Epidural for labor: What is an epidural, epidural side effects, and more (2024)

What is an epidural?

An epidural is the most commonly used method of pain relief for labor in the United States. It provides continuous pain relief while allowing you to remain fully conscious.

An epidural for childbirth reduces sensation in the lower half of your body but doesn't cause a total lack of feeling. You'll likely still feel the pressure of your contractions (which will be helpful when it's time to push) and be aware of (but not bothered by) vagin*l exams during labor. And you'll still be able to feel your baby moving through the birth canal and coming out.

Epidural medication is delivered through a catheter – a very thin, flexible, plastic, hollow tube – that's inserted into the epidural space just outside the membrane that surrounds your spinal cord and spinal fluid. Because they require an anesthesiologist, epidurals are usually only available in hospitals, not birth centers.

The medication delivered by the epidural is usually a combination of:

• a local anesthetic (this blocks sensations of pain, touch, movement, and temperature)
• a narcotic (this blunts pain without affecting your ability to move your legs)

Used together, the anesthetic and narcotic provide good pain relief at a lower total dose than you'd need with just one or the other, while allowing for more sensation in your legs.

While there are some small and rare risks, epidurals are considered a very safe way to manage childbirth pain.

What is the epidural procedure like?

Here's a step-by-step guide to what happens when you have an epidural:

1. Injection prep: You lie curled on your side or sit on the edge of the bed while an anesthesiologist cleans the injection site, numbs the area, then carefully guides a needle into your lower back – into a small space outside your spinal cord.
2. Catheter insertion: The anesthesiologist then passes a catheter (a small, soft tube) through the needle, withdraws the needle, and tapes the catheter in place. At this point, you can lie down without disturbing the catheter, and medication can be administered through it as needed.
3. Test dose, full dose, and monitoring: First you're given a small "test dose" of medicine to be sure the epidural was placed correctly, followed by a full dose if there are no problems. Your baby's heart rate is monitored continuously, and your blood pressure and heart rate are taken every five minutes or so for a while after the epidural is in to make sure it isn't causing any concerning changes in these vital signs.
4. Medication takes effect: You'll start to notice the numbing effect about 10 to 20 minutes after the first dose of medication, though the nerves in your uterus will begin to go numb within a few minutes. You'll receive continuous doses of medication through the catheter for the rest of your labor.
5. Adjusting your medication: You may also have the option of patient-controlled epidural analgesia (PCEA), which means you can control when you get more medication through a pump that's connected to the catheter. The amount of medication you can give yourself is limited, so there's no chance of overdose.
6. After you deliver your baby: The catheter will be removed. (If you've had a c-section, sometimes the catheter is left in to administer postoperative pain medication.)

How long does an epidural last?

The pain relief from an epidural can last as long as you need it. Once the epidural is in place, the medication can be increased or decreased throughout your labor.

Sometimes women find they need an additional amount of epidural medication (sometimes called a "redose") as their labor progresses. This can be safely given by the anesthesia team (using the same catheter already in place).

Does an epidural hurt?

Most women don't find the epidural insertion painful, though it can be briefly uncomfortable. The anesthesiologist will numb the skin before inserting the needle. You might feel a pinch or stick followed by some pressure – much like you would having an IV inserted.

The needle is removed once the catheter is in place, and the catheter isn't painful or uncomfortable. Having the catheter removed when you're finished doesn't hurt at all, either, beyond the sensation of having the tape pulled off.

Pros and cons of an epidural

Advantages of having an epidural:

• It provides a route for very effective, safe pain relief that can be used throughout your labor.
• The anesthesiologist can control the effects by adjusting the type, amount, and strength of the medication. This is important because as your labor progresses and your baby moves down into your birth canal, the dose you've been getting might no longer be adequate, or you might suddenly have pain in a different area.
• The medication only affects a specific area, so you'll be awake and alert during labor and birth. And because you're much more comfortable during labor, you can rest (or even sleep) as your cervix dilates and conserve your energy for when it comes time to push.
• Unlike systemic narcotics, only a tiny amount of medication reaches your baby.
• Once the epidural is in place, it can be used to provide anesthesia if you need a c-section or if you're having your tubes tied after delivery.

