What Is an Epidural and How Does It Work?

Learn about epidural injections to decide whether this form of anesthesia is right for your labor and delivery.

Epidural
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No matter how many books you read or friends' stories you hear, you won't know exactly what to expect during labor and delivery until you're in the midst of it. While childbirth is different for everyone, you may experience nervousness, wonder, joy, and, yes, some pain.

Some people choose to forgo pain relief medications during labor, but many others opt to use medication to manage discomfort, and the most common form of pain management used during labor in the US is an epidural. In fact, it's used by an estimated 70% of birthing people during childbirth. In addition to being common, epidurals are effective and safe.

An epidural works by delivering numbing medication into your lower spine to blunt the pain of labor and delivery without sedating you or putting you to sleep. Here is all you need to know about epidurals during labor from how they work to the risks and side effects.

What Is an Epidural?

When you're in labor, your uterus contracts, leading to pain that travels from the uterus via nerves in the spine or backbone to the brain, says Sangeeta Kumaraswami, MD, an anesthesiologist specializing in obstetrics at Westchester Medical Center in Valhalla, New York. "The pain is usually mild early on in labor, but gets worse closer to delivery," she notes.

An epidural is an injection of pain medication into the lower spine or backbone area that blocks those intensifying sensations. "It numbs the body below the injection, allowing a [person] to remain alert but more comfortable throughout labor, and feel pressure to push when it is time to deliver [their] baby," says Dr. Kumaraswami. Epidurals can be placed during any stage of labor.

How Does an Epidural Work?

An epidural works by stopping pain signals from going up the spine to the brain. "The anesthetic agent bathes the nerves, which become numb and thus prevent the transmission of pain sensations," says Iffath Hoskins, MD, clinical associate professor in the Department of Obstetrics and Gynecology at NYU Langone Health in New York City.

To place an epidural, the anesthesiologist first injects a small amount of a localized numbing agent into your lower back. Then, they insert a needle and a small tube called a catheter into your spine. Anesthesia is then injected into the epidural space, which is a compartment surrounding the nerves in the spinal cord.

After about 15 minutes, you should feel numb between your belly button and upper legs. More medication can be added through the tube when you need it, for as long as you need it. "Small doses of the medication can be injected at intervals, as needed," Dr. Hoskins says. "This relief can last for the duration of labor—up to 24 to 36 hours—plus several hours later."

What Is a Combined Spinal Epidural (CSE)?

Sometimes a spinal injection, or "spinal block," is used in combination with an epidural to relieve pain more quickly. This form of anesthesia is called a combined spinal epidural (CSE).

For a CSE, your doctor injects a small amount of anesthesia into your spinal fluid. You should feel numb in your lower body right away, but the relief only lasts for an hour or so. By placing an epidural after the spinal block, the doctor can give you more medication later on.

Good to Know

If you happen to need an emergency cesarean (C-section) during labor or a tubal ligation following the delivery of the baby, the epidural treatment can act as the anesthesia through these procedures as well allowing you to stay awake rather than "going to sleep" under general anesthesia.

Walking Epidural

If you want an alternative to the complete numbness offered by classic epidurals, you could talk to a healthcare provider about a walking epidural. These epidurals provide effective, safe pain relief but do not completely blunt the feelings and sensations of your labor and delivery.

You also will have greater mobility in the lower half of your body during labor. Your anesthesiologist can adjust your dose to numb your pain while still allowing you enough feeling to participate in pushing during delivery.  

Risks and Side Effects of Epidurals

You may worry about the risks of having an epidural during childbirth, but the chance of harm is very low. It's a common misconception that when given early in labor, an epidural increases the rate of C-section delivery, but research shows that this isn't true. In fact, it may even slightly lower your risk of a life-threatening complication during labor.

Epidurals are also safe for babies. While babies born to parents who had an epidural during labor are a little more likely to have short-term troubles related to heart rate, alertness, and breathing immediately after birth, they are no more likely than other infants to have long-term health issues.

You may experience epidural side effects such as decreased blood pressure, mild itching, back pain, and headache, says Dr. Kumaraswami. "But a major complication such as nerve damage, bleeding, and infection in the spine and paralysis are extremely rare events," she says.

To minimize risks, speak to your doctor beforehand about any medical issues, such as allergies to local anesthetics, breathing problems, bleeding problems, or previous spinal surgeries, says Dr. Hoskins. You'll also do well to take it slow when the anesthesia starts to wear off. "After delivery, wait to move until you've regained full feeling in the lower extremities because there is a high chance of falling and injury if there is residual numbness," she says.

Ultimately, everyone has different experiences and varying tolerance when it comes to pain during childbirth. Dr. Kumaraswami recommends that people discuss epidurals and other pain relief methods with their birthing educators, physicians, or midwives several weeks before their estimated due date. When you understand your options, you'll feel less stressed and more comfortable when the big day arrives.

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Sources
Parents uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  4. Walking Epidural : An Effective Method of Labor Pain ReliefMedical Journal Armed Forces India. 2007.

  5. Epidural Analgesia and the Risk of Cesarean Delivery. American Family Physician Journal. 2018.

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