What Is an Epidural?

An epidural is a widely used procedure that delivers pain relief by injecting medication into the epidural space around the spinal cord. This technique is commonly employed for labor and childbirth, certain surgeries, and chronic pain management.

Here are some common uses for an epidural:

• Labor and birth. Provides pain relief during vaginal delivery or C-sections.

• Surgery. Used alongside or instead of general anesthesia.

• Post-surgery pain. Helps manage pain after major procedures.

• Chronic pain. Steroid injections may ease conditions like sciatica or herniated discs.

During the procedure, a thin catheter is placed in the lower back to deliver medication. Relief can last from a few hours to several months, depending on the type of epidural.

Side effects can include mild numbness, low blood pressure, or a headache—though more serious issues are rare. In this article, we’ll explore how an epidural works, what to expect, and how it may help during labor or other medical treatments.

What Is an Epidural?

An epidural is one of the most common methods of pain relief used during labor. The main advantage of an epidural is that it helps relieve most of the pain by numbing your lower abdomen and birth canal while allowing you to stay awake and alert throughout labor and delivery. You will still be aware of your contractions and able to push, although you may not be able to walk.

If you're considering an epidural for your delivery, it’s a good idea to discuss it with your healthcare provider during a prenatal visit to confirm whether it’s available at your hospital or birthing center. You can also include your pain relief preferences in your birth plan. However, it’s important to know that you can change your mind when the time comes; just let your medical team know.

How Does an Epidural Work?

An epidural works by delivering anesthetic medication into the epidural space, a fluid-filled area around your spine. This space acts like a cushion and the anesthetic blocks pain signals from traveling through the spinal cord to your brain in a specific region of your body, depending on where the epidural was injected.

The level of pain relief you experience from an epidural depends on several factors, including the type of drug used, its concentration, and the dosage. Some people may feel a temporary loss of sensation, while others may experience total numbness in the lower part of their body. This process allows you to stay aware of your contractions and participate in labor without feeling the intense pain of contractions.

The Difference Between Epidural Analgesia and Epidural Anesthesia

You might hear the terms epidural analgesia and epidural anesthesia when learning about pain relief options for labor, and while they sound similar, there’s an important difference between the two.

Epidural analgesia is designed to ease pain without completely blocking all feeling. With this option, you’ll still be aware of sensations like pressure from contractions, but the sharp pain will be much less noticeable. Many people like this option because it helps manage pain while still allowing them to feel more in control, and able to move their legs or shift positions.

Epidural anesthesia, on the other hand, provides more intense pain relief, usually numbing a larger area. This option is often used for cesarean deliveries or when stronger pain management is needed. While you’ll still be awake and able to follow along with what’s happening, you may find that your lower body feels heavier or harder to move.

Your healthcare provider will help you decide which option makes the most sense for you based on your needs during labor.

How Long Does an Epidural Last?

Once an epidural anesthesia is administered, it usually starts working within 10 to 20 minutes. The great thing about an epidural is that the pain relief may last throughout your entire labor, as more medication can be delivered through the catheter (if that is the delivery method chosen) to keep you comfortable for as long as you need it.

Other Types of Pain Relief During Labor

An epidural is one of several types of regional anesthesia you may have access to during your labor. Other types include spinal blocks and combined spinal-epidural blocks. Your provider can help you decide which type might be right for you. 

• Spinal block. In this case, the epidural medication is injected as a shot directly into the spinal fluid in the spinal cord. It generally takes effect more quickly than an epidural block, but the pain relief wears off more quickly, too (usually after one to two hours), because there is no catheter in place to continuously administer the medication.

• Combined spinal-epidural (CSE) block. As its name suggests, this method of pain relief can give you the benefits of both the spinal and epidural block. The spinal block is given first to provide fast pain relief, and the epidural catheter is inserted later to provide more long-lasting comfort throughout your labor.

There are other, non-medical types of pain relief you can try, too, and you may have learned about some of these in a childbirth class. These labor comfort measures can be used whether you’ve had an epidural or not. Some of these options include:

• Hypnobirthing. This is a relaxation technique that can help reduce fear, anxiety, and pain during labor.

• Massage therapy. Your birthing partner can gently massage your lower back or shoulders, which may help relieve some of the pain of contractions.

• Breathing exercises. Controlled breathing, such as the techniques taught in Lamaze classes, can also help you relax and decrease painful sensations during labor.