Disadvantages of having an epidural:

• You'll lose some sensation in your legs and be unable to stand or walk around. Many women want to be able to continue to move around, especially in early labor. Some will defer their epidural until later in labor when they're exhausted and ready to rest. (A "walking epidural" means that you still have what feels like normal strength and sensation in your legs because you're getting a lower dose of anesthetic. It's still not safe to walk around, though. And it's a difficult balance to achieve – many women don't feel adequate pain relief at this dose.)
• You'll have to stay still for 10 to 15 minutes while the epidural is put in, and then wait up to 20 minutes before the medication takes full effect.
• You'll need an IV, frequent blood pressure monitoring, and continuous fetal monitoring.
• An epidural can prolong the pushing stage of labor. That's because the epidural naturally blunts the intense sensation of pressure from the baby's head on your pelvic floor – giving you less immediate feedback as you work to push your baby out. You may want to have the epidural dose lowered while you're pushing so you can receive more of your body's cues – but the change may take time to take effect, and it also can raise your pain level significantly. Sometimes it's hard to find that "sweet spot." There's also no evidence that reducing the epidural dose actually shortens this stage of labor.
• In some cases, an epidural provides spotty pain relief. This can happen if the medication doesn't manage to reach all your spinal nerves as it spreads through your epidural space and because every woman has variations in anatomy. Previous spinal surgeries can complicate your epidural effectiveness, too. Be sure to discuss any history of spinal surgery or scoliosis with your ob-gyn before delivery. You may benefit from an anesthesia consult prior to labor to discuss your specific case.
• The catheter can also "drift" slightly, making pain relief spotty after starting out fine. (If you notice that you're starting to have pain in certain places, ask for your dose to be adjusted or your catheter reinserted.)
• The drugs used in your epidural may temporarily lower your blood pressure, reducing blood flow to your baby and slowing their heart rate. (This is fleeting and easily treated with fluids and sometimes medication.)
• Epidurals are associated with a higher rate of babies in the posterior position at delivery. Women whose babies are face-up have longer labors, tend to need Pitocin more often, and have a significantly higher rate of c-sections. However, there's controversy over whether having an epidural actually contributes to babies ending up in this position (because the pelvic floor is relaxed) or whether women whose babies are in the posterior position have more painful labors and so request epidurals more often.

Epidural side effects

Epidural headache

About 1 in 100 women develop a spinal headache in the days after the procedure. This can happen if the epidural needle punctures the bag of fluid that surrounds the spinal cord, causing the fluid to leak.

Let your provider know if you have a headache when you're upright that goes away when you're lying down. The problem can be treated with an epidural blood patch, a procedure in which blood is taken from your arm and injected into your back, where it clots and seals the hole caused by the needle. It's best if you can have this procedure while you're still in the hospital, but you can always return to the hospital to have it done.

The headache pain can be severe and can last for days or even weeks if not treated. Some women continue to have headaches even after treatment.

Fever

An epidural raises your risk of running a fever in labor. No one knows exactly why this happens, but one theory is that you pant and sweat less (because you're not in pain), so it's harder for your body to give off the heat generated by labor. This doesn't boost your or your baby's odds of getting an infection, but because infections in labor are common, it can be unclear whether the fever is from the epidural or an infection. So you and your baby may need to take antibiotics.

Other epidural side effects

• Itching: Narcotics delivered through an epidural can cause itchiness over the areas of the body the epidural is affecting (your abdomen and legs).
• Soreness for a few days at the insertion site.
• Decrease in your blood pressure while the infusion is running and especially with the initial dosing.
• Nausea and vomiting: Epidurals may bring on nausea, typically if the initial drop in blood pressure is significant. Nausea is less likely with an epidural than from systemic narcotic medication. Also, many women feel nauseated and throw up during labor even without pain medication.
• Anesthetics delivered through an epidural can make it impossible to tell when you need to pee. You'll have a catheter inserted into your urethra to drain urine during your labor.
• In very rare cases, if an epidural travels too high, it can affect your breathing muscles. Your obstetric and anesthesia team can safely deal with this complication, though.
• Also very rarely – if the anesthetic is injected into a vein instead of a nerve – numbness, tingling, or rapid heartbeat can occur. Ruling this out is what the "test dose" is for prior to fully dosing the catheter.
• Epidural hematoma. In extremely rare cases, you can have bleeding near the spinal cord that can push on your spinal cord or nerves, causing pain and perhaps damage. That's why your team will check your platelet count and sometimes test for your ability to form clots before placing your epidural. It's also why you need to stop taking most blood thinners 12 to 24 hours before receiving an epidural.
• Epidural abscess. This can happen when the epidural area becomes infected by bacteria, forming an abscess that presses on the spinal column. It's extremely rare but can cause paralysis or even death if not treated quickly.

The best time to get an epidural during labor

Most epidurals are placed during the first stage of labor, once you're having regular and painful contractions. But you can get an epidural at any time in labor, depending on your preferences, how busy the unit is, and your medical history. Talk with your midwife or doctor about the best timing. Keep in mind that it can take 20 minutes to work, and your anesthesiologist may be busy and not able to come immediately.

