What is an epidural?

An epidural is the virtually normally used method of hurting relief for labor in the United States. It provides continuous pain relief while assuasive you to remain fully witting.

An epidural for childbirth reduces sensation in the lower half of your trunk but doesn't cause a total lack of feeling. You'll likely still feel the pressure of your contractions (which will be helpful when information technology's fourth dimension to push) and be aware of (just not bothered past) vaginal exams during labor. And yous'll still be able to feel your baby moving through the birth canal and coming out.

Epidural medication is delivered through a catheter – a very thin, flexible, plastic, hollow tube – that'southward inserted into the epidural infinite merely outside the membrane that surrounds your spinal cord and spinal fluid. Because they require an anesthesiologist, epidurals are usually simply available in hospitals, not nascence centers.

The medication delivered by the epidural is ordinarily a combination of:

  • a local anesthetic (this blocks sensations of pain, bear on, motility, and temperature)
  • a narcotic (this blunts pain without affecting your ability to move your legs)

Used together, the coldhearted and narcotic provide skilful pain relief at a lower total dose than you'd need with just ane or the other, while assuasive for more sensation in your legs.

While in that location are some small and rare risks, epidurals are considered a very safe way to manage childbirth pain.

What is the epidural procedure like?

Hither'south a step-by-step guide to what happens when you have an epidural:

medical illustration of where an epidural is placed

  1. Injection prep: You lie curled on your side or sit on the edge of the bed while an anesthesiologist cleans the injection site, numbs the expanse, then carefully guides a needle into your lower back – into a pocket-sized space outside your spinal string.
  2. Catheter insertion: The anesthesiologist and then passes a catheter (a small, soft tube) through the needle, withdraws the needle, and tapes the catheter in place. At this point, you lot tin can lie downwardly without disturbing the catheter, and medication can be administered through it equally needed.
  3. Exam dose, full dose, and monitoring: Get-go you lot're given a small-scale "test dose" of medicine to be certain the epidural was placed correctly, followed by a full dose if there are no problems. Your babe's center rate is monitored continuously, and your claret pressure and heart charge per unit are taken every v minutes or and so for a while after the epidural is in to make sure it isn't causing any concerning changes in these vital signs.
  4. Medication takes effect: You'll start to detect the numbing outcome virtually 10 to xx minutes subsequently the first dose of medication, though the nerves in your uterus will begin to go numb within a few minutes. You'll receive continuous doses of medication through the catheter for the rest of your labor.
  5. Adjusting your medication: You may besides have the option of patient-controlled epidural analgesia (PCEA), which means you lot can control when you get more medication through a pump that's continued to the catheter. The corporeality of medication you tin can give yourself is express, and so there'southward no run a risk of overdose.
  6. After you deliver your baby: The catheter will be removed. (If you've had a c-section, sometimes the catheter is left in to administer postoperative pain medication.)

How long does an epidural terminal?

The pain relief from an epidural can terminal as long as you need it. Once the epidural is in place, the medication can be increased or decreased throughout your labor.

Sometimes women find they need an boosted amount of epidural medication (sometimes called a "redose") equally their labor progresses. This can be safely given by the anesthesia team (using the same catheter already in place).

Does an epidural hurt?

Well-nigh women don't find the epidural insertion painful, though it can exist briefly uncomfortable. The anesthesiologist volition numb the pare earlier inserting the needle. You lot might feel a compression or stick followed by some pressure – much like you would having an IV inserted.

The needle is removed once the catheter is in place, and the catheter isn't painful or uncomfortable. Having the catheter removed when you're finished doesn't hurt at all, either, beyond the sensation of having the tape pulled off.

Pros and cons of an epidural

Advantages of having an epidural:

  • It provides a route for very effective, prophylactic pain relief that can exist used throughout your labor.
  • The anesthesiologist can control the effects by adjusting the type, amount, and strength of the medication. This is of import because as your labor progresses and your baby moves down into your birth canal, the dose you've been getting might no longer exist adequate, or you might suddenly have pain in a unlike area.
  • The medication just affects a specific area, and so you lot'll be awake and alarm during labor and birth. And considering y'all're much more comfortable during labor, you can rest (or fifty-fifty slumber) as your cervix dilates and conserve your energy for when it comes time to push button.
  • Dissimilar systemic narcotics, only a tiny amount of medication reaches your infant.
  • Once the epidural is in place, it can be used to provide anesthesia if you demand a c-department or if you're having your tubes tied subsequently delivery.

