Get Our Stuff We Love Box!
To epidural or not to epidural Labor & Delivery

To epidural or not to epidural

That is the question this to-the-point guide is here to help you answer. We’ll give you the facts and demystify the process, so you can decide what’s right for you and baby.

There is no single way to birth a child. Because no two labors and deliveries are the same (from how long they last to how they feel), what works for one woman might not for another. But many people—mothers and prenatal care providers included—can become fiercely divided on the topic of epidurals.

“It’s not about judgment, and there is no one right answer for women,” says Eileen DiFrisco, RN, IBCLC, LCCE, president elect of Lamaze International and nurse manager of the mother-baby unit at New York University. “She has to make the decision that is right for her.”

Whether you ultimately choose to forgo all pain medication or you decide you want that epidural placed ASAP, what matters is that you’ve made an informed decision. That’s precisely what this primer aims to help you do. So, keep reading to get the scoop—from how it works to risks and benefits to what alternatives are available.

The procedure

Epidurals are an effective and widely used form of pain management during labor. Administering one requires the expertise of an anesthesiologist—not your regular prenatal care provider.

According to David Draghinas, MD, and Joe Jackson, MD, board-certified anesthesiologists and authors of The Epidural Blueprint: Your Complete Guide to Management of Labor Pain, once you’ve been admitted to the hospital and elected to have an epidural, the process typically follows these steps: You’ll be asked to sit on the side of your bed, bent over with your back arched. This position makes it easier to locate the ideal space for placement—an area in the spinal column just outside the outer protective covering.

The anesthesiologist will sterilize and numb the area, typically with lidocaine, so you won’t actually feel the epidural being placed, aside from some pressure. A needle with a syringe at the end will be inserted into the epidural space, and a tiny flexible tube (aka catheter) will be threaded through. After the catheter is in position and the needle is removed, the anesthesiologist will apply a sterile covering and tape to hold the tubing in place.

“Once the catheter is inserted, a small test dose is given … [to] monitor for any allergic reaction for about 10 minutes,” explains DiFrisco. “If there’s no reaction, the anesthesiologist will start the medication.”

Unlike spinal anesthesia—a one-time injection of pain meds—this allows medication to be delivered continuously throughout labor, and it will ease the ouch from your belly button on down. Expect it to take about 20 minutes for the epidural to be in full swing.

The epidural can always be adjusted, up or down. Some hospitals will even provide you with a button that controls the release of medicine, so you can press for more relief. However, it’s important not to overdo it. The objective is to alleviate pain without losing all feeling. You should still have a sense of pressure, which is what you can use to guide your pushing later on.

The considerations
In order to weigh your options, you’ll need to know the pros and cons. The most obvious advantage to an epidural is the lack of pain and discomfort you’ll be feeling. Being able to relax amidst contractions is important to some mothers. That also means a laboring woman will be able to rest— even sleep—so she can save her strength in preparation for pushing out a tiny human.

Other pluses: An epidural provides relief without sedation, so you don’t miss any part of your wee one’s arrival. And it can be given at any time during labor, notes DiFrisco, adding that it’s most recommended during the active phase.

“Most women have very positive results from the epidural,” she says, “but about 15 percent have either partial [relief] or no relief at all.”

Common side effects include headache, fever and a drop in mom’s blood pressure, which could require continuous IV fluids. You’ll also, of course, be confined to a bed, so your movement during labor and early postpartum will be restricted.

Some studies show that epidurals can slow down labor, DiFrisco says, particularly if they’re given too early.

In extremely rare cases, epidurals can cause lightheadedness, ringing in the ears, difficulty with speech or vision, and loss of consciousness, though the test dose is initially given to avoid these reactions.

The options
Laboring women have many choices when it comes to easing the hurt of contractions. Not all alternatives will numb pain entirely, like an epidural, but they can be effective in taking the edge off and making the process more manageable, explains DiFrisco.

Pharmacological

  • Narcotics, such as Demerol or Stadol. These increase pain tolerance and, consequently, mom’s ability to relax. They might cause drowsiness or nausea. If given too close to birth, DiFrisco adds, they could cause respiratory and neuro depression in the newborn.
  • Tranquilizers, such as Phenergan. These can be given early on or during active labor. They will lessen anxiety and can also up the effectiveness of a narcotic if the two are given together. These do not offer pain relief on their own.
  • Sedatives, such as Ambien. These can be given in early or active labor to help moms rest. They may stop Braxton Hicks contractions and often cause drowsiness. They will affect mom’s whole body, as well as the baby’s.

Nonpharmacological
“These comfort measures can be used to provide natural pain relief, and they can be very effective during different phases of labor,” assures DiFrisco. “We always say if one is working, stick with it—if not, try another.” For some, these techniques could support them throughout labor; for others, they can be used up until an epidural.

  • Active purposeful relaxation. (Try not to tense muscles during a contraction.)
  • Focal point or guided imagery when a contraction occurs.
  • Deep cleansing breaths at the beginning and end of a contraction. DiFrisco notes that this will not only give you more oxygen, but it will also cue your partner when a contraction is starting and has ended.
  • Various breathing techniques during contractions to help refocus energy.
  • Effleurage or massage on the lower abdomen in a rhythmic manner when contractions are occurring.
  • Moving around and trying different positions.
  • Warm water, whether in a shower or tub.

There are a few instances in which an epidural might be necessary. If an expectant mother is having a C-section, an epidural is the best option that allows her to be awake and part of the birth of her child, says DiFrisco.

If a woman has had a lengthy labor and is exhausted, an epidural would allow her to rest and regain energy for delivery. Or if a mom-to-be feels her pain is intolerable and can’t get relief, an epidural might be a helpful alternative.

In most cases, the choice is yours to make. “Don’t worry about what other people think,” urges DiFrisco. “Make your decision based on a good understanding of the pros and cons of your different options. … Your decision should be about information, not judgment.”