornursemama.com/third, and you can get that birth prep pack for third trimester.

We have one for each trimester.

Here's the deal.

When it comes to epidural, when it comes to your pain management plan, it's your choice.

doesn't matter what Nana or Mama or Aunt Sally did, or your bestie did.

It's matters about, like, What do you want?

Just be educated and informed and make the decision from a place of education and knowledge and not from fear.

So wherever you land on this, this is the right answer for you.

What I want you to walk away from this episode with is not a decision, it's feeling clear, knowing what's coming, that whatever happens in that room, it happens on your terms.

So as always, I hope you enjoyed this episode.

No fluff, no BS, we're just talking straight, right?

And I would love if you would do me a couple favors.

One, hit subscribe, leave a review or a comment on Spotify, and share this with someone who's pregnant.

As always, I'll see you again next Friday.

Bye for now.