Disadvantages of having an epidural:

  • Yous'll lose some sensation in your legs and be unable to stand or walk around. Many women want to be able to continue to move around, especially in early labor. Some will defer their epidural until afterward in labor when they're exhausted and ready to rest. (A "walking epidural" means that you nonetheless have what feels similar normal strength and sensation in your legs because you're getting a lower dose of coldhearted. Information technology's still not safe to walk around, though. And it'south a hard balance to achieve – many women don't feel adequate hurting relief at this dose.)
  • You'll have to stay yet for 10 to 15 minutes while the epidural is put in, and and then await up to 20 minutes before the medication takes full issue.
  • Y'all'll need an Iv, frequent blood pressure monitoring, and continuous fetal monitoring.
  • An epidural can prolong the pushing phase of labor. That'due south because the epidural naturally blunts the intense sensation of pressure level from the baby'southward head on your pelvic floor – giving you less immediate feedback as you work to push your baby out. You may want to have the epidural dose lowered while you're pushing then y'all can receive more of your body'due south cues – but the change may accept time to have outcome, and it also can raise your hurting level significantly. Sometimes it'south hard to find that "sweet spot." In that location's also no evidence that reducing the epidural dose really shortens this stage of labor.
  • In some cases, an epidural provides spotty pain relief. This can happen if the medication doesn't manage to accomplish all your spinal fretfulness as it spreads through your epidural space and considering every woman has variations in beefcake. Previous spinal surgeries can complicate your epidural effectiveness, besides. Be sure to hash out whatever history of spinal surgery or scoliosis with your ob-gyn before delivery. You may do good from an anesthesia consult prior to labor to discuss your specific case.
  • The catheter can too "drift" slightly, making pain relief spotty later on starting out fine. (If y'all discover that you're starting to have hurting in certain places, ask for your dose to be adjusted or your catheter reinserted.)
  • The drugs used in your epidural may temporarily lower your claret force per unit area, reducing claret menses to your babe and slowing their center charge per unit. (This is fleeting and easily treated with fluids and sometimes medication.)
  • Epidurals are associated with a higher rate of babies in the posterior position at delivery. Women whose babies are confront-upward have longer labors, tend to demand Pitocin more frequently, and accept a significantly college charge per unit of c-sections. However, there'due south controversy over whether having an epidural actually contributes to babies ending up in this position (considering the pelvic floor is relaxed) or whether women whose babies are in the posterior position have more than painful labors and so request epidurals more often.

Epidural side effects

Epidural headache

Virtually 1 in 100 women develop a spinal headache in the days after the procedure. This can happen if the epidural needle punctures the purse of fluid that surrounds the spinal cord, causing the fluid to leak.

Permit your provider know if you have a headache when y'all're upright that goes away when you lot're lying downwards. The trouble can exist treated with an epidural claret patch, a procedure in which claret is taken from your arm and injected into your dorsum, where information technology clots and seals the hole caused by the needle. It's best if you can have this procedure while you're still in the infirmary, only yous tin can always return to the hospital to have information technology done.

The headache pain can exist severe and can terminal for days or even weeks if non treated. Some women continue to take headaches even after handling.

Fever

An epidural raises your risk of running a fever in labor. No one knows exactly why this happens, but one theory is that you pant and sweat less (because you're non in hurting), so it's harder for your body to requite off the heat generated by labor. This doesn't boost your or your infant'due south odds of getting an infection, but because infections in labor are mutual, information technology can be unclear whether the fever is from the epidural or an infection. So y'all and your baby may demand to have antibiotics.

Other epidural side effects

  • Itching: Narcotics delivered through an epidural tin cause itchiness over the areas of the trunk the epidural is affecting (your belly and legs).
  • Soreness for a few days at the insertion site.
  • Decrease in your claret pressure while the infusion is running and especially with the initial dosing.
  • Nausea and vomiting: Epidurals may bring on nausea, typically if the initial driblet in blood pressure is significant. Nausea is less likely with an epidural than from systemic narcotic medication. Too, many women feel nauseated and throw up during labor even without pain medication.
  • Anesthetics delivered through an epidural tin can arrive impossible to tell when y'all need to pee. You'll take a catheter inserted into your urethra to bleed urine during your labor.
  • In very rare cases, if an epidural travels too high, it tin can bear upon your breathing muscles. Your obstetric and anesthesia team can safely deal with this complexity, though.
  • Besides very rarely – if the anesthetic is injected into a vein instead of a nerve – numbness, tingling, or rapid heartbeat can occur. Ruling this out is what the "examination dose" is for prior to fully dosing the catheter.
  • Epidural hematoma. In extremely rare cases, you lot can have bleeding almost the spinal cord that can push on your spinal cord or nerves, causing hurting and maybe impairment. That's why your team will check your platelet count and sometimes examination for your ability to form clots earlier placing your epidural. Information technology's also why you need to stop taking nearly blood thinners 12 to 24 hours before receiving an epidural.
  • Epidural abscess. This can happen when the epidural area becomes infected by bacteria, forming an abscess that presses on the spinal column. It's extremely rare only can cause paralysis or even death if non treated quickly.

The best time to go an epidural during labor

Most epidurals are placed during the outset stage of labor, one time yous're having regular and painful contractions. Merely y'all tin get an epidural at whatever time in labor, depending on your preferences, how busy the unit of measurement is, and your medical history. Talk with your midwife or dr. nearly the best timing. Go on in mind that it can accept 20 minutes to work, and your anesthesiologist may be busy and not able to come immediately.

