You're approaching your due date and thinking about what labor will be like. Maybe you've decided on an epidural, or maybe you're unsure and want to know more. Either way, it's smart to understand what an epidural involves — so you can make an informed choice.
An epidural is the most effective form of pain relief during labor and is used by roughly half of all people giving birth in hospitals. Here is all the information you need.
What Is an Epidural?
An epidural (epidural anesthesia) is a form of regional anesthesia where pain-relieving medication is injected into the epidural space — an area just outside the spinal cord membrane in the lower back. The medication blocks pain signals from the uterus and birth canal, so you feel little or no pain.
With an epidural, a thin catheter (plastic tube) is inserted into the epidural space through a needle. The needle is removed, and the catheter remains in place. Through the catheter, the anesthesiologist can administer additional doses of pain medication as needed throughout labor.
The medication used is typically a combination of a local anesthetic (e.g., bupivacaine) and a low-dose opioid (e.g., fentanyl). The dose is adjusted so that you lose pain sensation but retain as much movement and feeling in your legs as possible.
How Is an Epidural Placed?
The procedure usually takes 10–20 minutes and is performed by an anesthesiologist:
- Preparation — you sit leaning forward or lie on your side with your back curved. This opens the spaces between the vertebrae.
- Disinfection and local anesthesia — the skin in the lower back is cleaned and numbed with a small injection.
- The epidural needle — a special needle is guided between the vertebrae to reach the epidural space.
- Catheter — a thin plastic catheter is threaded through the needle and into the epidural space.
- Needle is removed — the catheter is secured with tape on the back and connected to a pump.
- Test dose — a small dose is given to check that the catheter is correctly positioned.
- Full dose — pain-relieving medication is given, and the effect starts within 10–20 minutes.
You need to stay completely still during the procedure itself. Your midwife or nurse will hold you and help with positioning. If you have a contraction, the anesthesiologist will wait until it is over before inserting the needle.
Patient-Controlled Epidural (PCEA)
Many hospitals use a patient-controlled epidural, where you can press a button to receive extra doses within a safe limit. This gives you more control over your pain relief.
When During Labor Can You Get an Epidural?
An epidural can in principle be placed at any point during the active phase of labor. Previously it was recommended to wait until the cervix was 3–4 cm dilated, but more recent research shows that early epidurals do not slow down labor.
- Earliest — when active labor is established and you need pain relief
- Latest — it may be too late if labor progresses very quickly and you are already in the pushing stage. In practice, it takes time to call the anesthesiologist and place the epidural.
- Planned — some people choose to request an epidural in advance. You can write this in your birth plan.
Birth plan tip: Write clearly whether you want an epidural early, want to try without one first, or want to take it as it comes. The clearer your preferences, the better your midwife and doctor can adapt. Consider writing a birth plan to communicate your wishes.
Benefits of an Epidural
An epidural is the most effective pain relief available during vaginal labor:
- Very effective pain relief — most people experience complete or near-complete freedom from pain
- You remain conscious — you are awake and present throughout the entire birth
- Adjustable — the dose can be adjusted for stronger or lighter relief
- Reduces stress — lower levels of stress hormones can contribute to a more relaxed labor
- Can be used throughout — effective throughout the entire labor via refills through the catheter
- Ready for interventions — if an emergency cesarean is needed, the epidural can be strengthened to full anesthesia
Who Benefits Most From an Epidural?
- Long labors where exhaustion becomes a problem
- Labors that need artificial induction
- Multiple pregnancies (twins or more)
- People with very strong contractions or low pain tolerance
- Labors where manual assistance is needed for a breech presentation
Disadvantages and Side Effects
Like all medical treatments, epidurals can have some possible side effects and drawbacks:
Common Side Effects
- Low blood pressure — the most common side effect. Monitored with a blood pressure cuff and treated quickly with intravenous fluids.
- Reduced feeling in the legs — you may feel your legs as heavy or difficult to move. The degree varies.
- Difficulty urinating — temporary, resolved with a urinary catheter if needed.
