Epidurals in Labor: How They Work, Side Effects and Other Pain Relief

What an epidural is

• An anesthesiologist places a thin, soft tube in your lower back, outside the spinal cord's covering. Numbing medicine (often with a little opioid) flows through it for the rest of labor.
• You stay awake and alert. Most people still feel pressure and touch but much less pain.
• A combined spinal-epidural adds a quick one-time dose that works within minutes. A spinal alone is what's usually used for a planned C-section.

How it goes

• You sit hunched forward or lie curled on your side. The skin is numbed first; most people feel a sting and then pressure. Your support person can often stay and help you hold still between contractions.
• It usually takes 10-20 minutes to place and another 10-20 minutes to work well.
• Many hospitals give you a button to top up the dose yourself within safe limits.
• You'll have an IV, a blood pressure cuff and fetal monitoring. Most people get a urinary catheter because the bladder is numb too.

Timing

• There's no need to reach a certain number of centimeters first. ACOG's view is that asking for pain relief is reason enough.
• It can be hard to place very late, when the baby is about to arrive, because there may not be time for it to work.

Common side effects

• A drop in blood pressure, treated with fluids or medicine.
• Itching, shivering, heavy or numb legs (you usually can't walk safely).
• One-sided or patchy numbness: tell your nurse, since the tube can often be adjusted.
• Fever during labor is more common with an epidural.
• Pushing may take a bit longer. Some teams let you rest and let the baby move down first.
• About 1 in 100 people get a bad headache afterwards that is worse sitting up. It is treatable, often with a small "patch" procedure.

Common myths

• It does not raise the chance of a C-section, according to large studies.
• It does not cause long-term back pain; soreness at the site for a few days is common.
• Very little medicine reaches the baby. Research on any effect on breastfeeding is mixed; early skin-to-skin and lactation help make a difference (see the first hour after birth guide).

Who may not be able to have one

Very low platelets, blood thinners taken recently, an infection in the lower back or some spine conditions. Tell your team ahead of time; many people with back surgery can still have one.

Other options

• Nitrous oxide (laughing gas) you breathe in during contractions, where offered.
• IV opioids for a short time, which can make you and the baby drowsy.
• Movement, water, massage, heat, breathing, a doula or continuous support person. These can be used alone or before an epidural.

When to check in

• Book a prenatal anesthesia consult if you have a bleeding disorder, spine surgery or other concerns.
• After birth, tell your nurse about a headache that gets worse when you sit up, or numbness that lasts more than a day.
• If you have a sudden severe headache, chest pain or trouble breathing after you're home, call 911.