Walking Epidural: Fact & Fiction
For as many pregnant women walking the earth at any given time, there are just as many ideas about what an “ideal” birth would look like, with varied expectations about the setting, medical interventions, and pain medication. It’s no secret that when it comes to everything from shopping to child-bearing, many women want options—the more, the better.
We spoke with Darren Tate, M.D., OB/GYN and physician on the medical staff at Texas Health Fort Worth, about the walking epidural to find out what this strange-sounding procedure is and what it does.
Q: What exactly is a walking epidural?
A: Sometimes the anesthesiologist will give a narcotic in the epidural space which doesn’t paralyze the nerves, so some people call that a walking epidural. Or it can also refer to a “regular” epidural with a much lower dose, but really both are misnomers.
Very few hospitals will allow patients to walk once they’ve been given an epidural, so it’s very misleading. It might be hard to keep your balance and some patients might be more likely to fall, so it’s a concern.
I tell patients that the whole point of an epidural is pain relief, but there is something to be said for using lower doses so women can still move around in bed and help push. The amount of medication is always up to the anesthesiologist, so it varies at different institutions.
Q: What are some of the biggest misconceptions about epidurals?
A: There are really two main misconceptions about when they do and don’t work. Women will say that when it came time to push, their epidural stopped working. The truth is that once the baby gets under the pubic bone, it’s just a different pain. The epidural is more about helping ease pain during contractions, so they work beautifully in the first stage. Once you get into the second stage of labor, it’s going to be more painful but that doesn’t mean your epidural didn’t work.
The other misconception is that an epidural will “wear off” during a long labor. Occasionally these longer labors will malposition the epidural catheter and knock it out of place, but they don’t just wear off.
Q: What should pregnant women know about epidurals?
A: Some hospitals are known for how thorough their block is and some are known for using less medication, but I don’t know of anybody that allows patients to walk, regardless of the amount of anesthesia. Women have choices and there are all kinds of pain-relieving strategies, but at the end of the day, epidurals are the most effective method of pain relief during labor.
The main limitation is that you’re flat on your back, which can be boring. There are also some health risks, like blood clots, and long inductions can be tough.
Q: If a woman isn’t sure whether an epidural is right for her, what would you say?
A: Birth plans can be self-defeating. If you and the baby are medically safe enough to go into natural labor that’s fine, but the more interventions we do, the more it leads to other interventions. At the end of the day, whatever you choose, it’s ultimately about having a healthy mom and a healthy baby.
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