First off, no such thing as a 'pain free birth' If I could find the no-good-so-and-so that's been spreading that rumor, they'd get some quality ICU time
Epidurals control/eliminate most
of the pain, the sharpness of the contractions, but it's called labor for a reason, and it's gonna hurt a little bit. I love a good epidural, especially for long labors. Moms get comfortable enough to get much needed rest, the support person can go get some food, walk, etc. But, they don't always work. Women get so wrapped up in the idea of getting an epidural, being pain free, that when we can't get a good one (and it takes a lot
for us to give up) they don't have any backup coping skills. They didn't attend childbirth classes, have no idea what methods they can use to get through the process. CRNA tries and can't get it in or gets a one sided block, calls the MD and then the anesthesiologist can't get it any better. Now what?
Even if the epidural works, I've seen moms progress out of it, if that makes sense? Make huge progress in a single contraction, and that's pain no epidural can control. There's intense pressure as the head comes down also, and most of the time we can't eliminate that pressure/burn as the baby crowns and delivers
Some docs won't let moms get an epidural until 4cm, others let her have it whenever she needs it (as long as she's actually in labor.) Research to support both positions (some say epidurals slow labor, others say it makes no difference) I've seen labor fizzle out after one, I've also seen moms go from 3cm to complete in an hour once they get comfortable and relax.
We turn them off if mom is too numb to push effectively (sometimes they aren't able to push at all) if moms BP has a huge drop we'll turn them off until anesthesia gives some neo to bump them up, and occasionally for a high block with mom c/o SOB or tingly fingers. If it's working the way it's supposed to, we leave them running until after delivery so any repairs can be done comfortably. If we turned it off for pushing and mom is starting to get uncomfortable we can have the CRNA bolus them or set the pump for a lower rate.
The options we have are IV meds-nubain Q2, until about 2 hours prior to delivery or epidurals. Occasionally anesthesia will do an interthecal, think shorter acting spinal, for fast progressing moms. They go in and work faster than epidurals. The OBs can do a pudendal block, but not many moms are excited about having lidocaine injected into the nerves in their who-who :uhoh21: Most OBs don't use them effectively either. Lido takes a few minutes to set up, but they usually don't do the block until they're ready to deliver.
Hope this info helps