Everything You Need to Know Before Getting an Epidural

If you’re considering an epidural for pain management during labor, you’re far from alone—according to the Columbia University School of Public Health, 65–80% of pregnant people in the U.S. choose to receive this type of labor pain relief.

While it’s certainly possible to wait until you’re actually in labor to determine if an epidural is right for you, it’s an even better idea to do the research in advance. Learning about the different types, what to expect if you receive one and the pros, cons and risks involved with getting an epidural will help you weigh your options ahead of time—and empower you to make decisions when your labor begins.

Here’s everything you need to know about getting an epidural.

What is an epidural?

An epidural is a type of anesthesia used to provide pain relief during labor and delivery. The anesthesia is injected near the bottom of the spine and works by blocking nerve impulses in the lower back, resulting in decreased feeling in the bottom half of the body.

But keep in mind that the goal of an epidural is to provide relief from pain, not total numbness. You may still feel your contractions happening, though it won’t be pain, just pressure. “The transition phase [right before pushing starts] can be really intense whether you have an epidural or not,” says Meredith Sheffield, a labor and delivery nurse in Wilmington, NC. “Intense pressure is normal and can help you push more efficiently when it’s time.”

Even with an epidural, you should still be able to push when the time comes, but the relief from typical labor pain will keep you comfortable and completely alert during your birth experience.

Types of Epidurals

The term epidural is used fairly broadly. What we know as “an epidural” is actually called labor neuraxial analgesia in medical terminology, and there are three types:

• Epidural. An epidural is administered via a catheter in your epidural space (the space between your vertebrae and the outer layer of your spinal cord). The catheter is left in place so more medication can be given later if needed, but keep in mind that it may limit your mobility, and you may not be able to customize the amount of numbness, says Dr. Hector Chapa, a board-certified ob-gyn and Clinical Assistant Professor at Texas A&M University.

• Spinal block. Administered directly into the spinal fluid, this single injection can be used either alone or in combination with an epidural. Because it's a single dose, it wears off more quickly.

• Combined spinal-epidural (CSE). A hybrid of the two, a CSE—often referred to as a “walking epidural”—is a combination of a spinal and an epidural. Because it involves a lower dose of medication, it leaves you with a bit more feeling in your lower half and provides more freedom to shift and change positions (though not necessarily walk around, which we’ll explain later), and pain relief can be a bit more customized. “CSEs give fast relief,” Dr. Chapa says, “but with a slightly higher risk of side effects like low blood pressure.”

Hospitals and anesthesiologists often differ on the types of epidurals they offer as well as the combinations of medications and dosages used. If you're interested in getting an epidural, talk to your healthcare provider to find out what your hospital’s specific protocols are to make sure their options are right for you. When it comes down to it, “each option depends on personal preference, labor circumstances and medical advice,” Dr. Chapa says.

Pros & Cons of Getting an Epidural

There are upsides and downsides to any medical intervention, so if you’re considering getting an epidural during labor, it’s good to learn as much as you can about what they might be to feel more informed and empowered about your decision.

Pros

• Pain relief. It’s no secret that giving birth isn’t exactly a walk in the park. If you’re looking for an effective and trusted option for pain relief during labor, then getting an epidural might make sense for you.

• Be mentally and emotionally present during baby’s birth. An epidural will help to relieve your pain during birth—whether it’s vaginal or via c-section—while also allowing you to be awake and alert (and not distracted or overwhelmed by potential pain).

• A much-needed break. For some, especially if it’s your first baby, labor can last a while (like, 24+ hours) and leave you feeling pretty exhausted. An epidural provides a much-needed opportunity for you to rest, re-focus and restore your energy before it’s time to push.

Cons

• Limited movement. Although walking epidurals do allow for more movement and more sensation during labor, the “walking” part is a bit of a misnomer. The majority of people aren’t able to actually walk around after receiving an epidural. You’ll need to stay in your hospital bed, since you’ll also need to be hooked up to an IV and a fetal monitor, which further limits your mobility.

• A (slightly) longer labor. According to a study in 2014, there was about a two-hour difference in the length of the second stage of labor (the pushing part) between those who received an epidural when compared to those who didn’t.

• Post-birth numbness. The effects of an epidural can take a few hours to fully wear off, so if you’re hoping to get up and walk around immediately after giving birth, an epidural may not be the best decision for you.

• Urinary catheter. Since the medication used in an epidural will numb the lower part of your body, you may need a urinary catheter put into place if your labor lasts more than a few hours. The catheter will be removed once the epidural wears off, but some people still report a bit of stinging and discomfort a few hours after the catheter comes out.

Epidural Risks and Side Effects

Making any medical decision can be stressful, especially when you’re pregnant. It’s good to be aware of the risks and long-term side effects of getting an epidural—but the good news is that the overall risk is extremely low.

“As long as the standard of care practice is followed, it is very unlikely to have any long-term side effects from an epidural,” says Dr. Mary Casciano Geneve, an anesthesiologist at Monmouth Medical Center in Long Branch, NJ.

Risks and short-term side effects can include maternal hypotension (a sudden drop in blood pressure), shivering, nausea or soreness or bruising around the injection site. According to Dr. Casciano Geneve, there’s also a very small risk—about 1 in 200—of developing a severe headache called a post-dural puncture headache. “This can be severe and debilitating, but there are treatment options available,” she says.

As for long-term side effects, very rarely, epidurals can cause permanent nerve damage in the area where the catheter was injected.

And what about epidural effects on baby? Dr. Casciano Geneve says that one of the biggest benefits of the epidural is that it provides relief for you without affecting your baby. “Unlike some intravenous medications, such as narcotics, which can cause neonatal respiratory depression (respiratory distress), the epidural should not affect baby,” she says.