When thinking about your birth experience, you might be thinking about getting an epidural when you’re in labor. If you don’t know what an epidural is, an epidural delivers pain relief medication continuously to your lower body and blocks labor pain. The medicine goes through a catheter, which is a very thin and flexible tube. An anesthesiologist inserts the catheter into the laboring mother’s epidural space in her lower back.

Epidurals are the most commonly used method of pain relief for labor in the United States. Many women plan on getting an epidural for pain management when they go into labor. Here are some benefits of getting an epidural (according to the American Pregnancy Association).

Benefits:

• 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 exhaustion, irritability, and fatigue.
• An epidural can allow you to rest, relax, focus, and give you the strength to move forward in your birth experience.
• The use of epidural anesthesia during childbirth is continually being refined, and much of its success depends on the skill with which it is administered.

Like any intervention, epidurals also have risks. Here are some risks when getting an epidural (according to the American Pregnancy Association).

Risks:

• Epidurals may cause your blood pressure to drop. For this reason, your blood pressure will be routinely checked. This usually happens every 15 to 30 minutes. Your medical team wants to ensure there is adequate blood flow to your baby. If there is a sudden drop in blood pressure, you may need to be treated with IV fluids, medications, and oxygen.
• You may experience a severe headache caused by leakage of spinal fluid. (Less than 1% of women experience this side effect.) If symptoms persist, a procedure called a “blood patch,” which is an injection of your blood into the epidural space can be performed to relieve the headache.
• After your epidural is placed, you will not be allowed out of bed. This means you will need to alternate sides while lying in bed. You will also have continuous fetal monitoring to check for changes in fetal heart rate.
  • Rotating sides ensures that 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 very numb and heavy while the top side regains more feeling.
  • Lying in one position for too long can also potentially cause baby to get into an unfavorable pushing position (like posterior, also known as sunny-side up). Remaining in one position for too long can also sometimes cause labor to slow down or stop. This is why epidurals often come with Pitocin, the synthetic form of oxytocin that causes contractions.
• You might experience the following side effects with an epidural: shivering/shaking, ringing of the ears, itching, backache, soreness where the needle is inserted, nausea, or difficulty urinating.
• You could find that your epidural makes pushing more difficult. Because of this, additional medications or interventions may be needed, such as a vacuum, episiotomy, forceps, or a cesarean. When creating your birth plan, talk to your doctor about what interventions they generally use in such cases. (You can also request that the epidural be turned off when pushing. This allows you to feel more of where to push and how to push so that you can push more effectively. This can help you avoid other second-stage interventions.)
• For a few hours after the birth, the lower half of your body may feel numb. Numbness will require you to walk with assistance.
• In rare instances, permanent nerve damage may result in the area where the catheter was inserted.
• Though research is somewhat ambiguous, most studies suggest that some babies will have trouble “latching on,” causing breastfeeding difficulties. Other studies suggest that a baby might experience respiratory depression, fetal malpositioning, and increased fetal heart rate variability. This increases the need for forceps, vacuum, cesarean deliveries, and episiotomies.

Alright, you now 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? Is there really a right time to get it? One doctor may say that getting an epidural is fine as soon as you get to the hospital. However, another doctor may say that 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. Here’s why:

Waiting to Get an Epidural

Having been to 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 you are in active labor and your cervix has dilated to at least 4 centimeters before you call for an epidural is beneficial. At this point, your body has established active labor. This means strong and continuous contractions. Because of that, it’s more likely for things to continue to progress. As a result, you reduce your chances of needing more medical interventions and reducing your chances of a C-section. Conversely, if you get an epidural too soon, it can potentially 1) slow your labor, 2) stop your labor altogether if you don’t have Pitocin, and 3) it increases your chances of needing other interventions, which may then lead to a C-section.

1. Slows Your Labor

Ladies who had received an epidural before they had a strong, consistent labor pattern and minimal cervical dilation have experienced their labors slow 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 then leaves more time for potential problems to arise.

2. 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 slow down and come 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. If this happens to you, 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.

3. 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. If your body cannot progress to get you to pushing, you will need a cesarean birth.

Not Waiting to Get an Epidural

This is your body, your baby, and your birth experience at the end of the day. You get to choose when you want an epidural. Your care provider might give you their opinion, but it’s ultimately your choice. And now that you know all of this information, you can make an informed decision. You have a better understanding of what is right for you. I recommend listening to your body and making the best choice for you, whatever and whenever that is. This is why I say that both options are right whenever you decide to get an epidural—whether at the beginning of labor or later in labor. They are right because you have made the best decision for yourself.