If I've lost you already, pay attention to this part: Epidurals may not take your pain away 100%. Let me say it again: It's a widely held misconception that patients with epidurals feel absolutely nothing. Sure, there are those lucky souls that get so numb, they have to be woken up to deliver their baby, but that's not the norm. I even expect my patients to notice their contractions or even become mildly uncomfortable at some point - it's usually a great sign that delivery is imminent and it doesn't mean your epidural has worn off or stopped working. Sometimes the way the baby is positioned can lead to more discomfort regardless of a well-placed epidural. Sometimes when things change quickly, you just need a little extra juice. (But, feeling some slight discomfort and/or pressure makes pushing much more effective). Before you lose your mind and all, notice I didn't say your pain will eventually be out of control. It's just good to know ahead of time that epidurals aren't a guaranteed, foolproof cure-all. Delivery is.
That all being said, there is just nothing else out there that works as well for labor pain as an epidural. IV narcotics and sedation can suffice during early labor, but for the hard stuff, it just doesn't cut it. Personally, I had a fantastic epidural, it was a little one-sided, but worked well. I felt a tolerable amount of pressure and discomfort towards the end of my labor, and efficiently pushed my 9 pound, 6 ounce baby out.
Another word (er, um... words) about epidurals. There are always outliers. A handful of people have a really difficult time getting an epidural, or have a positive test dose, or end up with a spinal headache, or *shudder* get no relief despite a well-placed catheter. It's pretty uncommon, but these things do happen.
Basically, I just took three blog posts to say that every epidural is completely unique, which is totally vague and noncommittal. Sometimes they work too well, sometimes they don't work quite well enough. There are some funny side effects, which may or may not happen. There are benefits (hello?! I pushed out a 9+ pound baby and the only tears I cried were tears of joy), and there are trade offs. And with each sentence I type, I feel like I could tell 27 stories and follow 6 new rabbit trails. I can already think of like a dozen talking points regarding epidurals, like "What's the latest I can get an epidural?" (I've sat patients up who are 10cm) and "Will it slow down my labor?" (maybe.) and "Can I move with that catheter in my back?" (Yes, but do so gingerly - you don't want to dislodge the catheter) and "Will I have back pain forever?" (The likelihood of long-standing back pain is probably the result of being pregnant and pushing out 7 pounds of cute baby, but a brief period of localized soreness from the epidural placement is appropriate)... I could go on and on, but then I'd probably need to start a Part IV post. There's just a lot to say. It's really easy for me to gloss over so much of this considering I sit with patients through their epidurals every single workday. I've seen probably a thousand epidurals, but my patients have only sat through one or two, so I understand the concerns. My hope is that with knowledge (be it ever so vague...) comes added peace, eased minds, and lessened anxieties.
My tips for preggos who know they want an epidural: Try not to stress too much about the whole process... I mean, the REAL thing you should be afraid of is when they hand over your newborn baby and tell you to go home. Ha! Just kidding.... but really. Familiarize yourself with the hospital policies and your doctor's orders (i.e. who can hold your hand during the epidural placement, is there anesthesia in house 24 hours/day, and how far dilated must you be before getting an epidural), because these things are completely out of your nurse's hands. Be very upfront with your labor nurse about your desires. Don't wait until you feel like death is a great alternative to the pain of labor to ask for your epidural. Be very descriptive with your nurse or anesthesia provider if you have pain after your epidural is placed. Terms like ache, pressure, sharp, crampy, etc. all have different connotations and may be treated differently. Is the pain only with contractions or does it last all the time? Is the pain one-sided, all over, or localized? Telling the nurse that you're hurting is a good start, but telling her that you're having sharp pain that lasts beyond contractions and pointing where the pain originates really makes finding a solution much easier. Lastly, like with all things labor and delivery related, be flexible.
Clear as mud?