When thinking about your birth experience, you might consider getting an epidural while in labor. Epidurals are the most commonly used method of pain relief for labor in the United States.¹ Many women plan on getting epidurals for pain management, but what are the benefits and risks? Should you wait or not wait to get one? Read on to learn more about when to get an epidural during labor.

What Is an Epidural?

An epidural delivers pain relief medication continuously to your lower body and blocks labor pain. The medicine goes through a catheter, which is a skinny and flexible tube. An anesthesiologist inserts the catheter into the laboring mother’s epidural space in her lower back.¹

Let’s explore the benefits and risks associated with epidurals.

Benefits of Epidurals

Here are some of the benefits of getting an epidural:^1,5

• It allows you to rest if your labor is lasting too long.
• It helps reduce the discomforts of childbirth so women can have a more comfortable and positive birth experience.
• If you deliver by cesarean, an epidural will allow you to stay awake to see your baby.
• After a cesarean, an epidural will also provide effective pain relief during recovery.
• If you tear during pushing, your epidural numbs your perineum while your doctor is stitching.
• When other coping techniques are no longer helping, an epidural can help you deal with feeling exhausted and irritable.
• An epidural can allow you to relax and focus so that you can continue in your birth experience.

Risks of Epidurals

Like any intervention, epidurals also have risks. For instance, you might experience the following side effects with an epidural: shivering/shaking, ringing of the ears, itching, backache, soreness at the site of the needle insertion, nausea, and trouble urinating. In addition, your lower body may be numb for a few hours after birth, so you’ll need assistance to walk. In rare cases, you can have permanent nerve damage where the catheter was inserted.^1,5

Here are some of the other risks of getting an epidural:

Drop in Blood Pressure

An epidural can cause your blood pressure to drop, which would require the use of IV fluids, medications, and oxygen. Your medical team will check your blood pressure routinely (about every 15-30 minutes). This helps them ensure the proper blood flow to your baby.¹

Headache

Epidurals might cause a severe headache due to the leakage of spinal fluid. However, there’s a relatively small chance this can happen, as less than 1% of women experience this side effect. But if your symptoms do persist, your medical team may perform a blood patch (a procedure where blood is injected into the epidural space to stop the leaking) to relieve your headache.^1,2

Frequently Changing Positions

After your epidural is placed, you won’t be able to get out of bed. This means you will need to alternate sides while lying down. You will also have continuous fetal monitoring so that your medical team can check for changes in the fetal heart rate. Here’s why you need to alternate sides:^1,6

• Rotating sides ensures your epidural medication is evenly dispersed throughout your lower body. Due to gravity, if you lay on one side for too long, the bottom side of your body will become numb and heavy while the top side regains more feeling.
• Lying in one position for too long may cause the baby to get into an unfavorable pushing position (like posterior, also known as sunny-side up).
• Remaining in one position for too long can sometimes cause labor to slow down or stop. This is why epidurals often come with Pitocin, the synthetic form of oxytocin that causes contractions.

Difficulty Pushing

An epidural can make it more difficult for you to push during labor. Because of this, you may need additional medications or interventions, such as a vacuum, episiotomy, forceps, or a cesarean. When creating your birth plan, you and your doctor can discuss what interventions they may use in these cases. You can also request to turn off the epidural when pushing. This allows you to feel where and how to push more effectively, which can help you avoid other second-stage interventions.¹

Issues With Baby

With an epidural, some babies will have trouble latching on, making it difficult for mothers to breastfeed.^1,3 A baby might also experience respiratory depression, fetal malpositioning, and increased fetal heart rate variability. This increases the need for forceps, vacuums, cesarean deliveries, and episiotomies.¹

When To Get an Epidural During Labor

Now you know some of the benefits and risks of having an epidural. If you have decided you want an epidural, the question is: when is the right time to get one in labor? And is there even a right time to get it? One doctor may say getting an epidural is fine as soon as you get to the hospital. Another might say you need to be in active labor and at least 3, 4, or 5 centimeters dilated before they will call the anesthesiologist. So, what’s the right answer? Honestly, both answers are correct.

After being at many hospital births and supporting women through all types of deliveries, I’ve noticed similar patterns and outcomes when women get epidurals too early. I’ve seen that waiting until your cervix has dilated to at least 4 centimeters before you call for an epidural is beneficial.^1,7 At this point, your body has established active labor. This means strong and continuous contractions, so it’s more likely for things to continue to progress.⁸ As a result, you reduce your chances of needing more medical interventions and reduce your chances of a C-section.⁴

Conversely, suppose you get an epidural too soon. In that case, the epidural can potentially 1) slow your labor, 2) stop your labor altogether if you don’t have Pitocin, and 3) increase your chances of needing other interventions, which may lead to a C-section.^4,9 Here’s more information on these three possibilities:

1. It Slows Your Labor

In my experience, women who had received an epidural before they had a strong, consistent labor pattern and minimal cervical dilation experienced their labor slowing down. This resulted in them needing Pitocin to help increase and strengthen their contractions. When your labor slows down, this prolongs your labor and your baby’s birth. And unfortunately, this leaves more time for potential problems to arise.⁹

2. It Can Stop Your Labor

Some women who have gone to the hospital at the beginning of their labor and received an epidural shortly after have experienced their contractions slowing down and coming to a complete stop. Sometimes, even Pitocin can’t help the body get into a good labor pattern in situations like this. Your receptors in your body might not respond to the Pitocin. The epidural makes your body slow down and relax, and the Pitocin tells your body to hurry up and have a baby.^1,6

If this happens, your doctor might try to break your water to increase your contractions. The problem is that breaking your water is not always a reliable form of induction and doesn’t always cause more and stronger contractions.¹⁰

3. It Increases Your Chances of a C-Section

The earlier you receive an epidural, the more you increase your chances of needing more interventions, potentially resulting in a C-section.⁴ If your body cannot progress to get you to pushing, you will need a cesarean birth.¹¹

At the end of the day, this is your body, your baby, and your birth experience. You have a better understanding of what is right for you. And you get to choose when you want an epidural. Your care provider might give you their opinion, but it’s your choice. Now that you know all this information, you can make an informed decision.

I recommend listening to your body and making the best choice for you, whatever and whenever that is. This is why I say either option is right for when you decide to get an epidural — whether you get it at the beginning of labor or later. They are both good options because you have made the best decision for yourself. 🙂