What Is In An Epidural? Here's What They Don't Tell You
Epidurals are often seen as the go-to for pain relief for labor. But, have you ever wondered what is an epidural, actually? If someone is about to inject something into my spine, you better believe I'm asking all the questions! In this post, we'll break down what is in an epidural, the risks, and how it affects birth and breastfeeding. We'll also talk about what you can do to support a more natural labor and positive birth experience.
What is an Epidural?
An epidural is a form of regional anesthesia that numbs the lower half of the body. Meanwhile, you are still awake and aware during labor. It's administered through a catheter placed in the epidural space of your spine. Once in place, pain relief kicks in within 10 to 20 minutes and can be adjusted throughout labor.
Sounds magical, right? Well, let's take a look at what's actually inside that little vial of pain relief.
What is in an Epidural?
Epidurals contain a mix of:
Opioids (e.g., fentanyl, sufentanil) - These help boost pain relief.
Local anesthetics (e.g., lidocaine, bupivacaine) - These numb the nerves that send pain signals.
Epinephrine (sometimes) - This helps the medication last longer.
Saline - Used to dilute the medication and keep it flowing smoothly.
While epidurals are widely used, knowing what is in an epidural helps you make an informed choice. Some of these ingredients, particularly opioids, can cross the placenta, which brings us to our next point...
Risks of an Epidural
Before jumping on the epidural train, let's chat about potential risks. Because while it may seem like the golden ticket to a pain-free birth, it's not without its downsides:
Drop in blood pressure - This can make you feel dizzy or nauseous. It can also lead to more interventions and an emergency C-section. The cause of emergency being the reaction to the epidural.
Slowed labor - Epidurals can sometimes interfere with contractions. This can lead to interventions like Pitocin, forceps delivery or a C-section.
Higher risk of tearing - Since you won't fully feel what's happening, you may push less effectively.
Back pain after birth - Some mamas report lingering back discomfort after birth for years to come.
Breastfeeding difficulties - Which leads us to our next section...
Can an Epidural Affect Breastfeeding?
Unfortunately, yes. Did you know that babies born after an epidural may have more difficulty latching in the first few hours? Some studies suggest that epidural opioids can get in the way of a newborn's instinct to nurse right away. Since the opioids cross the placenta barrier, they can be born sleepy and not eager to nurse. Plus, when epidurals lead to more interventions, such as a C-section, it could delay the golden hour of skin-to-skin and early breastfeeding cues.
An epidural can also impact the mom's ability to produce milk at first. The opioids and fluids can interfere with the natural hormonal cascade that signals milk production. Some moms experience delayed onset of their milk coming in, which can affect early breastfeeding success.
This isn't to say you can't successfully breastfeed after an epidural (many moms do!), but it's something to keep in mind if establishing breastfeeding is a top priority.
How to Avoid an Epidural with Natural Birth Support
If you're hoping to avoid an epidural and have a more natural birth, you don't have to do it alone! Working with a midwife and doula can make a world of a difference. Midwives provide holistic, hands-on care throughout pregnancy and labor. Doulas offer emotional and physical support (plus all the encouragement you need when contractions kick in!). Research shows that having a birth doula can reduce the need for epidurals and other interventions, leading to a more positive birth experience.
👉 Learn more: What Is a Midwife?
👉 Learn more: What Is a Doula?
Epidural Birth: What to Expect
If you choose to get an epidural, here's a quick rundown of what to expect:
You'll get an IV for fluids (epidurals can lower blood pressure).
You'll be asked to sit or lie in a curled position while the epidural needle is placed.
Once the epidural is in, here's what can happen next:
Numbness kicks in. Within 10 to 20 minutes, your lower body should start to feel numb.
You'll have a urinary catheter. Since the epidural numbs your lower body, you may not feel when your bladder is full. A urinary catheter is often placed to help you with that.
The epidural stays in place. After the epidural needle is removed, a catheter stays in your back to keep delivering meds as they wear off.
You may need assistance pushing. With reduced sensation, pushing can be harder. Your provider may coach you, or interventions like forceps or a vacuum can be needed.
You might experience the "epidural shake." Some women get uncontrollable shivers after an epidural due to hormonal shifts, a drop in temperature and how the nervous system reacts to the cocktail of pain meds.
Labor could slow down. Epidurals can sometimes stall contractions, leading to Pitocin, a C-section or other interventions.
Recovery takes time. The numbness wears off within a few hours, but it can take time to regain full strength in your legs.
Birth with Confidence
Birth is one of the most powerful, transformative experiences a woman can go through. Our body was designed to have the ability, strength and pain tolerance to do this. It's important to know what is in an epidural before saying yes to the needle. When we approach birth informed and confident - rather than fearful - we unlock a strength we didn't even know we had. Trust yourself, your body and your baby, and know that you are capable of anything!
*This content is for informational purposes only and is not medical advice.