Epidurals: Should I Get an Epidural?


What exactly is an epidural?

The full name is Epidural Analgesia- this term actually refers to the place the medication is administered rather than an exact medication (epidural = space inside the bony spinal canal, just outside the dura).

Depending on what hospital you go to & who your anesthesiologist is (or nurse anesthetist), your exact medication administered to you through the catheter will vary (see below for explanation).

Getting the exact medication details, is a great topic to chat about with provider and/or anesthesiologist before labor.

What happens if I want an epidural?

The first thing that happens is you’ll be hooked up to continuous electronic fetal monitoring, given fluids via an IV, then have a blood pressure cuff put on (most likely an automatic one). After that, the anesthesiologist (or nurse anesthetist) comes in and gives you a local anesthetic in the skin over the area where they’re going to place the epidural in your back (so you won‘t feel the next part).

Then a needle goes into the lower back (along the spine). A small tube (what is referred to as a catheter) is threaded through the needle into the space inside the bony spinal canal (in your spine). The needle is removed and the catheter stays put so that the pain meds can be given periodically or continually, depending on what YOU decide (often mamas have control over the amount of drugs received- there’s a limit so you don’t take too much). This is another great talking point between you & your doctor before labor.

The catheter is taped to your back preventing it from slipping out. Depending on many different factors, such as how your body responds, the type of epidural and the dose, you’ll either be numb from the chest down or from the top of your uterus to your pelvis.

Some women don‘t feel much pain relief at all. It all goes back to where the epidural is placed, the medications used and the dosage. For each woman the effects of the epidural are different.

When Can I get the epidural?

The big question of “when” depends on a few factors, some of which may be out of your control. One of them is the protocol of the hospital, another one is how quickly your labor is progressing and whether there’s even time. The biggest one is where the anesthesiologist is and can he/she get to you.

Remember, they have other patients and might even be in the middle of a C-Section when you decide you want the epidural. This might mean waiting for a while or on the other hand, could result in you being offered an epidural early-on, before you’re really ready for it or labor is established.

Many doctors recommend being in active labor (dilated to 4 or 5 cm) before getting the epidural. This can help keep labor going & not slow down once you get the epidural (which happens sometimes, not all the time).

Some doctors also recommend checking the baby’s positioning to make sure the baby is in the optimal birth position (head down- you might hear it called “vertex position”). Once you get the epidural, you’ll most likely be unable to feel the entire bottom half of your body (each person’s body responds differently to the drugs and dosage). If you can’t move around, your baby won’t be able to move around to get into a more optimal position either. So ensuring baby is in place is a great idea before it’s epidural time.

**A doctor shared an important clarification with us. An Epidural is not like taking an Advil. It doesn’t just take the pain away. It numbs everything, which also means your lower body won’t be of much use. You can’t stand up on your own, you’ll need a catheter to go pee, etc.

The Pros and Cons of Epidurals

The Advantages:

  1. Possibility for complete pain relief (though results vary for each woman). 

The Downsides:

  1. Will interfere with your ability to move around (you have to be in bed) which can hinder labor progress or getting the baby into the most favorable birthing position. Remember your baby is working hard too. If baby can’t get into position for the maneuvering through your pelvis, you’re moving towards a c-section. Moving around helps baby move around and into position. You’re a team! 
  2. Will require bedpan or urinary catheter so you can pee. 
  3. Since you may not be able to feel when it comes time to push you might have increased chance of injuring your perineum (area between vadge & anus) resulting in tearing- there is a chance of tearing in an umedicated birth as well. 
  4. Can cause low blood pressure in the mama (and therefore less oxygen for baby). This is a risk often glossed over by providers. It’s common. It’s a major contributing factor to complications (as shared by a very well respected Ob/Gyn). When the blood pressure drops it causes less blood and oxygen to be pumped through the placenta and cord to the baby. The baby shows signs of fetal distress with decelerations in the heart rate. Attempts are made to resuscitate the baby with a change in mom’s position, fluids in the IV, oxygen given to mom etc. If this doesn’t work then a c-section very commonly happens.
  5. It changes birth into more of a “medical experience” b/c big time with IV’s, Pitocin pump, epidural pump, continuous electronic fetal monitor & blood pressure cuffs becoming the focus…instead of you and your baby. 
  6. Research shows that using epidural analgesia during labor lengthens labor which might require drug Pitocin to get labor going again. 
  7. Increases the chance your provider will use a vacuum or forceps to help get baby out-because mama doesn’t have the muscle control or strength to push the baby out which could also lead to a c-section. 
  8. Risk of fever in mamas- which leads to baby being given antibiotics for fear they have an infection from the mama. That means more blood draws, longer stay in hospital and a weakened immune system for baby (since antibiotics kill the good and bad bacteria in baby’s gut that gives them immunity.) 