In the past, many providers wanted a woman to be in active labor (when contractions become intense and your cervix begins to dilate more rapidly) before starting an epidural because there was a concern that it might slow down contractions. Some providers still prefer to wait until active labor. However, studies have shown starting an epidural in early labor, compared with later in labor, is not more likely to prolong labor or lead to a c-section or other interventions.

If you're trying to have a vagin*l birth after a cesarean section (VBAC), your obstetrician may encourage you to get an epidural on the early side to ensure that you have reliable and quick anesthesia available in case you need a cesarean delivery.

If you want to put off the decision on whether to have an epidural, you could get some narcotic pain medication through an IV to take the edge off your early labor contractions and allow you to rest. You can then get an epidural later in labor if you decide to. This kind of systemic pain relief can make you sleepy, so you'll need to stay in bed. It can also make your baby sleepy and less interested in breathing after birth, so your providers won't want to give it to you close to delivery. These narcotics wear off for both you and your baby after a few hours, so getting them early is no problem.

Alternatively, if you arrive at the hospital before you're in active labor and know you want an epidural later on, you can ask whether the anesthesiologist can place the catheter as soon as you're settled. Then you can wait to start the medication when active labor begins.

Is it ever too late to get an epidural?

It's never too late to get an epidural, unless the baby's head is crowning. It takes as little as ten to 15 minutes to place the catheter and start getting relief, and another 20 minutes to get the full effect.

However, in certain circ*mstances, it may be harder to get an epidural late in labor because:

• The anesthesiologist may be busy with other patients, so it could take longer for them to arrive once you decide you want this pain management.
• Your labor and delivery team may encourage you to manage without pain medication if they think you'll deliver your baby soon.
• Your anesthesiologist may decide it's too risky to try to place the needle if you're unable to remain reasonably still during contractions. Luckily, most women are able to hold still, and your labor team can warn the anesthesiologist when a contraction is coming, if necessary.

Other pain medication during labor

Systemic medications

Systemic painkillers, such as narcotics, dull your pain but don't completely eliminate it. They affect your entire body rather than concentrating pain relief in the uterus and pelvic area.

Systemic drugs are either delivered through an IV line to your bloodstream or injected into a muscle. They may make you feel sleepy. However, unlike the general anesthesia that's often given for surgery, these drugs won't make you unconscious.

You may also be given a tranquilizer – alone or in combination with a narcotic – to reduce anxiety or nausea, or to relax you. In some hospitals, you may be offered nitrous oxide – laughing gas – which you inhale during contractions.

Systemic analgesics can cause itching, nausea and vomiting, drowsiness, and trouble concentrating. Just as they affect you, they can affect your baby. If given within a few hours of delivery, these drugs may temporarily impact your baby's breathing. (Your baby may then require oxygen or other support.) Narcotics may make your baby drowsy, too, making it harder to breastfeed for a few hours after delivery.

Spinal block

A spinal differs from an epidural in two ways:

1. It's delivered directly into the spinal fluid (rather than into the space just outside the membrane that surrounds the spinal fluid), and
2. It's a one-time injection rather than a continuous feed through a catheter.

As a result, relief is rapid and complete but lasts only an hour or two.

Your practitioner may order a spinal block if:

• You decide you want pain relief late in labor or,
• You're progressing so rapidly that delivery is likely to be relatively soon, and you can't wait for an epidural or,
• You're having a cesarean delivery

A spinal block and epidural have the same side effects and risks.

Combined spinal/epidural

A combined spinal/epidural (CSE) block offers the rapid pain relief of a spinal block and the continuous relief of an epidural.

You may opt for a combined spinal/epidural so you get immediate relief from the spinal while you're waiting for the epidural to work. A CSE has the same side effects and risks as an epidural.

Can anyone have an epidural?

Not all women are good candidates for this kind of pain relief. You won't be able to have an epidural if you:

• Have abnormally low blood pressure (because of bleeding or other problems)
• Have a bleeding disorder
• Have a blood infection
• Have a skin infection on the lower back where the needle would be inserted
• Had a previous allergic reaction to local anesthetics
• Had back surgery involving spinal fusions or Harrington rods or have significant scoliosis

Note that if you're taking certain blood-thinning medications, you can get an epidural if enough time has elapsed since your last dose. It's very important to discuss any blood thinning medications with your obstetric and anesthesia team.

If you have any concerns about whether an epidural is safe for you, discuss them with your provider during your pregnancy. Most hospitals also allow you to consult with an anesthesiologist, too, once you arrive at the hospital.

Learn more:

• What does labor feel like?
• Signs of labor
• Natural ways to induce labor