If you’re thinking about getting an epidural to help manage the pain of childbirth, you’re not alone. More than 70% of women delivering at hospitals elect for an epidural or other spinal anesthesia during labor and delivery,[1] and with good reason.
Epidurals are considered one of the safest methods of pain control available — and since they numb the pain of contractions but allow you to stay awake and alert during your child’s birth, you’ll still be able to push when you need to.
Here’s the lowdown on how epidurals work and potential side effects you might experience. As always, discuss your wishes related to labor pain relief with your doctor ahead of time as part of your birth plan so you know what to expect.
What is an epidural?
An epidural is a procedure in which a combination of medications — for example, analgesics (pain relief meds that don’t cause a loss of muscle movement) and anesthetics (pain relief meds that cause a loss of sensation) — are injected into a specific area around your spinal nerves called the epidural space.
Epidural drugs stay in the epidural space and do not enter the bloodstream, which means they don't circulate to your baby.
Here’s a little more about the various epidural types that you’ll likely be offered:[2]
- Epidural block. This block, which is a combination of analgesics and anesthetics, is the most commonly administered type of epidural during childbirth. It’s given through a tiny tube in the lower back. You’ll enjoy pain relief but will still be alert and able to push when the time comes.
- Spinal block. This single shot of pain relief is directed into the fluid surrounding the spinal cord. It kicks in quickly, lasts about an hour or two, and is usually given during C-section deliveries.
- Combined spinal-epidural. A combined spinal-epidural (or CSE) is a mix of the above two epidural types. It also works to quickly block pain and offer continual relief as needed.
How does an epidural work?
An anesthesiologist will inject the epidural into the area around your spinal nerves via a catheter — technically, into the epidural space, between the ligament that sheathes the vertebrae and the membrane that covers the spinal cord.[3]
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By using a catheter, you can be given continuous medication as needed. Once an epidural is inserted, you’ll most likely feel pain relief within about 15 minutes.[4]
As part of the epidural process, you’ll first be hooked up to IV fluids to prevent a blood pressure drop. Depending on the hospital’s policies, a urinary catheter may be inserted into your bladder just before or after the epidural is administered to drain urine while the epidural is in effect, since you may not feel the urge to go to the bathroom. In other hospitals, the bladder is drained with a catheter as needed.
Are epidurals safe?
Epidurals are known to be very safe, and any serious complications or side effects that arise are extremely rare and almost always temporary. Very little medication is needed to numb and block the pain with an epidural, which makes it one of the safest and most effective methods of pain control during labor and delivery.[5]
How big is an epidural needle?
The epidural needle is wider than the one used for flu shots and usually 3 1/2 inches long. To prep for the needle, you’ll receive local anesthesia on a small area of your low- to mid-back, which will be sterilized with antiseptic to prevent an infection. Once you’re numb, you’ll lie on your side or lean over, with support from a nurse, while a larger needle is inserted into the spine’s epidural space.
The needle is removed, leaving a fine, flexible catheter in its place through which the drug is delivered. The tube is taped to your back so you can move from side to side. Three to five minutes after the initial dose, the nerves of the uterus begin to numb and after about 10 minutes, you'll feel the full effect, though it can take 15 or 20 minutes for some women.
The medication numbs you from the bottom of your rib cage down, making it hard to feel any contractions at all. And that's the point!
If you end up having a C-section later in your labor, the amount of medication will be bumped up so you'll no longer be able to feel your lower half at all.
Does it hurt to get an epidural?
Some women report feeling pressure, tingling, or momentary shooting pain when the epidural is being administered. If you're lucky (and many women are), you might not feel a thing. Besides, compared to the pain of contractions, any discomfort from a needle poke is likely to be pretty minimal.
“Honest to goodness, I can’t remember what the epidural felt like,” recalls What to Expect Community mom baby-beluga. “My contractions were intense during my induction, so I got the epidural, but I was so uncomfortable I don’t even remember the anesthesiologist inserting the needle.”
What is a “walking epidural”?
A “walking epidural” — i.e., a combined spinal-epidural — uses a smaller amount of medication and allows you to move your legs a little more than you would during a typical epidural, which has a much higher dose and doesn't allow you to move your legs very much, if at all.
The anesthesiologist will start you off with a shot of analgesic directly into the spinal fluid to help relieve some pain. But because the medication is delivered only in the spinal fluid, you'll still be able to feel and use the muscles in your legs. When you need more pain relief, more medication is placed into the epidural space (through a catheter inserted at the same time the spinal medication is given).
Don’t be fooled by the name — even with a so-called "walking epidural," your legs will still be weak, so you likely won’t be able to get up and walk around as your legs won’t completely hold you up.
“I had what was probably considered a walking epidural, but I was still not allowed to get up,” says What to Expect Community member Rach185. “I did, however, have free ability to move, situate, and adjust myself.”
When can you get an epidural during labor?
An epidural can usually be given as soon as you ask for one (and an anesthesiologist is available), even if you’re minimally dilated. Because you’ll have to sit very still for the shot to be given between contractions, and this gets harder as labor progresses, it’s a good idea to ask for the epidural relatively early in the labor process.
