The Labor Epidural: What It Is, When You Can Have It, and Common Side Effects

An epidural is the most effective form of pain relief available for labor. A thin, flexible catheter is placed in the lower back, in the space just outside the membrane that surrounds the spinal nerves. Medication — usually a low concentration of local anesthetic combined with a small dose of opioid — then flows through the catheter for as long as labor continues, and can be adjusted as labor progresses.

When can I have one?

The American College of Obstetricians and Gynecologists states that, in the absence of a medical contraindication, a woman's request is sufficient reason for pain relief during labor.¹ The ASA and the Society for Obstetric Anesthesia and Perinatology advise that an epidural need not be withheld until the cervix reaches an arbitrary dilation; the decision is individual.² Your anesthesiologist will review your health history, any blood-thinning medication and recent blood test results before placing it.

How it is placed

You sit up or lie on your side and curve your back. The skin is numbed first, so most women feel pressure more than pain. Once the catheter is in place, the needle is removed and the catheter is taped to your back. Relief typically builds over the following minutes.

What the evidence says about labor

A 2018 Cochrane review of 40 trials involving more than 11,000 women found that epidurals relieved labor pain better than non-epidural methods. Epidurals were associated with a higher rate of assisted vaginal birth (forceps or vacuum), but did not significantly increase the overall rate of cesarean delivery, and showed no difference in long-term backache.³

Side effects worth knowing

Common, generally manageable effects include a drop in blood pressure, itching from the opioid, shivering, leg heaviness and difficulty passing urine. A less common complication is a post-dural puncture headache — a headache that worsens when sitting or standing — which can occur if the needle passes through the membrane around the spinal fluid. It is treatable, and you should tell your providers if it happens after you go home. Serious nerve injury and infection are rare.¹

Dr. Seitz provides anesthesia for labor and delivery. If you have questions about whether an epidural is right for you, raise them with your anesthesiologist before or early in labor.

Sources

1. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 209: Obstetric Analgesia and Anesthesia. Obstet Gynecol. 2019;133(3):e208–e225.
2. Practice Guidelines for Obstetric Anesthesia: An Updated Report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia and the Society for Obstetric Anesthesia and Perinatology. Anesthesiology. 2016;124(2):270–300.
3. Anim-Somuah M, Smyth RM, Cyna AM, Cuthbert A. Epidural versus non-epidural or no analgesia for pain management in labour. Cochrane Database Syst Rev. 2018;5(5):CD000331.