If you’re thinking about an epidural to help manage the pain of childbirth, you’re not alone. A full two-thirds of women delivering at hospitals elect for an epidural during labor and delivery, and with good reason: Epidurals eliminate the pain of contractions, you’ll be awake and alert during the birth, and they’re considered one of the safest methods of pain control available.
Here’s the lowdown on how epidurals work and potential side effects. As always, discuss your wishes related to pain relief with your doctor ahead of time so you both know what to expect.
What is an epidural?
An epidural is a numbing agent that may be a combination of analgesics (pain relief without the loss of muscle movement) and anesthetics (pain relief with a loss of sensation). It's the most common type of pain control used in childbirth.
Epidural drugs stay in the epidural space and do not enter the bloodstream, which means that the drugs don't circulate to your baby.
Here’s a little more about the various epidural types that you’ll likely be offered:
- Epidural block. This block, which is a combination of analgesics and anesthetics, is the most commonly administered type of epidural during childbirth. It’s given through a tiny tube in the lower back. You’ll enjoy pain relief but will still be alert and able to push when the time comes.
- Spinal block. This single shot of pain relief is directed into the fluid surrounding the spinal cord. It kicks in quickly, lasts about an hour or two, and is usually given during C-section deliveries.
- Combined spinal-epidural. A combined spinal-epidural (or CSE) is a mix of the above two and works to both block pain and offer continual relief as needed.
How does an epidural work?
An epidural is injected directly into the spine via a catheter — technically, into the epidural space, between the ligament that sheathes the vertebrae and the membrane that covers the spinal cord. By placing it here, you can be given continuous medication as needed. Once an epidural is inserted, you’ll most likely feel pain relief within about 10 to 15 minutes.
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As part of the epidural process, you’ll first be hooked up to IV fluids to prevent a blood pressure drop. Depending on the hospital’s policies, a urinary catheter may be inserted into your bladder just before or after the epidural is administered to drain urine while the epidural is in effect, since you may not feel the urge to go to the bathroom. In other hospitals, the bladder is drained with a catheter as needed.
Are epidurals safe?
Epidurals are known to be very safe and any serious complications or side effects that arise are extremely rare. Very little medication is needed to numb and block the pain with an epidural, which makes it one of the safest methods of pain control during labor and delivery.
How big is an epidural needle?
The epidural needle is wider than the one used for flu shots and usually three and a half inches long. To prep for the needle, you’ll receive local anesthesia on a small area of your low- to mid-back, which will be sterilized with antiseptic. Once you’re numb, you’ll lie on your side or lean over, with support from a nurse, while a larger needle is inserted into the spine’s epidural space.
The needle is removed, leaving a fine, flexible catheter in its place through which the drug is delivered. The tube is taped to your back so you can move from side to side. Three to five minutes after the initial dose, the nerves of the uterus begin to numb and after about 10 minutes, you'll feel the full effect, though it can take 15 or 20 minutes for some women.
The medication numbs you from the bottom of your ribcage down, making it hard to feel any contractions at all. And that's the point!
If you end up having a C-section later in your labor, the amount of medication will be bumped up so you'll no longer be able to feel your lower half at all.
Does it hurt to get an epidural?
Some women report feeling pressure, tingling or momentary shooting pain when the epidural is being administered. If you're lucky (and many women are), you might not feel a thing. Besides, compared to the pain of contractions, any discomfort from a needle poke is likely to be pretty minimal.
What is a “walking epidural”?
A combined spinal-epidural or epidural block are commonly known as a "walking epidural." A walking epidural uses a smaller amount of medication and allows for motor control of the legs. Both of these types of epidurals are different from the epidural you would receive during a C-section, which is a much higher dose and doesn't allow for movement of the legs.
The anesthesiologist will start you off with a shot of analgesic directly into the spinal fluid to help relieve some pain. But because the medication is delivered only in the spinal fluid, you'll still be able to feel and use the muscles in your legs. When you need more pain relief, more medication is placed into the epidural space (through a catheter inserted at the same time the spinal medication is given).
Don’t be fooled by the name — even with a so-called "walking epidural," your legs will be weak, so you wouldn't be able to get up and walk around as your legs wouldn't completely hold you up.