Epidurals are effective pain relief for most women in labor. It’s not like taking an Advil to make the pain go away. It affects the entire lower half of your body and renders it useless. That’s an important distinction to be aware of and to expect.

If you’re planning on getting an epidural during labor, it’s STILL important you learn how to cope with pain without meds, as a back-up plan. Because epidurals aren’t always effective & sometimes they just don’t work. Be prepared mama. Check out this incredible class that will teach you “How to have less pain in labor {even if you’re getting an epidural}” & you’ll be better prepared. 

Talk to your providerabout your medical history, and find out what medications the anesthesiologist uses in the epidural to ensure you don’t have any allergic/adverse reactions.

Ask your provider about the risks of epidurals before you’re in labor. Having these chats during your prenatal appointments gives you the time to think through your options & do more research (if needed), so you make the best decision for you & your baby.

An epidural might be the best option for you. As you gather info to make your decision, there are 2 primary things plenty of providers rarely discuss with you:

First, once you receive an intervention, the likelihood for more interventions goes way up (some refer to this as ‘cascade of intervention’). The more interventions you have, the closer you get to a C-Section. 

This study from the Cochrane Collaboration, of over 13,000 women, concluded a C-Section is more likely from the very first intervention laboring women receive. Often that first intervention is Continuous Electronic Fetal Monitoring (which is not supported by evidence  unless there is a medical need requiring constant monitoring, like when receiving an Epidural, because the meds in the epidural can mess with the mama’s blood pressure (and adversely affect baby), constant monitoring is a must in that case. BUT, a mom can labor without the Continuous Electronic Fetal Monitoring up until the time she requests an epidural. Which is a good distinction to make.

Second, a ton of moms manage pain just fine without an epidural. Most of us compare lying in bed with an Epidural directly to lying in bed with no Epidural. Research shows women have less pain, request less pain medication, have faster labors & recover faster when they have freedom to move around during labor & birth.

Moving around helps optimally position mama’s body & baby for baby’s journey through the birth canal. Lying on your back physiologically makes your birth canal smaller (up to 30% smaller), and doesn’t allow your coccyx (tail bone) to move out of the way so baby’s head can pass through (making baby’s job more difficult). It also requires you to push against gravity. {we have an interview with one of the world’s best experts on birth positions right here: Birth Positions with Barbara Harper}

There are options to effectively manage pain beyond JUST an Epidural, if that is down your alley. Nitrous oxide (yep, the same laughing gas used at the dentist) is being used more and more for effective pain relief without the risk & side effects of the epidural. Ask your provider if they can hook you up:)

For some reason many providers & birth classes don’t share these scientifically researched & proven options with you. We think that’s cray-cray. It’s your decision, not theirs to make for you. You’re the one {and your baby} who ends up dealing & feeling the outcome of the birth.  This is your pregnancy & your baby! Whatever you decide, knowing your options & making an informed decision will give you more confidence.

“What lies behind us and what lies before us are tiny matters compared to what lies within us.” Ralph Waldo Emerson click to tweet  

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