What You Should Know About Walking Epidurals

Ultra-low dose anesthesia promotes mobility and control

Pregnant Caucasian woman timing contractions in hospital
JGI/Jamie Grill / Getty Images

Pain relief is commonly prescribed during childbirth, especially if there were complications during pregnancy or labor. One of the most common forms of pain relief is a procedure called an epidural in which anesthesia is administered directly into the epidural (outermost section) of the spinal cord. 

More than of  50 percent women giving birth at hospitals use an epidural. The goal of the procedure is to provide analgesia (pain relief) rather than anesthesia (an all-body lack of feeling) so that a woman can more fully experience the delivery of her baby.

It works by numbing the lower half of the body beneath where the IV catheter is inserted into the spine.

As with anesthesia itself, there is more than one form of epidural a woman can undergo. One type is considered the continuous classic epidural, while the other is called a walking epidural (a.k.a. combined spinal epidural).

Difference Between a Classic and Walking Epidural

A walking epidural uses the same medications as a classic epidural only in far smaller amounts. The drug cocktail typically contains a narcotic (morphine, fentanyl) and a drug like epinephrine to prolong the anesthetic effect and stabilize the woman's blood pressure.

The walking epidural does not have a "deadened" numb feeling a classic epidural can cause; rather it provides enough pain relief for the woman to remain comfortable but still aware of her contractions. And despite its name, most women receiving a walking epidural will not walk, either due to leg weakness, low blood pressure, or simply choice.

(Many hospitals will discourage walking for insurance reasons.)

Advantages of a Walking Epidural

One of the advantages of a walking epidural is that the very ability to move promotes contractions.This, in turn, decreases pain and shortens the course of labor in most cases. It also decreases the need for forceps and vacuum extraction.

Mobility is especially useful in the second stage of labor (pushing) where the adoption of a more upright or squatting position can help with the birth. It also gives a woman more control over her body which may improve her emotional state as she during delivery.

Several studies have also shown that a walking epidural is associated with lower rates of cesarean birth.

Disadvantages of a Walking Epidural

On the flip side, having a lower dose of anesthesia translates into less relief in the event of extraordinary pain. As such, women will sometimes switch from a walking to classic epidural mid-labor. Fortunately, it's an easy switch to make, and relief is returned as soon as the higher dose drugs are delivered.

While a walking epidural exposes you to far lower doses of medication, it doesn't' entirely erase the risk associated with treatment. Common risks may include:

  • nausea
  • shivering
  • ringing in the ears
  • back ache
  • localized pain at the catheter insertion site
  • a sudden drop in blood pressure
  • difficulty urinating
  • a severe headache caused by the leakage of spinal fluid
  • in rare cases, nerve damage where the catheter was inserted

While there is no evidence that an epidural can cause damage to the baby, some mothers are understandably concerned that indirect exposure to the anesthetic drugs may affect the baby's respiration and heartbeat at birth.

It is important, therefore, to discuss both the benefits and risk of an epidural with your doctor and to see whether a walking epidural is an appropriate option for you.

Sources

  • Rao, Z.; Choudhri, A.;  Naqvi, S.; et al. " "Walking epidural with low dose bupivacaine plus tramadol on normal labour in primipara." J Coll Physicians Surg Pak. 2010; 20(5):295-8.
  • Wilson, M.; MacArthur, C.; Cooper, G.; Shennan, A.; COMET Study Group UK. "Ambulation in labour and delivery mode: a randomized controlled trial of high-dose vs mobile epidural analgesia." Anaesthesia. 2009;64(3):266-72. 

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