Epidurals Explained: Everything You Need to Know Before Labor

The epidural is the most common form of pain relief during labor in the United States, with about 70% of women choosing this option. Whether you're strongly considering one or want to understand it just in case, this guide covers everything you need to know.

What Is an Epidural?

An epidural is a regional anesthesia that blocks pain signals from the lower part of your body. Unlike general anesthesia, you remain awake and alert throughout labor and delivery.

The medication is delivered through a small catheter (thin tube) placed in the epidural space of your spine—the area just outside the membrane surrounding your spinal cord.

How It Works

The Procedure

1. Positioning: You'll either sit up and curl forward or lie on your side in a curled position
2. Local anesthetic: The anesthesiologist numbs a small area of your lower back
3. Needle insertion: A special needle is inserted into the epidural space
4. Catheter placement: A thin catheter is threaded through the needle
5. Needle removal: The needle is removed; the catheter stays in place
6. Medication delivery: Pain medication flows continuously or in doses through the catheter
7. Taping: The catheter is secured to your back

The entire process takes about 10-20 minutes.

Time to Take Effect

You'll typically feel relief within 10-20 minutes of medication delivery. The effect can be adjusted throughout labor if needed.

What Does It Feel Like?

With an epidural, most women experience:

• Significant reduction or elimination of pain from contractions
• Numbness or tingling in the lower body
• Ability to still feel pressure (which helps with pushing)
• Heaviness in the legs
• Continuing awareness of contractions, but without the pain

Modern epidurals often aim for a "walking epidural" effect—enough pain relief to be comfortable while maintaining some sensation and movement.

Benefits of Epidurals

Pain Relief

The most obvious benefit: epidurals are highly effective at reducing labor pain. For many women, this allows them to:

• Rest during a long labor
• Be more present and calm during birth
• Have a more positive birth experience overall

Flexibility

If a cesarean section becomes necessary, the epidural can often be used for surgical anesthesia, avoiding general anesthesia.

Blood Pressure

For women with preeclampsia or high blood pressure, epidurals can help lower blood pressure during labor.

Rest and Coping

Pain relief allows many women to sleep during long labors, conserving energy for pushing.

Potential Risks and Side Effects

Common Side Effects

• Drop in blood pressure: Managed with IV fluids and positioning; may require medication
• Itching: Especially with certain medications; can be treated
• Fever: Slightly increased risk of fever during labor
• Shivering: Common but harmless
• Difficulty urinating: A catheter may be needed temporarily

Less Common Risks

• Headache: If the needle punctures the membrane (spinal headache), occurring in about 1% of cases
• Inadequate pain relief: The epidural may not work completely or evenly
• Prolonged pushing stage: Labor may take longer, though research is mixed
• Nerve injury: Very rare (about 1 in 4,000)

Important Notes

• Epidurals do NOT increase the risk of long-term back pain
• They do NOT increase cesarean rates (according to current research)
• The medication reaches the baby in very small amounts and is not harmful

Who Can Have an Epidural?

Most women in labor can have an epidural, but it may not be recommended if you:

• Are on blood thinners or have bleeding disorders
• Have certain infections
• Have had previous spinal surgery (discuss with your anesthesiologist)
• Are too far along in labor (though this varies by provider)

When Can You Get an Epidural?

Traditional Timing

Many hospitals have traditionally recommended waiting until you're at least 4-6 cm dilated to avoid slowing labor. However, recent research suggests epidurals can be given earlier without affecting labor progress.

Early Labor

Some women request epidurals in early labor, especially if they're exhausted or struggling to cope.

Late Labor

If you're very close to delivery, there may not be time for an epidural to take effect. At that point, other options may be suggested.

The Bottom Line on Timing

Discuss timing preferences with your provider beforehand. Know that "no epidural" can change to "yes, please" at any point—and that's completely okay.

What You Can Still Do With an Epidural

Modern epidurals don't mean you're completely immobile:

• Many women can still change positions with assistance
• You may be able to squat or use a squat bar for pushing
• Peanut balls can help with positioning
• You'll still feel the urge to push (pressure, not pain)

Questions to Ask Your Provider

Before labor, consider discussing:

1. When can I request an epidural?
2. Is there always an anesthesiologist available?
3. What type of epidural do you typically use?
4. Can I still move or change positions?
5. What if the epidural doesn't work well?
6. Will I have continuous monitoring after the epidural?

Making Your Decision

You Might Want an Epidural If:

• Pain relief is a priority for your birth experience
• You'd like to rest during a long labor
• You're anxious about coping with labor pain
• You have a medical condition that benefits from it

You Might Wait or Skip It If:

• You want an unmedicated birth experience
• You want full mobility during labor
• You'd prefer to feel everything during delivery
• You've had negative reactions to anesthesia before

Remember:

• You don't have to decide in advance
• It's okay to change your mind either way
• Getting an epidural is not a failure
• Going without one isn't a requirement for a good birth

Preparing for the Possibility

Even if you hope to avoid an epidural, it's wise to:

• Understand how they work
• Tour your hospital's delivery rooms
• Know the procedure so it's not scary if you choose it
• Have a support person who respects any decision you make

The Bottom Line

An epidural is a personal choice, and there's no wrong answer. The best birth is one where you feel informed, supported, and able to make decisions that are right for you in the moment.

Some women plan for epidurals from the start. Others use every natural technique first, then gratefully accept one. Still others go medication-free. All of these are valid choices.

Whatever you decide, document your pain management preferences in your birth plan so your care team knows your wishes.