While very safe, epidurals still carry some risk. Here's what you need to know about choosing an epidural for your delivery.
Epidurals are the most common form of pain relief used during labor—with around 60% of pregnant women in the U.S. opting to receive one. They're a marvel of modern medicine—allowing women to manage the pain associated with childbirth without major side effects in the majority of cases.
"Labor can be intensely painful for many women, and epidurals have been shown, over and over again, to be safe and effective for helping pregnant patients cope with labor pains," says Dr. Sarah Bjorkman, OB/GYN and Motherly's Medical Advisor.
But epidurals are not without risks. For the most part, epidural side effects are very mild, though rarely, more serious complications may arise.
What is an epidural?
An epidural is a form of pain relief used during birth (and other situations) that involves administering medication through an injection into the epidural space around the spinal cord in the lower back area. Epidurals effectively numb your body from the waist down, but you'll otherwise remain awake and alert.
Because the anesthetics used in the epidural block the pain signals from reaching your brain, you'll likely still be aware that your contractions are happening, but the pain will be much less intense. Even with an epidural, you should still be able to push down during contractions to birth your baby vaginally. And while you'll be able to move the lower half of your body, you may not be able to walk.
For a cesarean delivery (C-section), the amount of medication transferred through the epidural is increased, fully numbing you before the surgical procedure—and serving as a type of regional anesthesia.
Electing to have an epidural can mean you'll get one of three options:
- Epidural block: The most common form of epidural, using a combination of anesthetic and analgesic (pain-relieving) medications. Epidurals are administered slowly, and the effects set in after about 10 to 20 minutes.
- Spinal block: More often used with C-sections, as the numbing takes effect very quickly, though it only lasts an hour or two. Spinal blocks are administered into the spinal fluid.
- Combined spinal-epidural block: The combo version works quickly and lasts longer than either the epidural or spinal block alone.
Common side effects of getting an epidural
In most cases, the side effects of epidurals are generally mild, and may include:
- Itching: Certain medications used in epidurals (typically opioids) can cause itchiness.
- Low blood pressure: Blood pressure can drop with epidural administration, and your doctor will monitor you regularly to prevent any issues.
- Nausea: Opioids, which are sometimes used in epidurals, can cause nausea.
- Fever: If left in for a long period of time, epidurals may cause fever, especially if administered for more than six hours (this is more common with first births).
- Difficulty urinating: Because epidurals numb the nerves that signal when you need to pee, your doctor may insert a catheter to help empty your bladder.
- Back pain: After having an epidural, lower back pain is fairly common, but should dissipate a few days after birth.
Rare side effects of getting an epidural
The more serious risks of having an epidural are very rare—but can include trouble breathing and nerve damage, among other issues.
- Breathing difficulty: Rarely, the anesthetic drugs used (typically opioids) can slow your breathing—your physician will be monitoring you closely.
- Spinal headache: In the rare case that the epidural injection actually punctures the membrane surrounding the spinal cord, it could result in some spinal fluid leaking out and causing a severe headache. But don't worry—this is very treatable.
- Infection: As with any type of injection, there's always a small risk of infection, but because your skin will be swabbed and the needle used is sterile, this is a very minor risk.
- Nerve damage: In rare cases, the epidural injection could hit a nerve and result in the temporary or permanent loss of sensation in the lower part of your body. Be sure to tell your doctor if you're still feeling numbness or tingling after your epidural should be worn off.
The connection between epidurals and assisted deliveries
By choosing an epidural, there is a chance that you may need to rely on other supportive tools to help you birth your baby, as getting an epidural may extend the second phase of labor. Researchers in 2020 showed that women who have an epidural have a higher chance of needing an assisted delivery (one that requires the use of instruments such as forceps or a vacuum)—but have a lower chance of needing a C-section.
On that note, "excellent scientific studies including thousands of patients have shown that the initiation of epidural analgesia at any stage during labor does not increase the risk of cesarean delivery," adds Dr. Bjorkman.
You may have heard that an epidural will slow down your labor, but studies have shown that on average, an epidural prolongs pushing only by about 7.5 minutes and has no negative effects on the baby, Dr. Bjorkman says.
Do epidurals affect babies?
Because a very small amount of the medication used in the epidural does get into the bloodstream, yes, epidurals can technically reach the baby. However, it's good to know that overall, the research shows that the amount of epidural medication absorbed by the infant is minimal—and not shown to significantly affect Apgar scores in newborns—especially as compared to using general anesthesia.
Epidurals are administered in millions of births each year—and most of the potential side effects are only temporary. Should you get an epidural? It depends on your pain tolerance. Some pregnant women may find that unmedicated labor techniques such as breathwork and using a doula can help modulate pain enough to be manageable, while others may find that using medication is the best method for them to experience birth.
"It's important to remember that every single person experiences pain differently. Whatever the threshold is for you, know that there are a variety of options to help you keep it manageable—and that your OB provider wants to support you to have the best, most comfortable experience possible. I always encourage patients to learn about all the different pain control options and to find out which ones are available to them at their hospital, as studies have shown that women generally underestimated the pain they would experience during labor," shares Dr. Bjorkman.
No matter which method you choose, it's 100% your choice, mama.
Medically reviewed by: Dr. Sarah Bjorkman, OB/GYN and Motherly's Medical Advisor.
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Institute for Quality and Efficiency in Health Care (IQWiG). Pregnancy and birth: Epidurals and painkillers for labor pain relief. Updated March 2018.
Kim WH, Hur M, Park SK, Yoo S, Lim T, Yoon HK, Kim JT, Bahk JH. Comparison between general, spinal, epidural, and combined spinal-epidural anesthesia for cesarean delivery: a network meta-analysis. International Journal of Obstetric Anesthesia. 2019 Feb 1;37:5-15.
Sng BL, Leong WL, Zeng Y, et al. Early versus late initiation of epidural analgesia for labour. Cochrane Database Syst Rev. 2014;(10):CD007238. Published 2014 Oct 9. doi:10.1002/14651858.CD007238.pub2
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