When can you get an epidural during labor?
An epidural can usually be given as soon as you ask for one (and an anesthesiologist is available), even if you’re minimally dilated. Because you’ll have to sit very still for the shot to be given between contractions, and this gets harder as labor progresses, it’s a good idea to ask for the epidural relatively early in the labor process.
Does labor still hurt if you have an epidural?
It’s normal to worry that you’ll still feel some pain even after you’ve been given an epidural. Most women experience great pain relief with an epidural, but it won’t be 100 percent pain-free. Many women report feeling pretty comfortable after receiving an epidural, but there’s also some pressure felt when the contractions occur and you need to push.
The bottom line: Though you’ll be numb to the pain, most women find they’re still able to push effectively with coaching. You likely will still have some sensation, but you'll feel removed from it.
Does an epidural slow down labor?
There’s no evidence that an epidural will slow down labor, but getting one may extend the length of the second stage of labor by an hour or more with your first baby and less with subsequent children, according to some research. One study found that epidurals may up your labor by two hours whether it's your first baby or not. Happily, studies show that an early epidural doesn't increase your risk of C-section.
But if your labor doesn’t move along with pain-free pushing, the medication can be adjusted so you feel your contractions more strongly again. Likewise, the medication can be bumped up post-delivery as your doctor repairs any perineal tears. Should your labor slow at any point, you might receive Pitocin to get your contractions up to speed.
How long does an epidural last?
The numbness you may feel in your legs can linger until the medication wears off, which is usually within about eight hours.
Does an epidural have any risks?
As the epidural drug kicks in, the medication causes some women experience a decrease in their blood pressure, so yours will be monitored continuously. To counteract any dips in pressure, IV fluids are given and lying on your side may be suggested.
Less common epidural side effects include mild back pain, headache, fever or soreness. The opioids in the epidural may cause you to feel itchy (which can be taken care of with another medication) and, in rare cases, may cause nausea and vomiting.
Does an epidural have side effects?
While epidurals are generally extremely effective, some people experience side effects that can include:
- One-sided pain. Some women might experience numbness on one side of the body only (as opposed to complete pain relief). And epidurals may not offer complete pain control with back labor (when the fetus is in a posterior position, with the head pressing against your back).
- Slightly limited birthing options. With an epidural, you won't be able to labor in water. And if you're hoping to deliver at a birthing center, know that they don't offer epidurals. That means if you end up wanting one, you'll have to be transferred to a hospital.
- Troubling peeing. Lastly, having an epidural and/or catheter may decrease the sensitivity of the bladder or your alertness to its signals, which may make urinating in the first 24 postpartum hours a bit more challenging.
Can you get an epidural if you’re pregnant with multiples?
If you’re expecting twins or more, an epidural might be strongly encouraged — or even mandated — by your hospital, in case a vaginal birth isn't possible and an emergency C-section is required.
If you’re hoping to avoid an epidural and are expecting multiples, speak with your practitioner and hospital ahead of time, because their policies could differ.
Can you get an epidural if you have a tattoo?
A lower-back tattoo shouldn't stop your anesthesiologist from giving you an epidural during labor. As long as the tattoo ink is dried and the wound is healed, sticking that needle through it won't be risky. Research related to tattoos and epidurals is limited and reports of problems between the two are rare.
If, however, you got a tattoo during pregnancy and the skin is still red and inflamed (tattooed skin takes at least two weeks to heal), you may not be able to get an epidural if the art covers your entire lower back. In that case, poking an epidural needle through the skin can boost the chances of an infection, and your anesthesiologist won't want to take that risk.
If you're still unsure about how the anesthesiologist will react to your body art, consult with your practitioner or the hospital before you go into labor so you know whether it will raise any issues.
Can you get an epidural if you have scoliosis?
Scoliosis usually does not interfere with an epidural, though it may make it a little more difficult to place the needle, especially if you have a corrective rod low in your spine.
Let your doctor know about your scoliosis ahead of time and share recent X-rays, if you have them. Still, an experienced anesthesiologist should have no problem inserting the epidural needle where it needs to go.
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