In the past, many providers wanted a woman to exist in active labor (when contractions become intense and your cervix begins to amplify more rapidly) earlier starting an epidural because in that location was a business that it might wearisome down contractions. Some providers withal adopt to wait until active labor. However, studies have shown starting an epidural in early labor, compared with later in labor, is not more than likely to prolong labor or lead to a c-section or other interventions.

If you're trying to have a vaginal birth after a cesarean department (VBAC), your obstetrician may encourage you to get an epidural on the early on side to ensure that yous have reliable and quick anesthesia available in case yous demand a cesarean delivery.

If you lot want to put off the conclusion on whether to have an epidural, you could get some narcotic pain medication through an IV to have the edge off your early labor contractions and allow yous to rest. You tin and so get an epidural afterward in labor if you lot decide to. This kind of systemic pain relief tin brand you sleepy, so you lot'll demand to stay in bed. It can besides make your infant sleepy and less interested in breathing after nascence, so your providers won't want to give it to you close to delivery. These narcotics habiliment off for both yous and your babe after a few hours, so getting them early is no trouble.

Alternatively, if yous get in at the infirmary before you're in active labor and know you want an epidural subsequently on, you can ask whether the anesthesiologist can identify the catheter as shortly every bit you're settled. Then you can wait to kickoff the medication when active labor begins.

Is it ever besides late to get an epidural?

It's never also late to get an epidural, unless the baby's head is crowning. Information technology takes as little equally ten to 15 minutes to identify the catheter and showtime getting relief, and another xx minutes to go the full effect.

However, in certain circumstances, information technology may be harder to get an epidural late in labor considering:

  • The anesthesiologist may be busy with other patients, and then it could take longer for them to arrive once you decide y'all want this pain management.
  • Your labor and delivery squad may encourage y'all to manage without pain medication if they think you'll deliver your baby soon.
  • Your anesthesiologist may decide it's as well risky to endeavour to place the needle if you're unable to remain reasonably still during contractions. Luckily, most women are able to hold however, and your labor team can warn the anesthesiologist when a contraction is coming, if necessary.

Other pain medication during labor

Systemic medications

Systemic painkillers, such as narcotics, tedious your pain only don't completely eliminate it. They affect your entire body rather than concentrating hurting relief in the uterus and pelvic surface area.

Systemic drugs are either delivered through an IV line to your bloodstream or injected into a muscle. They may make y'all feel sleepy. All the same, different the general anesthesia that'south often given for surgery, these drugs won't brand you unconscious.

You may also be given a tranquilizer – alone or in combination with a narcotic – to reduce anxiety or nausea, or to relax you. In some hospitals, you may be offered nitrous oxide – laughing gas – which you inhale during contractions.

Systemic analgesics tin crusade itching, nausea and vomiting, drowsiness, and problem concentrating. Simply as they bear upon you lot, they tin can touch your baby. If given inside a few hours of delivery, these drugs may temporarily impact your infant's breathing. (Your baby may then require oxygen or other support.) Narcotics may make your infant drowsy, too, making it harder to breastfeed for a few hours later delivery.

Spinal block

A spinal differs from an epidural in two ways:

  1. It's delivered directly into the spinal fluid (rather than into the space just outside the membrane that surrounds the spinal fluid), and
  2. It'south a one-time injection rather than a continuous feed through a catheter.

As a outcome, relief is rapid and consummate but lasts simply an hour or two.

Your practitioner may gild a spinal block if:

  • Yous make up one's mind you desire pain relief tardily in labor or,
  • Yous're progressing so rapidly that delivery is probable to be relatively soon, and you tin can't wait for an epidural or,
  • You're having a cesarean delivery

A spinal block and epidural take the same side effects and risks.

Combined spinal/epidural

A combined spinal/epidural (CSE) cake offers the rapid pain relief of a spinal block and the continuous relief of an epidural.

You lot may opt for a combined spinal/epidural so yous become immediate relief from the spinal while y'all're waiting for the epidural to work. A CSE has the same side effects and risks as an epidural.

Tin can anyone have an epidural?

Non all women are good candidates for this kind of pain relief. You won't be able to have an epidural if you lot:

  • Have abnormally low blood pressure (because of bleeding or other problems)
  • Have a bleeding disorder
  • Have a blood infection
  • Take a skin infection on the lower back where the needle would be inserted
  • Had a previous allergic reaction to local anesthetics
  • Had dorsum surgery involving spinal fusions or Harrington rods or take pregnant scoliosis

Annotation that if yous're taking sure blood-thinning medications, you can get an epidural if enough fourth dimension has elapsed since your terminal dose. It'south very of import to discuss whatever blood thinning medications with your obstetric and anesthesia team.

If you take whatever concerns about whether an epidural is safe for you lot, discuss them with your provider during your pregnancy. Nigh hospitals also allow you to consult with an anesthesiologist, too, once y'all arrive at the hospital.

Learn more than:

  • What does labor feel like?
  • Signs of labor
  • Natural ways to induce labor