If you’re preparing for birth, chances are the word “epidural” has come up more than once. In the U.S., over 70% of people giving birth choose an epidural. Some people swear by them, others are firmly against them, and many feel unsure about how an epidural might affect their birth experience. Wherever you fall on that spectrum, you probably have questions:
What exactly is an epidural, and how does it actually work?
This post will answer those questions and help you feel more informed about whether an epidural is the right choice for you. Let’s dive in.
What Exactly Is an Epidural?
An epidural is a type of pain relief used during labor. It involves placing a catheter (a small plastic tube) in your lower back, into the epidural space surrounding your spinal cord. This delivers medication—usually a combination of a local anesthetic and an opioid—to block sensation in the lower half of your body.
The medication stays mostly in the spinal area, though a small amount may enter your bloodstream and reach your baby. The amount that reaches your baby is significantly less than what would pass through IV medications or general anesthesia.
What Happens When You Get an Epidural?
If you decide to get an epidural, here’s what the process typically looks like.
You can request an epidural at any point in labor, up until you can no longer sit still—or when your baby is about to arrive. Usually, people are admitted to the hospital when their cervix is 4 or more centimeters dilated. So most people get epidurals sometime between the time they are 4 centimeters dilated and the time they start pushing.
When it’s time, an anesthesiologist or nurse anesthetist will place the epidural. To start, you’ll be given IV fluids to help prevent a drop in blood pressure. Before the epidural, you’ll get a numbing injection. Once numb, you’ll sit or lie on your side, curving your back to make the epidural placement easier. A needle will be placed into your back, and over top of that needle, the catheter. Your partner (and any other people with you) will be asked to stand away from you during epidural placement to keep the area sterile and minimize risk of infection.
Once the catheter is in place, the medication is delivered either continuously or in small doses. You’ll also have a button to press if you need an extra boost, although the system ensures you can’t get too much medication.
It takes around 10 minutes to place the epidural. Relief typically begins within 10 to 20 minutes of placement. Many people describe the sensation as a band of numbness from their belly button to their upper legs, along with a feeling of heaviness in their lower body. Depending on how your body reacts, you may still feel some sensation in your feet or legs, but you won’t be able to walk or move freely.
While mobility is limited, you can often change positions with assistance. Some people even use tools like a squatting bar or birthing stool to push, depending on their care provider’s preferences.
What Are the Benefits of an Epidural?
Epidurals offer significant pain relief and additional benefits:
- Rest: An epidural can allow for much-needed rest during long labors, helping conserve energy for pushing.
- Mental Relief: For some, knowing pain relief is available reduces anxiety and helps them feel more in control.
- Focus and Presence: Some women say the epidural helped them stay engaged in their birth experience, rather than being consumed by pain.
- Relaxation and Labor Progress: In some cases, epidurals can even help labor progress. When pain and tension create resistance, the relaxation brought on by an epidural may allow your body to open up more easily.
Are There Downsides to Consider?
Like any medical intervention, epidurals have potential drawbacks:
- Mobility: Mobility is one of the biggest changes to prepare for—you won’t be able to walk or move around as freely as you might without one. You won’t be able to use gravity to your advantage for the baby to descend the same way you would without an epidural.
- Pushing Sensations: Most people don’t feel the natural urge to push with an epidural. Your care team will guide you, but some prefer the instinctive feedback that comes without pain relief.
- Side Effects: There are also potential side effects, such as a drop in blood pressure, itchiness, or nausea. More serious complications exist but are very rare.
- Longer Labor: Studies suggest that epidurals can increase the first stage of labor (where the cervix dilates) by around 30 minutes and the pushing stage of labor by 15-30 minutes.
- Additional Interventions: Epidurals come with additional monitoring and interventions. They require IV fluids, oxygen monitoring, added blood pressure checks, and possibly a urinary catheter (since you can’t get up to use the bathrooms) and Pitocin (if your labor slows down).
Making the Choice: Is an Epidural Right for You?
Deciding whether to have an epidural is deeply personal. It’s not about what anyone else would do—it’s about what feels right for you, your baby, and your values.
If you’re weighing the decision, consider how you feel about managing labor pain with or without medication. Think about whether mobility during labor is a priority for you and whether you’re open to trying other comfort measures, like breathing techniques or massage.
(Important Tip: Even if you plan to get an epidural, I highly recommend having some other coping methods ready to go. That way, if your epidural doesn’t work as expected or takes longer than expected, you can still have a positive birth experience.)
Also, ask yourself: If I plan NOT to use an epidural, are there circumstances where I might change my mind? Exploring these scenarios with your partner or support team can help you feel more prepared, whatever happens on the day.
How to Prepare for Your Birth Journey
Whether or not you choose an epidural, birth preparation is about understanding your options and making informed, confident decisions. This is where education and support become invaluable.
My Birthing from Within for Hospital Births class is designed to help you embrace birth as a profound and empowering journey. Together, we’ll explore tools, knowledge, and techniques to help you approach labor feeling strong, prepared, and supported—whether that includes an epidural or not.
Your birth is a journey worth preparing for, and you don’t have to navigate it alone.
You’ve got this.