What is an epidural? Is it safe? And what are the risks and concerns about epidural use during pregnancy? These are just some of the questions you might ask if you or someone you know is getting an epidural during pregnancy.
An epidural is a type of local/regional anesthesia that numbs around the area it is given only (such as the pelvis for pain relief during labor and delivery).
Epidurals have side effects, like all medications and medical procedures, but are generally very safe and effective.
About half of pregnant patients choose to get an epidural, and most are satisfied with their experience.
Epidurals are ultimately a personal choice. Discuss thoroughly with your medical provider.
What is an epidural?
An epidural is a type of anesthesia. Anesthesia is a medical treatment that involves controlled, temporary loss of sensation or awareness to prevent patients from feeling pain. Anesthetics are medications that are used for pain control, typically during surgeries or procedures.
Labor and delivery of a baby can be severely painful for the mother. She will experience contractions of the uterus that may start weeks or even months before delivery. The delivery process involves stretching the cervix (the opening of the uterus), the vagina, and all the tissues in the pelvic region as the baby is pushed through the vaginal canal.
Anesthesia is an option for pain relief. Some birthing women choose to use anesthetics to help make their delivery process less painful. Others opt for childbirth without the use of any medications.
Types of anesthesia
General anesthesia, or “going under,” is the most extreme form of anesthesia, in which a patient is put into a state of unconsciousness by medications injected into the bloodstream through an IV (intravenous) line, and/or inhaled from a mask. The patient is closely monitored and breathing assisted if needed. See our article on General Anesthesia.
General anesthesia is typically required for major surgeries, such as if the woman would need an emergency cesarean birth (c-section), not for typical vaginal deliveries.
For natural (vaginal) deliveries, it is important that the mother is conscious enough to be able to push (bear down and increase pressure in her lower abdominal area) to aid the delivery of the baby. It’s for this reason that an epidural anesthesia process is more commonly used for pain relief.
How is an epidural done?
An epidural is the most common procedure for labor and delivery. It involves an injection of medication into the epidural space surrounding the spinal cord to block off or reduce signals of pain sent from the spinal cord to the brain. The injection site is important because it affects which part of the body will be numbed.
The provider uses a long needle to access the epidural space in the patient’s lower back, specifically the lumbar spine, to provide pain relief in the pelvis area. They may use an analgesic rather than a fully numbing anesthetic to reduce pain. An analgesic will maintain some movement in the legs, allowing the mother to push.
They will then remove the needle but leave a catheter (long flexible small hollow tube) in the patient’s back to allow more medication to be administered. The medication is given either continuously or in doses, both of which had similar patient satisfaction. The patient can self-administer their doses by pressing a button, but the settings do not allow them to overdose if too much medication has been given already.
An epidural is typically injected at a level that creates a band of numbness from the belly button to upper legs. The patient can still feel pressure from contractions causing the baby’s head to push against her cervix, which would signal her to push.
What medications are in an epidural?
An epidural is called “local” anesthesia because it only numbs part of the body in the nearby area instead of the entire body. Drugs that are used in the epidural include bupivacaine, chloroprocaine, or lidocaine. They are often given with opioids or narcotics such as fentanyl and sufentanil for a combined effect.
The medical provider may also use epinephrine, fentanyl, morphine, or clonidine to prolong the epidural’s effects or to stabilize the patient’s blood pressure.
When can you get an epidural?
A patient can request an epidural at any time during the labor and delivery process. However, it is usually saved for when labor is further along and the cervix is dilated more than a few centimeters. This is because the epidural may numb the patient so much that she cannot walk without assistance, and movement is important for aiding the labor process, and for the prevention of blood clots and other complications.
Before that, she may be given intravenous pain medications for pain relief through a catheter into the bloodstream in her arm. Since the patient cannot easily walk or urinate, a foley catheter is usually also placed into the bladder at the time of the epidural. This is so that the patient will not have to go to the bathroom on her own until after delivery.
What are the risks and side effects?
Epidurals are very safe. Side effects are usually minimal, and serious complications are extremely rare. However, like all medical procedures, there is some risk. Some potential side effects include:
- Pain and soreness in the lower back;
- Ringing of the ears;
- Numbness leading to difficulty walking;
- Difficulty urinating;
- Drop in blood pressure;
- Permanent nerve damage.
Drop in blood pressure can lower the baby’s heart rate. To decrease this risk, the patient is usually given extra IV fluids, repositioned, or even given a medication to keep blood pressure up.
In very rare cases, permanent nerve damage where the needle was inserted but this is only one in 240,000 patients (some patients can develop a temporary “pinched” nerve from compression from pushing, swelling and positioning during labor).
Possible effect on delivery: some studies show that an epidural can speed up labor by allowing the mom to relax. There have been concerns that pushing is less effective when the mom is numbed, but those have recently been disproven. There are no studies that show a clear link between epidurals and delayed delivery or increased risk of vacuum, forceps, episiotomies, C-sections, or other assisted delivery options.
Possible effect on baby: trouble latching on during breastfeeding, respiratory depression, and increased fluctuations in heart rate, but studies are not clear.
Who cannot get an epidural?
Certain medical conditions make it hard or dangerous for the patient to get an epidural. Make sure to give your medical provider a thorough medical history. These may prevent you from being able to get an epidural:
- Allergies to anesthetic drugs;
- Blood clotting disorders;
- Certain infections;
- Congestive heart failure;
- Active cancer at the site of the injection;
- Actively getting epidural steroid injections for a condition;
- Severely uncontrolled diabetes;
- Mom is actively bleeding.
How much does it hurt?
It truly varies for every person and her personal pain tolerance. It also depends on the medical provider and whether or not multiple attempts at placing it need to be done. Some patients have more difficult spines for epidural placement due to scoliosis, kyphosis, or other medical conditions.
Most women who had gotten the epidural reported that they were satisfied and would do it again for their next pregnancy.
One study of 10,000 women found about 68% of patients were either “satisfied” or “very satisfied.” The ones who were not satisfied had side effects or more complicated deliveries that were not clearly linked to the use of the epidural.
In conclusion, getting an epidural is ultimately a personal choice. While there are risks, many women (about half) choose to have epidurals for pain relief during pregnancy.
Factors that affect a patient's decision to get an epidural or not include prior epidural experience, parity (what number of pregnancies this was), age, education, race, income, language, insurance type, partner's preference, duration of labor, and whether Pitocin was used or not to aid contractions.
If you decide to get it, you can always request it to be turned off and no further medication given through the catheter as well. If it’s not working for you, sometimes the catheter can be taken out and a new epidural can be placed, as well.
Discuss this with your medical provider thoroughly before making a decision.