Everything You Need to Know Before You Decide on an Epidural

The questions come in constantly. What if I can't handle it? Is it okay to get an epidural? I want to try natural birth but I'm not sure.

Here's the thing: there is no wrong answer. But there is an uninformed one.

About two thirds of people giving birth in U.S. hospitals receive an epidural. It's one of the most common medical procedures in childbirth, and it's also one of the least explained. 

Most people going into labor know epidurals exist, but have no real understanding of what they do, how they work, what can go wrong, or what's actually in them.

That's what this is for.

A Little Background

Epidurals have been used in childbirth since the 1940s, making them a relatively modern invention in the long history of human birth. Before their introduction, the options for pain management during labor were limited to general sedation, inhaled gases, or nothing at all. The epidural changed that picture significantly.

The original and primary purpose was analgesic pain relief. Analgesic simply means pain reduction without causing loss of consciousness. Unlike general anesthesia, which puts you completely under, an analgesic keeps you awake, alert, and present while blocking or dulling the sensation of pain in a targeted area of the body. 

With an epidural specifically, that targeted area is the lower half of your body, from roughly the waist down, while you remain fully conscious and aware of everything happening around you.

The mechanism works by delivering medication directly into the ‘epidural’ space, a narrow area just outside the membrane that surrounds your spinal cord. 

When drugs are introduced there, they interrupt the nerve signals traveling from your uterus, cervix, and surrounding tissues up to your brain. 

Your body is still doing the work of labor. You just stop receiving the pain signals from it.

Over the decades, the drugs used, the delivery methods, and the level of control given to the patient have all evolved. 

What started as a fairly blunt tool has become significantly more refined. 

Today, epidurals are one of the most commonly performed procedures in hospital birth settings in the United States, administered by an anesthesiologist or a nurse anesthetist, depending on who is available at your hospital at the time.

How an Epidural Is Administered

The process is more involved than most people realize, and knowing what to expect ahead of time makes it significantly less stressful if you decide to go that route.

Before the epidural itself, you'll receive a bag of IV fluids. Epidurals have a tendency to lower blood pressure, and the fluids are there to keep your pressure from dropping too far too fast.

From there, the anesthesiologist or nurse will walk you through the procedure, ask you screening questions, and get you positioned with your back exposed. 

A needle is used to place a thin catheter into the epidural space of your spine. The needle comes out. The catheter stays in, connected to a pump that delivers medication continuously throughout labor.

The pump also has a patient-controlled button. If you start feeling discomfort or breakthrough pain, you can push it for a stronger bolus of medication. There's a built-in timer to prevent overuse.

Another option is a walking epidural, which uses a lighter flow of medication that preserves enough motor function in your legs that some people can still move around. It's less common in practice, but it does exist and is worth asking about if mobility during labor matters to you.

Remember, though: timing matters. 

The generally recommended window for consenting to an epidural is around six centimeters dilated, which is roughly the transition point from early labor into active labor. Getting it around that point gives you the best odds of a vaginal birth.

The Benefits

While the primary use of an epidural is pain relief, there are a few other reasons you might choose to use an epidural.  

Rest during a long labor. If you've been laboring for a day or more and you're running out of fuel, an epidural can give your body a window to sleep. Sleep during labor is not a small thing. It can be the difference between having enough left in the tank to push your baby out or not.

Blood pressure management. If your blood pressure is running high during labor, an epidural can be used as a tool to bring it down. In some cases it's not just a comfort measure, it's a clinical one.

Position changes are still possible. Movement is still encouraged with an epidural. You're not locked in one position for the duration.

It can be turned down or off. If you want to feel your baby emerging, if you want to experience the fetal ejection reflex, or if you simply decide you want to labor without it for a stretch, the medication can be reduced or stopped. You have options even after you've committed to it.

Peace of mind. For some people, knowing the epidural is there or already in place allows them to relax in a way that actually supports their labor. That's real, and it counts.

The Risks

While it’s great women have the option, what hospitals don’t often warn them of are the many risks that come from a medicated birth.

