Contrary to popular belief, an epidural isn't an instant, magic cure-all for labor pains. There's more to it than just saying, "Give me drugs, now!"
The waiting game
When you decide it's epidural time, hopefully the anesthesiologist will be readily available. Be prepared to wait a bit, though, if she's with another patient (or in the OR for a C-section). You will need to have IV fluids administered and an external fetal monitor placed (if you don't already have both). Meanwhile you'll be having contractions so strong you ask for an epidural in the first place! Try slow, deep breathing and relaxation.
The good news is, once the epidural is administered "Obstetrical anesthesiologists monitor a woman's pain levels very closely, so we know very quickly whether the relief is adequate," says David Wlody, MD, Chief of Anesthesia at Downstate Long Island College Hospital in Brooklyn.
When an epidural doesn't provide full pain relief
"There are small anatomical variations in women that can interfere with the spread of local anesthesia throughout the spine," Dr. Wlody explains. "If that's the case, usually by adjusting the catheter we can improve pain relief."
When an epidural doesn't fully work, comfort measures to try include visualization, listening to music or a nice hand or foot massage. Unfortunately, you won't be able to try positions like walking around or sitting on a birth ball. You'll need to stay in bed. You can lay on your side, sit up in bed, and may even be able to use a squat bar with support when it's time to push.
Be sure to talk to your anesthesiologist if you're not getting relief. Wlody says, "At times the epidural just doesn't work for reasons we just can't identify. When that happens, we give a second epidural and then pain relief is achieved."
The best of both worlds approach
In childbirth classes, I stress the importance of keeping an open mind — until you're in labor you won't know what will work best for you to ease pain. If you want a natural childbirth, go for it! But it's okay if you change your mind. If you wish you could get an epidural in the hospital parking lot, remember you'll likely need to use some more natural coping measures before getting an epidural — or if it doesn't work right away.