In the past, many obstetricians wanted a woman to be in active or true labor before calling the anesthesiologist to start an epidural because they were concerned that it might slow down the contractions. These days, most providers allow you to start an epidural whenever you ask for it.

If you arrive at the hospital before you’re in active labor and know you want an epidural, you can ask the anesthesiologist to place the catheter as soon as you’re settled. Then you can wait to start the medication when active labor begins.

Advantages:

1. Increased maternal satisfaction

2. Retention of the urge to bear down and the ability to push during the second stage

3. Retention of bladder sensation / avoidance of urinary retention

4. Obstetric outcome may be improved

5. Long-term post-partum blockade may be reduced

Disadvantages:

1. You have to stay still for 10 to 15 minutes while the epidural is put in, and then wait up to 20 minutes before the medication takes full effect.

2. You’ll need an IV, frequent blood pressure monitoring, and continuous fetal monitoring.

3. In some cases, an epidural provides spotty pain relief.

4. The drugs used in your epidural may temporarily lower your blood pressure.

5. In very rare cases, an epidural affects your breathing.

In the most recent article of the World Health Organization recommendation on epidural analgesia for pain relief during labor, suggests that an epidural does not have a negative effect on a newborn, as measured by his Apgar score less than 7 at 5 minutes. It remains controversial whether an epidural affects a baby’s ability to breastfeed immediately after birth. Some experts suggest that the baby may have trouble latching on if the mother had an epidural. Others believe there are no good studies to support this conclusion. Moderate-certainty evidence suggests that babies whose mothers received epidural analgesia rather than parenteral opioids are probably less likely to need naloxone administration.

Reference: WHO recommendation on epidural analgesia for pain relief during labour. (2018, February). Retrieved December 1, 2018, from https://extranet.who.int/rhl/topics/preconception-pregnancy-childbirth-and-postpartum-care/care-during-childbirth/care-during-labour-1st-stage/who-recommendation-epidural-analgesia-pain-relief-during-labour

Unfortunately, not all pregnant women can avail this kind of pain relief. You won’t be able to have an epidural if you:

1. Have a skin infection on the lower back where the needle would be inserted
2. Have a bleeding disorder
3. Have a blood infection

You also need to be managed carefully if you’re taking certain blood-thinning medications and planning to have an epidural. If you have any concerns about whether an epidural is safe for you, send us a message and we will talk about it.