Last updated Dec. 28, 2017.
The thought of giving birth is intimidating — we’ve seen plenty of depictions of painful deliveries with screaming and crying and breathing exercises and fainting partners. Labor can be painful. You have to squeeze a relatively large baby through a relatively small passage, and that takes a lot of stretching, pressure, and contractions. Of course, every delivery is different and people experience varying degrees of pain.
Over the past 40 years or so, epidurals have become a popular way to manage the pain of labor. In fact, more than 60% of deliveries in U.S. hospitals involve an epidural. An epidural has pros and cons, like any medical procedure. Here’s what you need to know when deciding whether you should have an epidural.
What is an epidural?
An epidural is a “regional analgesic” — a medication used to manage the pain in a specific area of the body. An epidural is used to block the nerve signals from the lower part of the spine, decreasing the pain you feel from the lower part of your body. It’s often combined with narcotics or opioids to increase pain relief and decrease the amount of anesthetic required.
An epidural is not just a shot. If you’re receiving an epidural, you’ll need an IV drip and monitors for both yourself and the baby. Then, you’ll either lay on your side or sit up and arch your back. You’ll receive a shot of local anesthetic over your spine. For a regular epidural, your anesthesiologist will insert a larger needle into the epidural space surrounding your spinal cord and use it to thread a small epidural catheter into that area. For a “combined spinal epidural” (CSE), the anesthesiologist will first inject a local anesthetic into the area around your spine, then place the catheter. The catheter will be taped down to keep it in place and it will start to deliver the epidural drugs. A CSE and an epidural function much the same way, but the CSE kicks in faster.
There’s a limited window within which you can get an epidural. Your doctor will want to wait until your cervix has already dilated to 4-5 centimeters; an earlier epidural may slow down the labor process. If you’re already fully dilated, it’s too late. Once the epidural is in place, it can take anywhere from 10-20 minutes to kick in.
An epidural can only be administered at a hospital, so it’s not an option for home births or at most birthing centers.
See also: Where Should I Give Birth?
The biggest epidural benefit is the pain relief. In addition, an epidural will allow you to stay awake and alert if you need a C-section. If you don’t have an epidural in place and the doctor decides that a C-section is necessary, they may have to use general anesthetic, meaning you’ll be unconscious for the birth.
See also: C-Sections: Everything You Need to Know
Like any medical procedure, an epidural comes with certain risks. Possible epidural side effects include:
- decreased blood pressure
- difficulty urinating
- pain at the site of the epidural
If you’re receiving low doses through the epidural, you may still be able to walk around with assistance. However, a full-strength epidural will make your legs go numb and you may not be able to walk. Because of the risk of a drop in your blood pressure, you’ll need to have frequent blood pressure checks and constant monitoring of the baby’s vitals. You’ll also need to have an IV so that your doctor can give you fluids to increase your blood pressure if necessary.
You may not be able to feel it when your bladder is full and you may not be able to urinate effectively, so you may need a catheter for the duration of the delivery process.
An epidural may make you so numb that it’s difficult to feel your contractions or push effectively. That may make the labor process longer. If you’re unable to push, you may need a dose of Pitocin to induce contractions or your doctor may use forceps to speed up the delivery process. Note that Pitocin may cause you to contract so hard that it causes fetal stress, which can be dangerous for the baby. In addition, the use of forceps or other delivery-assist tools come with a risk of lacerations and bruising for both you and the little one.
Sometimes, the epidural will only work on one side of the body or will work less well on one side than the other. The epidural may also be less effective if you have abnormal spinal anatomy or if the catheter is placed incorrectly. However, this is not common — epidurals are effective 98% of the time.
In very rare cases, an improperly placed or improperly sterilized epidural can cause a serious nerve infection.
How do epidurals affect the baby?
Epidurals have not been found to have any long-term effects on the baby. As mentioned above, deliveries with epidurals tend to take longer than those without, which can increase the risk of fetal stress. As epidural technology has advanced, anesthesiologists have learned to use smaller doses and more individually tailored drugs to deliver better pain management while still allowing effective labor and pushing. That means it’s even less likely that the epidural will affect the baby.
The drop in blood pressure sometimes caused by epidurals could be dangerous if left untreated, but your blood pressure should be regularly monitored if you have an epidural and any issues should be treated immediately. If a blood pressure drop is caught and treated in a timely fashion, it won’t harm you or the baby.
Some studies have found that babies may have a harder time suckling if an epidural was used during delivery, but other studies have found that not to be the case.
In other words, epidurals are widely accepted as safe for both mother and child.
Should I get an epidural?
In some cases, an underlying health condition makes an epidural dangerous or impossible. If you have low blood pressure or a bleeding disorder, the risk of your blood pressure dropping due to the epidural is too great. You should not have an epidural if you’re allergic to any type of anesthetic. You’ll also need to talk to your doctor about any medications you’re taking because some drugs increase your risk for side effects when combined with anesthetics.
If you are not able to use an epidural, you may want to talk to your doctor about other options for pain management during labor.
Unless you have a health condition that prevents you from having an epidural, it’s your choice. Some people want to feel the entire process while others prefer not to. Some people choose to give birth at home or at a birthing center, where an epidural is not an option, while others give birth at a hospital where epidurals are available.
Well before you go into labor, think about how you want to handle your delivery. Discuss your health and your questions with your doctor so you have all the information you need before you make a decision. You may also want to check with your insurance company to see what types of pain management are covered; not all health care plans cover the cost of an epidural. It may be helpful to have a birth plan in place so you know what to expect and so your partner and doctors know your wishes. You can change your mind on the big day, but keep in mind that an epidural cannot be administered at home or at most birthing centers.
You should have an epidural if you want one and you shouldn’t have an epidural if you don’t — the choice is yours!