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Best Time to Get Epidural During Labor

The best time to get an epidural during labor often depends on your individual experience and what method of delivery your healthcare provider recommends. While it’s usually administered during active labor; when your cervix has dilated to around 4 to 5 centimeters.

In some cases, your provider may suggest getting an epidural if you're having a vaginal birth that’s been induced, as induced labor contractions may sometimes be more intense. Epidurals are also commonly used during cesarean section. For example, if you initially planned for a vaginal delivery but end up needing a C-section, the existing epidural may be used to provide additional medication for the surgery.

In certain situations, such as a pelvic exam after 37 weeks of pregnancy, your healthcare provider may determine that your baby is in a breech position. If they attempt to turn your baby through a procedure called external cephalic version (ECV), an epidural might be used to help relax your uterus and make the process more comfortable.

How Many Times Can You Get an Epidural During Labor?

The number of times an epidural can be administered during labor depends on how your labor progresses and the type of delivery you have. If the epidural catheter is inserted, it can continuously deliver medication throughout labor. Your anesthesiologist may adjust the dosage or give additional doses as needed, so there's usually no need for a new injection unless the epidural isn’t providing effective relief.

For vaginal deliveries, the epidural may offer sufficient pain relief for the duration of labor. In the case of a cesarean section, your anesthesiologist may increase the medication to ensure you're comfortable during surgery.

Does an Epidural Hurt?

The idea of having a needle and catheter inserted into your lower back might sound intimidating, but rest assured, your healthcare provider will take steps to minimize discomfort.

Before the epidural is inserted, a local anesthetic is used to numb the area. This helps reduce any pain or discomfort you might feel during the procedure. Most people report feeling pressure or a slight pinch when the needle is placed, but this sensation normally goes away quickly. Overall, the relief from labor pain that follows tends to outweigh any brief discomfort during the procedure.

Epidural Side Effects

Like any medical procedure, getting an epidural may come with potential side effects. While most are mild and temporary, it's helpful to know what to expect and when to consult your healthcare provider.

Common side effects of epidural include:

• Drop in blood pressure. This may result in lightheadedness or dizziness.

• Mild itching or a sense of warmth. This is often due to the medication used.

• Headache. It may occur if spinal fluid leaks during the procedure. This is rare but treatable if it happens.

Your medical team will closely monitor you to ensure any side effects are managed. If you experience any unusual symptoms after your epidural, be sure to let your healthcare provider know.

Long-Term Side Effects of Epidural

While most side effects of an epidural are temporary, it's natural to wonder about potential long-term effects. Generally, epidural anesthesia is considered safe, but it's helpful to know what might occur in the longer term.

Long-term side effects are rare but may include:

• Persistent back pain. Some individuals may experience lingering back pain at the site of the epidural injection. This is often due to the needle or catheter and usually resolves over time.

• Chronic headaches. In rare cases, a spinal headache resulting from a leakage of spinal fluid might persist. Treatment is usually effective, and such headaches are not common.

• Permanent paralysis. Occurs from a hematoma when there’s a buildup of blood between the dura mater and the spinal cord.

It’s important to remember that these long-term effects are uncommon. Most people experience no lasting issues after an epidural. If you have any concerns or notice unusual symptoms after your epidural, be sure to discuss them with your healthcare provider. They can provide guidance and reassurance, ensuring that you receive the appropriate care if needed.

How Long After Getting Epidural Does Baby Come?

There isn’t a set time for how quickly your baby will arrive after receiving an epidural. Every labor progresses differently, and the timing depends on how far along you are when you receive the epidural. Typically, an epidural is administered during the active phase of labor when the cervix is dilated around 4 to 5 centimeters. This is when labor tends to intensify, and contractions become more regular.

After receiving the epidural, it may take several hours for your labor to fully progress, depending on factors like the position of the baby and how quickly your cervix dilates. Depending on which epidural is administered, some may find that an epidural may slow down labor slightly after receiving it but this is not always the case. In fact, for many, pain relief helps them relax and progress more efficiently.

Ultimately, the time it takes to meet your baby after receiving an epidural varies from person to person. Your healthcare provider will guide you through each stage of labor and monitor your progress.

The Bottom Line

An epidural is a common and effective option for pain relief during labor, allowing you to stay comfortable and alert. While there are potential side effects, most are mild and temporary. The decision to use an epidural is personal, and your healthcare provider will help guide you based on your needs. Whether you opt for an epidural or not, it’s important to feel informed and confident in your choice.

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