Pregnancy: Should I Have an Epidural During Childbirth?

An epidural is pain medicine that you get through a very thin tube (catheter) inserted into your back. Your lower body becomes partly or totally numb, depending on how much medicine is used. But you stay awake and alert.

Sometimes you can't get an epidural:

• Your labor may happen so fast that there isn't time for an epidural.
• You may be in a smaller hospital that doesn't offer them. If you think you may want an epidural, find out ahead of time if they are offered at the hospital or birthing center where you're planning to go.
• You may have a health problem that means you can't have an epidural.

• Epidurals are considered the most effective and easily adjustable type of pain relief for childbirth.
• After an epidural is started, you can quickly get pain relief if and when you need it during labor and delivery.
• The medicine in an epidural doesn't make you sleepy, so you are awake and alert for the delivery.
• If you were to end up needing a C-section, the epidural could quickly numb the area below your waist for the surgery.

• Drop in blood pressure. This can lower your baby's heart rate. To help prevent this, you receive fluids through an I.V. beforehand and are encouraged to lie on your side, which improves blood flow to the baby.
• Being unable to feel your contractions and to push. This may increase your risk of needing an assisted delivery (forceps or vacuum).^{footnote 2}
• Seizure. This is very rare.

After delivery with an epidural, you may have:

• Back soreness at the catheter site. This isn't common. Some women fear that an epidural causes long-term back pain. But studies have not shown a connection between new back pain and epidural use.^{footnote 2}
• A severe, prolonged headache. This can happen when the spinal cord sheath has accidentally been punctured during the epidural. This isn't common. After the puncture is fixed with a different medicine, the headache usually goes away.^{footnote 1}

• Pain medicines. You can get a shot of pain medicine or get it through an I.V. The most common medicines used are opioids, also known as narcotics. These medicines:
  • Help you relax between contractions.
  • Decrease the pain (but they don't take it away completely).
  • Have side effects, including drowsiness, nausea, and vomiting.
• Comfort measures. There are also several ways to control pain without using medicine. They include:
  • Distraction. Walk, play cards, watch TV, take a shower, or read to help take your mind off your contractions.
  • Massage. Massage of the shoulders and low back during contractions may ease your pain.
  • Imagery. For instance, think of contractions as waves rolling over you. Picture a peaceful place, such as a beach or mountain stream, to help you relax between contractions.
  • Focused breathing. Breathing in a rhythm can distract you from pain. Childbirth education classes teach you different methods of focused breathing.
• Nitrous oxide. You give yourself nitrous oxide (a gas) through a mask when you need pain relief. Nitrous oxide is not available in many places.

This is usually a personal decision, but an epidural might be recommended in certain situations, such as when:

• Your labor pain is so intense that you feel exhausted or out of control. An epidural can help you rest and get focused.
• You have a higher than average chance of needing a C-section. If you do need surgery, the epidural would already be in place and you could be quickly numbed.