Women's Health
Childbirth Pains & Back Injections

​​​Overview:

  • A back (or epidural) injection is an injection into the back to relieve pain in the lower half of the body.
  • Back epidural may be useful during labor.
  • In specific cases, epidural injections are not recommended.
  • Back epidural injections are mostly safe. In rare cases, though, they may develop complications.
  • There are several alternatives for anesthetization during labor.
Childbirth pains:
1. Labor pain (occurring due to cervical contractions and dilation)
2. The pain caused while the baby’s head passes through the birth canal
3. Post-C-section pain
Childbirth pains may vary from one woman to another, owing to:
  • The genetic factors controlling the ability to bear pain;
  • The baby’s head position during labor (the cephalic posterior position is more painful);
  • Induced pain (more painful);
  • Emotional support (may alleviate pain);
  • Other factors.
What is back injection?
An injection into the lower back (lumbar spine), intended to relieve pain in the lower organs of the body during labor or surgeries.
Types of back injection:
  • Epidural: an anesthetic injected into the epidural space.
  • Spinal: an anesthetic injected into the spinal cord.
  • Combined spinal-epidural (CSE): used by the anaesthetist, if the need arises, for anesthetization.
Uses:
  • Labor (mostly epidural anesthesia)
  • C-section procedure (spinal or epidural anesthesia)
  • Several lower-body surgeries
  • Post-surgery pain relief
Key information about back injections:
  • Taking a back injection is not mandatory; it’s the patient’s choice to make.
  • To date, there is no better labor pain reliever than the epidural injection.
  • During injection (incision of the needle), it is important for the woman to remain calm and quiet, and breathe naturally.
  • If pain persists after injection, the doctor should be informed to take an action.
  • The epidural is prefect for relieving labor pain, but it has little to do with the pain caused by the pressure of the baby’s head on the vaginal wall—which lasts only for a brief period.
  • In about 6% of cases, the medicine is injected into the epidural space, causing it to have but a limited effect, in which case the anaesthetist should intervene by reinjecting the epidural medicine.
  • In the case of spinal anesthesia, usually used for C-section procedures, only the pain nerves are anesthetized, while the sensory nerves (that respond to touch and pressure) remain working. It is normal for the pregnant woman, as such, to feel touch or pressure during the procedure.
  • As a result of moving and pulling the uterus during C-section procedures, symptoms such as vomiting or nausea may appear, which the anesthetist may handle.
  • A high dose of the anesthetic agent (drug) taken through a spinal injection for a C-section procedure may anesthetize the lower body up to the upper chest, potentially making the pregnant woman feel anxious (since she can’t feel the motion of her chest during breathing, she may get the feeling that she is choked). The anaesthetist may need to reassure her that she is able to breathe normally and try to calm her down.
  • The effect of the anesthesia usually ends a few hours after injection, during which the patient should rest until the anesthetic effect is over, and the sensation of the legs is recovered.
  • Car-driving should be avoided for 24 hours after the procedure.
Benefits of back injections for labor/ C-section procedures:
  • More effective at pain relief than any other method;
  • Help the mother to take rest if the labor continues for too long;
  • When used for labor and childbirth, the amount of epidural drug that reaches the baby is small, relatively compared to intravenous drugs;
  • Epidurals, typically used for labor, can be used for emergency C-sections;
  • Using an epidural for a C-section procedure reduces the portion of the drug that reaches the baby, compared to general anesthesia. Besides, the mother keeps awake, which allows her to be involved in the experience, and, hence, tightens the bond between her and her baby;
  • Effective for post-delivery pains;
  • In some health conditions (especially heart and brain conditions), pain, labor, and pushing may pose a threat to the mother’s life—in which case an epidural would be necessary;
  • In cases where general anesthesia poses an imminent threat to the mother’s life, an epidural would be a safe alternative.
When to take the epidural injection?
  • When the contractions increase, the diameter of the cervix reaches 3-4 cm;
  • An epidural can be taken during the breaks between labor cramps;
  • When preparing for a C-section procedure.
Epidural technique:
The epidural injection is administered by an anesthetist.  
  1. Convenient body position: the position convenient for taking an epidural injection is to sit, lean forward, and hug a pillow. Meanwhile, nurses may help to support the body, fix the shoulders, and help breathe slowly.​
  2. Don’t worry if the labor contractions occur while taking the epidural injection.
  3. Sterilize the injection area, and apply a topical anesthetic agent to alleviate the pain of incision.
  4. An elastic, tube needle is incised between the vertebrae, in the space between the backbone and the outer layer of the spine (epidural space).
  5. A thin tube (catheter) is inserted through the needle.
  6. The needle is withdrawn, with the catheter left on the back surface.
  7. Through the catheter, the anesthetist injects frequent shots of the anesthetic drug.
  8. Varying according to the injection type and anesthetic agent, the effect usually begins one or 10-20 minutes after injection.
  9. The mother’s heart rate, blood pressure, oxygen level, and the baby’s heart rate should be monitored frequently.
Contraindications of epidurals;
  • The patient’s disapproval;
  • High blood pressure in the brain (intracranial pressure);
  • Thin blood, whether caused by a medical condition or blood thinners;
  • Inflammations in the lower-back (injection area);
  • Pregnancies requiring a C-section procedure, where excessive bleeding is anticipated;
  • In cases where the mother has previously undergone a major surgery in the lower back, epidurals may not be appropriate, yet spinal injections (in C-sections) may still be applicable.
Risks and side effects:
Epidurals are mostly safe, but some rare complications may occur, including:
  • Sudden drop of blood pressure—this is why examining the blood pressure constantly is necessary to make sure that sufficient blood flows to the baby;
  • Severe headache during incision of the needle—this is a rare side effect, and normally improved in a few hours;
  • Post-incision headache (that improves while lying, and worsens while standing)—it usually improves in a few days;
  • Pricking a nerve is very rare, and normally does cause a persisting problem;
  • Some other (normal) side effects (e.g. temporary pain or bleeding in the needle incision area, nausea, difficulty urinating, itching, numbness in the legs).
A few hours after the labor or C-section procedure, the mother is asked to walk, with the assistance of a healthcare provider.
Alternative anesthetics for labor:
  • Intravenous opioid painkillers (e.g. morphine);
  • Inhaling nitrous oxide gas (by using an inhaler);
  • Topical anesthetization of the vaginal opening area and the cervical area;
  • Regular breathing, back massage, and emotional support.
FAQ:
  • Q: Which is better for a C-section: spinal or general anesthetization?
    • A: To determine which is better for the pregnant woman, the anaesthetist needs to be aware of her specific condition and if she suffers from other diseases; thereupon, he recommends the option he deems appropriate. Generally speaking, though, spinal anesthetization is recommended in most cases, given its pluses.
Myths & Truths:
  • Back injections cause paralysis.
    • Truth: Back injections don’t cause paralysis, except in the case of thin blood.
  • The needle remains in the back.
    • Truth: The needle is withdrawn; what remains is the catheter.
  • Epidurals make pushing of the baby, during labor, more difficult.
    • Truth: If the recommended doses are followed, epidurals don’t make the baby-pushing more difficult.
  • Back injections cause chronic back pain.
    • Truth: Post-delivery chronic pain is not attributable to the back injection, but to the normal physical changes during pregnancy.
 
Clinical Education General Department
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