6 things to know about an epidural

A range of different options can help relieve pain during childbirth. These can include breathing exercises, different birthing positions, nitrous oxide (“laughing gas”), and an epidural. Used by more than half of people who give birth in hospitals, an epidural is a form of anesthesia that uses a needle to inject medicine into your back to numb the lower part of the body.

Here, Jennifer Buck, MD, an OBGYN with Medical Center of Trinity in Trinity, Florida, answers some of the most frequently asked questions about the procedure.

During an epidural, an anesthesiologist uses a needle and a small tube, called a catheter, to deliver anesthetic (a medication that causes loss of sensation) to an area called the epidural space, located just beside the spinal cord in the lower back. The medication begins working within 10 or 20 minutes after injection, but the catheter is typically left in position so more anesthetic can be given as needed. This allows the person giving birth to experience less pain while remaining awake and alert, and to be able to push during delivery.

While epidurals are used commonly in obstetrics, they can also be administered during other procedures that involve the lower parts of the body, such as the pelvis, legs, urinary tract or reproductive organs.

Epidurals are safe for most people giving birth, and they are the most popular pain-relief method used during labor, according to the American Pregnancy Association. But there are some restrictions.

"The number one concern would be if a person has difficulty forming blood clots," Buck says. Those with bleeding disorders that decrease the ability of the blood to form clots, like hemophilia and von Willebrand disease, may be at an increased risk of excess bleeding around the spine during and after the epidural procedure.

Patients taking blood thinners—drugs used to prevent blood clots from forming—may also be at an increased risk of epidural-related bleeding, and may not be appropriate candidates for an epidural. According to the US Food and Drug Administration, patients should speak with their doctors about a safe time to take blood thinners following an epidural.

In rare cases, people giving birth may not be able to get an epidural if the catheter cannot be properly inserted due to prior back surgery or scoliosis (an abnormal curvature of the spine). Speak with your healthcare provider about existing conditions or medications that might interfere with your ability to have an epidural.

One myth about epidurals is that they may prolong delivery or increase the likelihood of a C-section. While an epidural does not actually increase your chances of having a C-section, it’s not completely clear whether it can increase the length of your labor. One  study published in 2017 suggests this is not the case: results showed  that an epidural had no effect on the length of time between complete cervical dilation (when the cervix has opened completely and labor usually starts) and delivery. Of the 400 women in the study, half were injected with epidural anesthetic and the other half with a salt solution, with no noticeable differences in the length of labor, position of the fetus or the rate of episiotomy (a surgical incision made in the area between the vagina and anus to help with delivery).

An epidural may affect the ability to sense when it's time to push, but it shouldn't decrease the ability to push. It may, however, increase the likelihood that the doctor might need to use forceps (an instrument that fits around the baby's head to pull the baby out) during delivery. If labor is not progressing, Buck may recommend that her patients try an epidural to ease labor pain, and she assures them that it shouldn’t make their birth experience any less fulfilling than going without medication.

A minimal amount of anesthetic may reach the fetus through the umbilical cord, but it typically doesn’t cause any negative effects or lead to long-term concerns. Those in labor may experience a decrease in blood pressure during the epidural, which could slow the fetus’s heart rate. But, according to Buck, "this is very easily treated with fluids or medication delivered via IV."

"With any procedure there are always risks," Buck says, "but the likelihood of somebody having a significant complication from an epidural is very low."

Although it's not a permanent concern, epidurals can cause a decrease in blood pressure, which is why it’s important to monitor both the parent and the fetus. Although very rare, there is a small risk of more serious complications in the person who receives the epidural, including bleeding around the spine, nerve damage, allergic reactions and infections such as meningitis (inflammation of the membranes that surround the brain).

In most cases, the benefits of an epidural far outweigh the risks—though it is always a personal decision. The anesthetic can sometimes cause itching of the abdomen, arms or legs, Buck explains. Also, because an epidural causes numbing of the legs, about 15 percent of women who receive one may have short-term difficulty urinating. In those cases, a urinary catheter tube can be inserted temporarily to help. Additionally, roughly 23 percent of women who receive an epidural may experience an epidural-related fever.

Post-epidural headaches (which occur after having an epidural) can last for up to a week and are another potential side effect, says Buck—though they occur in only 1 percent of those who have an epidural. These are likely the result of an injection that has punctured the layer of tissue around the spinal cord, allowing some spinal fluid to leak. As the puncture heals, the headache should subside on its own. If it doesn’t, the doctor can place a small amount of blood near the initial injection site for the epidural, which helps seal the wound and relieve headaches.