Such as….

It might not work. Epidurals fail. They can work on one side of your body and not the other. You might feel hot spots, patches of sensation, or nothing in some areas while others remain fully intact. Some people metabolize the medication quickly enough that they get little to no relief at all.

Blood pressure can drop too low. While low blood pressure is also listed as a benefit in high-pressure situations, it becomes a risk when it drops further than intended. This is monitored, but it does happen.

Headaches. A post-dural puncture headache can occur if the needle accidentally punctures the membrane surrounding the spinal cord. These can be significant and sometimes require follow-up treatment.

Heavy, numb legs. Most people with an epidural lose meaningful function in their legs. They feel dead, heavy, or completely immobile. This limits your ability to change positions freely and requires assistance from your support team for repositioning.

Nausea and vomiting. These are listed side effects of epidural medications and can occur even after the epidural is placed.

Pushing on your back. When you can't feel your body, directed pushing becomes the default. That means the classic chin-to-chest, count-to-ten, push-with-everything-you-have approach, repeated three times per contraction. That kind of sustained straining can deprive you of oxygen, contributes to headaches, and puts significant force on your pelvic floor.

Increased tearing. Pushing on your back, which is the most common position with an epidural, does not allow your pelvic tissues to stretch the way they're designed to. Combined with the inability to feel what's happening and the force of directed pushing, tearing rates go up.

Pelvic floor damage. The downward force generated during directed pushing is substantial. Pelvic floor complications after an epidural birth are real and worth understanding before you're in the room.

Labor stalls. A solid contraction pattern can slow or stop after an epidural is placed. When that happens, pitocin is typically introduced to restart or maintain contractions, which leads further down the intervention chain.

Urinary catheter. Most people with an epidural will have a catheter placed because they can't feel the urge to urinate. Some experience difficulty urinating for a period after birth as well.

Itching and numbness after birth. Opioid components in the epidural cocktail commonly cause itching. Some people experience lingering numbness in the days following delivery.

Shaking. Shaking can occur with epidural medications. Worth noting: shaking also happens in unmedicated birth as part of the hormonal process. It's not exclusive to epidurals.

Fetal distress and positioning issues. Reduced mobility can affect how your baby navigates the pelvis, and certain medications can affect fetal heart rate patterns.

Possible nerve damage. Rare, but it exists and should be on your radar.

Reasons You May Not Be Able to Get One

Sometimes the choice is made for you. 

Here's what can prevent an epidural from being an option:

• A medication you're already taking conflicts with the epidural drugs
• Blood work flags a contraindication
• The anesthesiologist cannot locate the epidural space in your back
• Active bleeding or a back infection
• No anesthesiologist is available at that moment
• Your hospital has a policy about how dilated you need to be first
• Your baby is already coming

That last one is more common than people expect. If you're planning to get an epidural at some point, don't wait until you feel like you absolutely cannot go on. By then it may be too late.

Ask What's In Your Epidural Cocktail?

This is the question almost no one thinks to ask, and it matters.

Epidural cocktails vary from hospital to hospital. The combination of drugs going into your spine is not always disclosed upfront, and you have every right to know what it is before you consent.

Fentanyl is increasingly common in epidural formulations. It is a synthetic opioid approximately 100 times more potent than morphine. It is not always mentioned by name or disclosed of its use. Ask specifically.

If you want to research any medication being used during your birth, drugs.com is a solid resource. Enter the drug name and it will pull up uses, side effects, and interactions in plain language.

It's Your Call

Natural birth or epidural birth, the decision belongs entirely to you. 

What matters is that you're making it with real information, not assumptions, not fear, and not pressure from anyone in the room.

Know your options. Know the tradeoffs. Build a birth plan that reflects what you actually want, and stay flexible enough to make an informed decision if things shift.

Whatever you choose, train for it. A prepared body and a prepared mind will serve you in either scenario.

Healthy Mommy, Healthy Baby, Labor On!

Krisha