- Itching — mild itching, especially on the face, is common and caused by the opioid in the mixture.
- Shivering — some people experience unexplained shivering, which is harmless but uncomfortable.
- Fever — a slight temperature rise occurs in some people.
Rare Side Effects
- Insufficient effect — in 5–10% of cases, the epidural does not work optimally, and it may be necessary to reposition it.
- Post-dural puncture headache — occurs if the spinal membrane is accidentally punctured. Affects about 1% of cases and can be treated.
- Nerve effects — temporary tingling or numbness in one leg. Permanent effects are extremely rare.
- Infection — extremely rare with proper sterile technique.
Many people fear that an epidural causes lasting back pain. Research shows that epidurals do not increase the risk of long-term back problems. Back pain after childbirth is common regardless of pain relief method and is usually caused by pregnancy itself and the physical strain of labor.
Epidurals and the Progress of Labor
How does an epidural affect the actual labor? Research gives a nuanced picture:
- Opening phase — more recent studies show that epidurals do not meaningfully prolong the opening phase.
- Pushing stage — may be somewhat longer (on average 15–20 minutes extra) because the urge to push can be reduced.
- Assisted delivery — somewhat higher probability of vacuum or forceps assistance, but differences are smaller than previously assumed.
- Cesarean section — an epidural itself does not increase the risk of cesarean according to large studies.
Skin-to-Skin and Breastfeeding
An epidural does not prevent skin-to-skin contact right after birth. Most people who have had an epidural can hold their baby immediately. An epidural also has no known negative effect on breastfeeding.
Alternatives to Epidurals
There are several other forms of pain relief during labor:
Medical Alternatives
- Nitrous oxide (Entonox) — a mixture of nitrous oxide and oxygen that you breathe in through a mask. Provides mild to moderate relief and is a common first-choice option.
- Spinal block — a one-time dose into the spinal canal. Faster effect than an epidural but cannot be topped up. Often used for cesarean sections.
- Pudendal block — local anesthesia of the birth canal. Used late in labor.
- Opioid injection — pain-relieving injection that provides mild relief and relaxation.
Non-Medical Methods
- Warm bath or shower — warm water can provide good pain relief, especially early in labor.
- Breathing exercises — controlled breathing helps manage pain and reduce tension.
- TENS — electrical nerve stimulation through electrodes on the back.
- Massage and pressure points — partner massage of the lower back and hips.
- Movement and position changes — walking, sitting on a birth ball, standing — finding positions that provide relief.
- Acupuncture — offered at some hospitals.
You don't have to choose one or the other. Many people start with nitrous oxide and other methods and add an epidural later if the need arises. Have an open plan and communicate with your midwife throughout.
Preparing for Your Choice
To make a good decision about pain relief during labor:
- Talk to your midwife or OB — discuss the options at your prenatal appointments.
- Visit the labor ward — many hospitals offer tours where you can ask questions.
- Write a birth plan — write down your preferences for pain relief and share them with your care team.
- Be open to changes — labor is unpredictable, and it is completely fine to change your mind.
- Track your contractions — use a contraction timer to time contractions and follow their progress.
Frequently Asked Questions
Does it hurt to get an epidural?
Most people describe it as uncomfortable, but not very painful. You feel a sting from the local anesthetic and then pressure when the epidural needle is inserted. Many say the contractions are far more painful than the procedure itself.
Can I walk with an epidural?
A traditional epidural makes the legs too heavy to walk. Some hospitals offer a "walking epidural" (low-dose) where you retain some mobility. Ask your labor ward about availability.
Can you get an epidural too late?
Yes, if labor progresses very quickly and you are already in the pushing stage, it may be too late. It takes 10–20 minutes to place the epidural and another 10–20 minutes for full effect. That's why it's wise to speak up early if you're considering an epidural.
Is an epidural dangerous for the baby?
No. The amount of medication that reaches the baby through the placenta is very small. Studies show no negative effect on the baby's Apgar score, breastfeeding, or bonding.