What can you expect from the procedure should you choose to undergo an epidural for pain relief during labor? When is the best time to ask for it? What positions can you be in? How long does it take to work? How long will it last?

I’m also introducing a concept called the Gate Control Theory of Pain, which explains how we can most effectively manage pain in childbirth with natural alternatives. This goes hand in hand with the idea that rather than fearing the pain of labor and delivery, by being informed and prepared, we can embrace the physical challenge for better experiences and outcomes.

An Epidural is spinal anesthesia offered to you at the Birth Center or Hospital.
Epidural medications fall into a class of drugs called local anesthetics, which includes bupivacaine, chloroprocaine, and lidocaine among others. They are often delivered in combination with opioids or narcotics such as fentanyl and sufentanil in order to decrease the required dose of local anesthetic. This produces pain relief with minimal effects. These medications may be used in combination with epinephrine, fentanyl, morphine, or clonidine to prolong the epidural’s effect or to stabilize the mother’s blood pressure. 1
An epidural can take time to be administered depending on the availability of the anesthesiologist. Just keep in mind that you may not get it the minute you ask for it; there can be a bit of a wait–anywhere from 15 min to 2 hours. Plan to cope with a potential wait using breathing, massage and relaxation techniques.
After a local anesthetic is administered, a catheter delivering the medication is placed in your lower spine.
You’ll start to feel the effects of the medication in 15 minutes or so. After it’s turned off, these effects will wear off in an hour or two.
You will not be allowed to leave the bed; however, you will be able turn on your side and use a peanut ball between your legs. 2
Since you won’t be able to get up to go to the bathroom, a urinary catheter will be inserted as well. They’ll put it in once you’re numb and take it out before you push.
Whether you have an epidural or not, most hospitals and birth centers will require you to have an IV, usually inserted in your non-dominant arm. If you choose not to have an epidural, you can ask for a hep-lock instead so you don’t have to carry the IV bag around with you. However, if you get an epidural, a continuous IV will be placed.
The fetal monitor is essentially two discs that are placed on your belly to help record the baby’s heart rate and monitor your contractions. It significantly limits your mobility. If you choose not to have an epidural, you may ask for intermittent fetal monitoring. However, in the case of an epidural, continuous electronic fetal monitoring is necessary. Studies have shown that there is no difference in birth outcomes between continuous and intermittent fetal monitoring and continuous fetal monitoring is associated with a greater chance of cesarian section. 3
You can ask for the button to control your own epidural medication. Studies have shown that when self-medicated, women give themselves smaller dosages! 4
Labor will likely slow down when you get an epidural. If labor does not progress, pitocin may be introduced to augment labor. 1
Occasionally, the epidural will be uneven, with more feeling in one leg or the other. Let your care provider know as soon as possible if that is the case. 5
Our recommendation si to wait until you are 6- 7cm dilated to get the epidural. Getting the epidural too early can stall labor. Once you’re at 8cm, you’re so close that it may not make sense unless it's been a really long labor and you're looking to rest.
Occasionally, some women are allergic to the medication. There isn’t a good way to test for this allergy, but you can ask for it to be administered in small test doses to start. 6
Studies have shown that epidurals can cause maternal fevers and in turn affect the baby. If you have a fever after birth, often the baby is taken to the NICU for 48 hours to ensure that they haven't developed any infections. 7
There is a risk for pelvic and hip injuries caused when pushing. Injury can occur both with an epidural and without but not being able to fully feel your internal musculature can put you at a greater risk.
The medications in an epidural are the same as those used for anesthesia in Cesarian sections. In case of a C-section, the epidural is left in for about a day to help numb the pain after surgery. You will be given pain meds after the epidural is taken out, and the scar from the incision will be kept numb for a few weeks.

The Gate Control Theory of Pain–A natural alternative to relieve pain

Have you ever burned your finger and immediately run it under cold water for relief? The Gate Control Theory of Pain explains that there are two types of fibers that transmit messages to the brain–slow-acting fibers, and fast-acting fibers. However, before the pain signals reach the brain, they encounter neurological “gates” along the spinal cord. These gates filter pain signals to determine which ones reach the brain. Pain is perceived when the gates give way to these signals, and is less intense when the gates close. If the fast fibers are stimulated more than the slow fibers, the gates close, inhibiting transmission of pain impulses and reducing pain perception. So when we pour cold water over a burn, the water activates the fast acting fibers which closes the gates, which results in fewer pain impulses reaching the brain and reduces our perception of the pain from the burn.

When we apply sensory stimulation–such as heat, cold, water in a bath/shower, firm pressure, intradermal water blocks, Transcutaneous electrical Nerve Stimulation (TENS) and massage–the fast fibers are activated, endorphins are released, and the transmission of pain never reaches the brain, preventing us from perceiving it.

So while waiting for the epidural (if you choose to have one), to manage your pain most effectively use methods that take advantage of the Gate Control Theory of Pain. For example, place a heat pack on your low back in the same spot where an epidural would be administered, or have someone massage you in that same spot. You can see exactly where on your lower back an epidural is administered at this link.