The medication in an epidural is a combination of a local anesthetic—similar to Novocain—and an opioid, typically fentanyl or hydromorphone. 

Weak concentrations of the drugs are typically used, and they stay in the spinal space. Only a small amount goes into your bloodstream. Therefore, it is safe for the baby, and you will not experience the typical side effects of an opioid, such as drowsiness, that occur when an opioid is taken orally or given via IV.

Before the epidural is administered, you’ll receive a numbing injection, much like you would at the dentist before a cavity filling. That initial injection in the lower back can hurt a little. But after that, you should feel no pain—just the pressure of the epidural needle being inserted.

Pain relief should begin about 10 minutes after receiving the epidural, which takes about 10-15 minutes to administer.

It’s important to note that an epidural will last as long as you’re in labor because the medication is delivered continuously until the baby is delivered.

You can get an epidural at almost any time in labor if you can remain relatively still; however, an epidural is generally not given if the baby’s head is crowning.

Some mothers have heard they need to be dilated (meaning the cervix opens in preparation for birth) a certain amount before an epidural is given. According to guidelines from the American College of Obstetricians and Gynecologists (ACOG), a request from the mother is sufficient for an epidural. This means that there isn’t a minimum cervical dilation. I have done epidurals at one centimeter and when a mother is fully dilated at 10 centimeters.

A common concern is that having an epidural early in labor slows down labor and delivery. There is some evidence that it does slow it down by 20 minutes or a half hour. But in the grand scheme of things, it is not a significantly longer time.

Usually, you have to stay in bed after receiving an epidural because of decreased sensation in your legs, which puts you at risk of falling. However, you should be able to move your legs and move around in bed.

Epidurals are safe, but as with any medical procedure, there are some risks of side effects and complications. Serious risks—including blood clots inside the spine, infection (around the spine or brain), and nerve damage—are very rare. 

Other possible complications include low blood pressure, itchy skin, and headaches. Blood pressure in both you and the baby are continuously monitored during labor. If blood pressure goes too far down or up for either, medication can be given IV to you which will help the baby. 

Additional risks include no pain relief or only one-sided pain relief, which would require redoing the epidural, and difficulty emptying the bladder while the epidural is in place. You may also experience a low-grade fever and heaviness or tingling in your legs during labor, depending on how much medication has been administered.

Nerve damage is the risk mothers are most often worried about. It is very rare and occurs in less than 1% of epidurals. This could occur if the needle is inserted in the wrong location, advances too far, or comes in contact with a nerve root. If nerve damage does occur, it is usually temporary, resolving typically within a matter of weeks.

Mothers also ask if an epidural causes back pain. It’s important to understand that back pain after childbirth is from hours of labor. That’s because labor and delivery is a process that involves stretching muscles and ligaments which can lead to back pain.

Headaches, often referred to as ‘spinal headaches,’ occur when the epidural needle goes farther than it should, and spinal fluid leaks out of the hole created by the needle. The fluid loss affects nerves and tissues in the brain, causing a headache that usually starts within 24 hours of the epidural placement. It typically goes away on its own in a week, but sometimes it can last longer.

The headache is either in the front or back of the head near the neck. It can be a sharp pain, and it feels worse when sitting up but goes away when you lie down. For treatment, you can take over-the-counter medications or a medication your OB doctor can prescribe. If these medications do not work, the ultimate treatment for a spinal headache s called an 'epidural blood patch.'

Essentially, this is another epidural and blood is taken from your hand or arm and injected into your back (near the site of the original epidural). The blood creates more buoyancy and seals the hole where the puncture occurred. The relief is usually immediate. 

Ideally, the blood patch is done before you are discharged, but if you develop the headache after you go home, you can return to have it done. 

A small amount of epidural medication reaches the baby, but it’s much less than medication delivered through the IV or when you receive general anesthesia (both of which enters your blood supply and crosses the placenta).

With epidural medicine, however, most of it circulates in the epidural space, and very little reaches the baby. 

Still, an epidural has some indirect effects on the baby, including blood pressure fluctuations which can be serious so it’s important to monitor the baby continuously.

The epidural you receive today is not the same as what has been used in years past. 

The changes have to do with the concentration of medicine we use. Over the years, mothers have told us they don't like being so numb that they can't move their legs. That’s why most hospitals give a lower concentration of medicine. With this, you no longer feel the sharp pain of contractions, but you can still able to move your legs.

The way the medicine is delivered has changed as well. When the catheter is placed and taped to your back, it is attached to a special pump. The pump usually has a button you can press to deliver extra doses of pain medication a few times every hour. Once that bag is empty, we will replace the bag until your baby is delivered.

Sometimes, the epidural pump is programmed to deliver a set amount, or bolus, of medication every 45-60 minutes. If so, you may hear the pump make a sound at this time. This type of delivery system is best at preventing too much medicine that leads to heavy legs.

Also, if what the pump provides isn’t controlling your pain well enough for your to talk or sleep, we can come and give you an extra dose of medication so that you can save your energy for pushing.

No, getting an epidural will not increase the risk of having a C-section—the surgical delivery of a baby through an incision made in the your abdomen and uterus. 

With higher amounts of medication, epidurals could increase the risk of needing to deliver the baby with special tools like a vacuum or forceps used by your OB doctor.

Through many studies, we know that a higher concentration of epidural medicine was associated with this risk. However, the lower concentration we now use actually helps you have a normal vaginal delivery without this assistance.

Not every mother’s birth plan goes as expected; some mothers need a C-section in the middle of labor. A benefit is that if you already has an epidural, I can give you much stronger medicine—surgical anesthesia—through the same catheter. This will make you numb from the waist down. You’re awake during the surgery, but feel pressure and tugging, and you can bond with your baby immediately.

If you didn’t have an epidural but you now need an emergency C-section, I would have no choice but to give you general anesthesia, which requires a breathing tube. That is fine, and I’ve done it many times, but now you’re asleep and your family member is not allowed in the operating room. Nearly all the medications given with general anesthesia will cross the placenta and reach the baby. This can lead to the baby being more sedated at delivery, which is why we always expedite the delivery during general anesthesia. Due to this, the epidural acts like an emergency line for me because it leads to a safer delivery for you and the baby.

Epidurals also help lower stress hormone levels which can help lower blood pressure and heart rate. This is particularly beneficial for mothers who develop high blood pressure or pre-eclampsia during pregnancy.