Labor Epidurals: Ten Important Things I Want You to Know

I’ve been asked many of the same questions over the years—and I hear the same rumors time and again. So let me clear the air and put some of your worries to rest.

#1 - You can change your mind.

You may go into labor planning to use nitrous oxide but find that it just isn’t enough. If you decide later that you want an epidural, you can ask for one. Labor can be unpredictable, and it’s completely okay to make different choices as things unfold.

After all, labor pain can be incredibly intense, and an epidural will give you a chance to rest and save your energy for delivery.

#2 - You don't have to wait until you're a certain dilation to get an epidural.

There is no magic number of centimeters of cervical dilation or be in a certain amount of pain before you can ask for an epidural.

The American College of Obstetricians and Gynecologists say that, in the absence of a medical reason not to have an epidural, maternal request is a sufficient indication for pain relief during labor, and an epidural can be offered during any stage of labor.

So you don't have to prove you're “far enough along” or “in enough pain.” If you want pain relief, all you have to do is ask for it.

#3 - An epidural is the most effective form of pain relief.

Nitrous oxide gas, IV medications, and being in a bathtub of water can help with labor pain and some women are very happy with them. But many of my patients describe these options as taking the edge off the pain, rather than taking the pain away.

An epidural is different.

The goal is significant pain relief so that you still feel in control of your labor, feel pressure, and—when the time comes—push. The epidural won't take away all sensation completely.

#4 - Very little epidural medication reaches your baby.

Nitrous oxide gas and IV medications cross the placenta a reach the baby, but in small amounts that are safe for the baby. One advantage of an epidural is that the medication is delivered directly near the nerves responsible for feeling pain.

Like for a dental procedure, the medication provides excellent pain relief with relatively small amounts going into your bloodstream and crossing the placenta. I sometimes describe it this way: think of a teaspoon of salt in the Empire State Building. It's not a literal measurement—just my way of illustrating how small the exposure can be to your baby.

This is an important reason anesthesiologists prefer epidurals for labor and delivery: we can provide pain relief during labor while minimizing your baby's exposure to medications that circulate throughout your body.

#5 - Epidurals have not been shown to cause long term back pain.

At the site in your back where the epidural was placed, the area may be tender for a day or two afterward—just as your arm might be sore after the flu shot.

But pregnancy and labor themselves put enormous stress on your back. Your muscles and ligaments stretch, your posture changes, and your pelvis and surrounding tissues undergo major changes. Some women develop back pain after giving birth whether they had an epidural or not.

And here's something you don't hear very often: plenty of women have epidurals and don't develop back pain afterward. I'm one of them! Those stories just don't tend to get repeated as much.

#6 - Permanent nerve damage or becoming paralyzed by an epidural is exceedingly rare.

This is probably the scariest epidural rumor I hear—and the good news is that serious permanent neurologic injury related to an obstetric epidural is very, very uncommon. The reality is that most postpartum nerve injuries are related to labor, positioning in bed, or pressure from the baby's head—not the epidural.

One situation we take especially seriously is blood-thinning medication because it can increase the risk of bleeding around the spine. If you take a blood thinner during pregnancy, ask your OB whether you should meet with an anesthesiologist before delivery. We can help make a plan for when to stop the medication so that an epidural can be performed as safely as possible.

#7 - Don't wait until you absolutely can't stand the pain, then ask for an epidural.

We all have different levels of pain tolerance. But regardless of that, once you've decided you want an epidural, it doesn't necessarily happen immediately. Your nurse may need to give you IV fluids, your anesthesiologist may be helping another patient, and we need time to talk with you, position you, place the epidural, and allow the medication to start working.

Here's my practical advice: don't wait until you absolutely can't stand the pain anymore.

I often tell patients to consider asking when contractions are becoming difficult enough that they interrupt your conversation, but you're still able to sit still and work with us. Give yourself a little buffer.

#8 - You have to stay in bed and can’t eat a solid food once you get an epidural.

After your epidural is working and your contraction pain is decreasing, you will be asked to stay in bed. This is because your legs will feel heavy or weak and it may not be safe to walk. Hospital policies vary, but most have you remain in bed following epidural placement.

Because you won't be walking to the bathroom and an epidural can make it harder to feel when your bladder is full, your nurse will explain how your bladder will be emptied when necessary.

In many hospitals, solid food becomes restricted once you have an epidural, while clear liquids, popsicles, jello, or pudding are okay to eat depending on the medical situation and hospital policy. Find out before you get an epidural so you can plan accordingly.

#9 - Sometimes, a planned vaginal birth turns into an emergency C-section.

To me, an epidural is like an emergency line that's already in place. If your baby suddenly has trouble (the heart rate decreases and won’t come back up), you will need to have an emergency C-section.

If that happens, I’ll give stronger medication through the epidural so that you’re much more numb and the OB can delivery the baby quickly and safely, allowing you to be awake to hear your baby cry.

If you don't have an epidural, and it’s a true emergency where every minute matters, there may not be enough time to place an epidural. In that situation, general anesthesia—putting you completely to sleep—may be necessary. That's one reason a well-functioning epidural can be valuable for more than just labor pain.

#10 - Some medical conditions require planning ahead.

Certain situations can make an epidural unsafe or simply require special planning—for example, medical conditions that affect the way your blood clots or if you have a serious heart condition or had heart surgery in childhood. If you have scoliosis, previous back surgery, a neurologic condition (like Multiple Sclerosis), or another condition that makes you wonder, just ask your OB and they can arrange for you to speak with an anesthesiologist before you go into labor.

Sometimes all you'll need is a conversation. Other times we may want to review your records, imaging, medications, or laboratory results and make a plan ahead of time.

If you had a bad experience with your last epidural, or a traumatic birth experience of any kind, you are not alone. This is also a very important reason to speak to an anesthesiologist so that a plan can be put in place to ensure that the chances of this occurring again are lowered. For more resources, contact me via email and I’d be happy to provide them.