You want to put that where??? Part II

So when we left off with part number one, I had talked through the process of getting an epidural from start to finish (go back & visit if you need a disclaimer refresher). I've already heard from a small village of people claiming my last post was terrifying, which totally wasn't the desired effect! I'm hoping that maybe today's post can relieve your fears a bit.

So, here goes nothing.

Now, THIS is terrifying. Source

How bad does the epidural hurt?

Overall, the procedure shouldn't be traumatic or painful (despite the horror stories that float around). The initial shot of numbing medication is often the most uncomfortable part of the entire procedure and I've heard it compared to a bee sting or fire ant bite (but in my personal experience it was hardly noticeable). The stinging usually subsides in about 10 seconds or so. After that, locating the epidural space often means feeling lots of pressure and sometimes some yucky feelings, but ideally no pain.

This is where I got the root canal reference from, and maybe I should've said it's more like getting a cavity filled. You know, the dentist numbs your mouth and it's a sting and a bite for a few seconds before half your mouth is drooping and drooly. From there, you still feel pressure (which sometimes is even a little uncomfortable, but easily tolerable) where the dentist is working but ideally no pain.  

If things DO get painful,  then be clear with your nurse or anesthesia provider about what exactly you are feeling, because most issues are easily remedied. I often find (and this is not with all cases, but humor me here for a sec, ok?), that the fear and anxiety that's associated with epidurals and the unknown aspects of them is the driving force behind a patient having a bad experience. Fear and anxiety can play crazy tricks on your mind when you're feeling bizarre things that are otherwise appropriate and anticipated -- especially when you're already dealing with megapainful contractions. That being said, sometimes there can be some actual pain involved. Repositioning or additional local anesthetic can often relieve some of the typical discomfort associated with epidural placement. As a side note: If you are concerned about preexisting back issues causing problems during your epidural placement, make sure and speak with an anesthetist BEFORE you're clawing the walls. For significant back issues (i.e.: previous surgeries and/or malformations), it would be wise to have your OB set up an anesthesia consult long before you're due to deliver.

A large majority of my patients tell me that the IV hurts worse than the epidural, just to put things into perspective. 

There are a few things you can expect to happen after epidural placement. First -- your entire lower body will become numb and tingly.  I repeat: your legs and bottom will feel warm, fuzzy, tingly, numb, heavy, etc.  It amazes me how many people seem surprised by this, because it IS the desired effect. Usually it takes 10-15 minutes for the anesthesia to fully take effect, so don't expect an immediate response (unless you're getting a combined spinal-epidural, but we aren't talking about that here today). It's a gradual numbing and as the level of anesthetic rises, you should feel contractions less and less. Maybe you can move your legs a little, maybe they're dead to the world, and either variable has patients concerned. So here's what I tell them: "You don't need legs to have a baby!"  Sometimes you'll be more numb on one side than the other, which isn't uncommon. Just like the leg thing, an uneven epidural isn't a big deal as long as your pain is well-relieved.

Some other anticipated side effects: You might experience a drop in blood pressure, which can make you feel dizzy, light-headed, nauseous, and yucky, but can be remedied quickly. If there is a narcotic in your epidural juice (again, provider specific preference!), you might be a little itchy (or a lot itchy).  It's totally normal to get the shiver-shakes at this time too. You may still feel tightening or pressure during contractions... which we'll discuss further in Part 3!

Stay Tuned.