Epidural 101: How It Works
If you’re planning to have a baby, the word “epidural” has probably come up more than a few times. While you likely have a decent idea that it’s supposed to help ease the pain of childbirth—and that there’s a needle involved—you might be a little fuzzy on the details of how it works exactly. And since people tend to have strong opinions about epidurals—is it really better than a natural birth?—it’s important to know the facts, so you can make the right decision for you and your growing family. Here, a quick-and-painless guide to all things epidural.
You know those wailing women in labor you’ve seen in movies and on TV? Chances are they didn’t have an epidural. Simply put, an epidural helps to ease the pain of contractions and delivery. Numbing medication is sent to the area around your spinal cord via a catheter tube, and “this makes you numb from the belly button down,” says Erin S. Grawe, MD, an assistant professor of clinical anesthesiology and director of perioperative services at the University of Cincinnati College of Medicine. Numb, yes, but not sleepy, which means you’ll be alert and at ease throughout baby’s delivery.
There are three different types of epidurals that offer varying degrees of pain relief:
• Standard epidural. A “regular” epidural uses anesthetics to block pain in your body, making you numb from the waist down. Since it blocks your motor control, you won’t be able to walk with a full epidural, says Christine Greves, MD, an ob-gyn at the Winnie Palmer Hospital for Women & Babies in Orlando, Florida.
• Low-dose epidural. This option offers a lower dose of the pain blocking medication, leaving you with greater movement in your legs. It’s often administered in the latent stage of labor, Greves says, before pain levels spike.
• Walking epidural. A walking epidural uses narcotics only to help lessen the pain without limiting your motor function. It won’t block the pain as much as a standard or low-dose epidural, Greves says, but you may be able to get up and walk around during labor, if your doctor and hospital allow it.
If you opt for a walking or low-dose epidural to begin with but decide you need more pain relief, you can upgrade your epidural as you go—but you can’t downgrade from a standard epidural to a low-dose option, or from a low-dose epidural to a walking one.
Technically, you can get an epidural at any time during labor, but it’s recommended that you do so during the active phase (i.e., the middle stage when your cervix begins to dilate rapidly), says Greves. That’s because an epidural could actually slow down labor, she says, so it’s best to administer it when things are already progressing quickly.
While you might be tempted to wait until you’re in teeth-clenching, unbearable pain to get an epidural, it’s actually better to do it before you reach the writhing point. A woman must be able to sit still when an epidural is administered, says Grawe—otherwise, it may be difficult for your anesthesiologist to safely give you one.
Don’t lose sleep at night worrying whether an epidural will cause harm to you or baby. “Epidurals are very safe,” Grawe says, “and there are no negative effects on the fetus or the labor process when used appropriately and in a carefully monitored setting.”
Epidural complication rates are low: According to a 2014 study, it’s just under 3 percent. But there are some potential side effects. Women may have soreness in their lower back where the epidural needle was inserted, Greves says. There’s also a risk of developing what’s called a spinal headache—a headache that occurs if there’s a leak of spinal fluid around the epidural catheter. But it’s very rare, Grawe says, and happens between 0.5 to 5 percent of the time. A woman might also have an infection at the site of the catheter, and bleeding or bruising in the epidural space, which can cause nerve damage—but again, Grawe says, it’s extremely rare.
Here’s what they didn’t teach you in biology class: Epidural medication is delivered through a tiny, flexible tube (aka a catheter) that’s inserted into your lower back. The tube goes into the epidural space, which is outside of the spinal cord and where all of the nerves live that go to the lower parts of the body, Grawe says. Doctors use the tube to administer special medication—often a combo of a local anesthetic (or numbing medicine) and a narcotic (or pain-relieving medicine)—near those nerves, and “the medication basically dazes the nerves, so you don’t feel the pain impulses coming in,” says William Camann, MD, an anesthesiologist at Brigham and Women’s Hospital in Boston and coauthor of Easy Labor: Every Woman’s Guide to Choosing Less Pain and More Joy During Childbirth.
The epidural stays in your back so you can continue to receive the medicine throughout labor. And here’s some comforting news: Many hospitals now have patient-controlled epidurals, which allow moms-to-be to manage the flow of pain-relieving epidural medication with the simple push of a button. But don’t worry: The machine is set so that it won’t deliver too much medication.
An epidural can last a pretty long time, as long as your catheter is in place and you’re receiving medication—in fact, it can last reliably for up to five days, according to Grawe. “Fortunately, labor doesn’t usually take that long, so the epidural doesn’t need to last that long,” she points out.
Some doctors will request that the epidural be turned off or down during the pushing phase to allow mom to feel the pressure of baby’s head, which creates an urge to push, says G. Thomas Ruiz, MD, an ob-gyn at Orange Coast Memorial Medical Center in Fountain Valley, California. But that can still make things tricky: “Turn down the epidural too soon and the pain of contractions can inhibit pushing in some women,” Ruiz says.
Once baby is delivered, your anesthesiologist will stop the medicine and pull out the catheter. After that, Grawe says, it can take up to four hours for the numbness to wear off.
Everyone’s pain tolerance is different, Greves says, but in general, it’s not painful—and definitely not nearly as uncomfortable as active labor pains. In fact, your anesthesia provider will help ensure you’re at ease by numbing the skin on your back with a small needle even before actually placing the epidural, Grawe says. “After that, you may feel pressure and pushing in your lower back, but nothing should feel like sharp pain,” she says. If you do feel anything sharp, just let your anesthesiologist know and she can give you more numbing medicine, Grawe says. “The job of the anesthesia provider is to make sure you’re comfortable and safe during your delivery.”
Updated November 2017