Does labor still hurt if you have an epidural?
It’s normal to worry that you’ll still feel some pain even after you’ve been given an epidural. Most women experience great pain relief with an epidural, but it may not be 100% pain-free. Many women report feeling pretty comfortable after receiving an epidural, but there’s also some pressure felt when the contractions occur and you need to push.
The bottom line: Though you’ll be numb to the pain, most women find they’re still able to push effectively with coaching. You likely will still have some sensation, but you'll feel removed from it.
“I did not feel contractions or any pain, however when it was time to push I definitely felt pressure — as if you're constipated and need to open your bowels — and I felt my body's natural urge to push,” says What to Expect Community mom lana1245.
Does an epidural slow down labor?
Some older research had suggested that getting an epidural could extend the length of the second stage of labor by an hour or more with your first baby and less with subsequent children. But happily, more recent research has found that epidurals do not prolong labor. An early epidural also doesn't appear to increase your risk of having a C-section.[6]
But if your labor doesn’t move along with pain-free pushing, the medication can be adjusted so you feel your contractions more strongly again. Likewise, the medication can be bumped up post-delivery as your doctor repairs any perineal tears. Should your labor slow at any point, you might receive a medication called Pitocin, which can get your contractions up to speed.
How long does an epidural last?
The numbness you may feel in your legs can linger until the medication wears off, which is usually within about eight hours.
Does an epidural have any risks or side effects?
As the epidural drug kicks in, the medication causes some women to experience a decrease in their blood pressure, so yours will be monitored continuously. To counteract any dips in pressure, IV fluids are given and lying on your side may be suggested.
Less common epidural side effects include mild back pain, headache, fever, or soreness. The opioids in the epidural may cause you to feel itchy (which can be taken care of with another medication) and, in rare cases, may cause nausea and vomiting or temporary nerve damage.
While epidurals are generally extremely effective, some people experience other side effects that can include:
- One-sided pain. Some women might experience numbness on one side of the body only (as opposed to complete pain relief). And epidurals may not offer total pain control with back labor, which is when the fetus is in a posterior position, with the head pressing against your back.
- Slightly limited birthing options. With an epidural, you won't be able to labor in water. And if you're hoping to deliver at a birthing center, know that they usually don't offer epidurals. That means if you end up wanting one, you'll have to be transferred to a hospital. Your birthing positions may be more limited too — for example, your legs will likely be too numb to allow you to squat or be on your hands and knees, and even side pushing can be difficult.
- Troubling peeing. Lastly, having an epidural and/or catheter may decrease the sensitivity of the bladder or your alertness to its signals, which may make urinating in the first 24 postpartum hours a bit more challenging.
Can you get an epidural if you’re pregnant with multiples?
If you’re expecting twins or more, an epidural might be strongly encouraged — or even mandated — by your hospital, in case a vaginal birth isn't possible and an emergency C-section is required.[7]
If you’re hoping to avoid an epidural and are expecting multiples, speak with your practitioner and hospital ahead of time, because their policies could differ.
Can you get an epidural if you have a tattoo?
A lower-back tattoo shouldn't stop your anesthesiologist from giving you an epidural during labor. As long as the tattoo ink is dried and the wound is healed, sticking a needle through it won't be risky. Research related to tattoos and epidurals is limited and reports of problems between the two are rare.
If, however, you got a tattoo during pregnancy and the skin is still red and inflamed (tattooed skin takes at least two weeks to heal), you may not be able to get an epidural if the art covers your entire lower back. In that case, poking an epidural needle through the skin can boost the chances of an infection, and your anesthesiologist won't want to take that risk.
If you're still unsure about how the anesthesiologist will react to your body art, consult with your practitioner or the hospital before you go into labor so you know whether it will raise any issues.
An epidural is a procedure in which pain medications are injected into the epidural space, an area around your spinal nerves. It’s one of the most common and effective labor pain management options.
If you opt for an epidural, an anesthesiologist will inject the medicine into the area around your spinal nerves using a needle via a catheter. Most moms report that this process isn’t painful, especially compared to the discomfort of contractions.
The medication can take 10 to 20 minutes to fully kick in, but once it does, it numbs your body from the ribcage down so you don’t feel the pain of contractions.
Epidurals are considered very safe, but side effects are possible, such as one-sided pain relief, back pain, a headache, or soreness. It’s always a good idea to discuss your birth plan wishes with your practitioner in the lead up to labor so you can consider all of your options and discuss whether an epidural might be right for you.
Can you get an epidural if you have scoliosis?
Scoliosis usually does not interfere with an epidural, though it may make it a little more difficult to place the needle, especially if you have a corrective rod low in your spine.
Let your doctor know about your scoliosis ahead of time and share recent X-rays, if you have them. Still, an experienced anesthesiologist should have no problem inserting the epidural needle where it needs to go.
How should you decide whether or not to get an epidural?
While epidurals are very safe and effective, only you can determine whether this option is right for you. For most women, the decision boils down to their own personal pain threshold and how they hope their birth experience will go. You should always feel empowered to discuss any questions you have with your doctor about epidurals, as well as other pain relief options you’re considering.
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