What to Expect from the Epidural Injection

What it is, how it works, and does it hurt?

epidural

If you aren't planning for an epidural, there's always a chance you could change your mind and your birth plan once labor starts. It’s also possible your labor could stall, leaving you uncomfortable for much longer than you expected, or that you could even need a surprise c-section. And, of course, your original birth plan could already involve an epidural.

Whatever your birth plan might be right now, it could always change. That’s why it’s smart to arm yourself with some information about epidural, so if you do need or want one, you’ll be totally prepared.

What It Is

You’ve probably heard about women getting epidurals during labor, but you might not know what it really is or how it works. Basically, an epidural is an injection of anesthesia into the base of your spinal column that numbs your body from your bellybutton to your upper legs, per the American Society of Anesthesiologists.

To be clear, an epidural isn’t just a single injection with a needle: instead, an anesthesiologist inserts a catheter into your lower back and leaves it there, so medication can continue to be given to you as needed throughout your labor and delivery.  

Timing

The procedure itself only takes about 10 minutes, and pain relief starts 10 to 15 minutes after it’s complete. You can usually get an epidural at any point during your labor: as soon as you get to the hospital, when you’re in active labor, or often even close to the end of labor. 

Once your baby’s birth is imminent (think: their head is crowning or birth is likely within 30 minutes), it’s generally too late for an epidural.

For the procedure to be done safely, you need to be able to lie perfectly still on your side for at least 10 minutes; the closer you get to your baby’s birth, the less likely it is that you’ll be able to do this.

The anesthesia can be delivered through your epidural for as long as you’re in labor, so there are no individual “doses” or any time frame on how long an epidural will last. You can think of it more as continuous pain relief that can be increased or decreased for the duration of your labor and delivery once the catheter has been inserted. 

After you’ve stopped receiving anesthesia from your epidural, the effects wear off in about two hours.

Do Epidurals Hurt? 

The placement of the epidural doesn’t hurt; the anesthesiologist numbs the area around your lower back first, before putting in the catheter. But the numbing injection may sting or burn a little, similar to the feeling of getting a normal vaccine or flu shot.

What Will I Feel After the Epidural?

The most significant thing women report feeling during labor when they get an epidural is pressure. Exactly how numb you become during an epidural is unique to each individual. In general, the medication doesn’t take away all feeling or make you completely numb; the goal is to greatly reduce the amount of obvious pain you feel during labor

You may still feel some slight discomfort during contractions or not. You may lose all sense of feelings in your legs (or not!). It may be easy to tell when it’s time to push, or you may have to rely on your delivery room staff to tell you when to start. But you will likely feel the pressure of your belly tightening as contractions come and go.

You know how Braxton-Hicks contractions are uncomfortable but not overtly painful? Experiencing labor contractions after getting an epidural is similar to that.

One other thing to note: you won’t be able to feel bladder sensations after an epidural and, at most hospitals, will be restricted from getting up to use the bathroom during labor. It’s standard practice to insert a bladder catheter in the urethra when an epidural is given to avoid urinary complications. The catheter is usually removed sometime in the 24 hours after birth. 

Common Fears

Some women are eager to get an epidural when labor starts and find relief from pain. Other women have concerns about getting an epidural, and that’s okay, too. Here are some of the most common worries women have about epidurals (and the myths and facts behind them!).

Could It Hurt My Baby?

Some of the epidural medication does reach the baby, though the amount is considered too small to harm your baby in any way. Rarely, a drop in the mother’s blood pressure can decrease your baby’s heart rate, but the anesthesia itself doesn’t cause side effects for your baby.

Could It Increase Risk for a C-Section?

Past studies have suggested that getting an epidural makes it more difficult for a woman to push effectively, which can mean that certain stages of labor take longer and the risk of c-section increases.

But newer studies find no correlation and experts, including those at Johns Hopkins Medicine, state there is not enough evidence to suggest that getting an epidural increases your chances of having a longer labor or requiring a c-section.

Could It Cause Permanent Side Effects?

Epidurals can cause headaches or migraines and back pain in the short-term, but these symptoms don’t last long. 

Like any medical procedure, there is always the chance of a rare and debilitating injury — but that’s true for most procedures (including birth itself!). The risk of permanent or severe injury is nowhere near high enough to make the procedure unsafe and it shouldn’t deter you from getting an epidural if you think it’s right for you.

Is It Safe to Insert a Needle Into the Spinal Cord?

Although it has a reputation for being a procedure that involves plunging a giant needle directly into your spine, the epidural is actually injected into the area surrounding your spinal cord, between ligaments and membranes, called the epidural space. Yes, it gets close to your spine — but it’s not a direct hit.

Does It Make You Feel "Out of It"?

The purpose of an epidural is to ease your pain, not turn you into a zombie. Most women report feeling vaguely numb but still totally alert and awake after receiving one. Remember, the amount of medication you get can be easily increased or decreased, so if you do feel any persistent grogginess or drowsiness, your doctor may simply need to lower your dose a bit. 

Keep in mind that being in excruciating pain can inhibit your mental state, too; if you have a low pain tolerance, suffering through contractions can affect your birth experience just as much as an epidural.

Will It Work?

It is possible, in rare cases, that your epidural may not work. Epidural failure doesn’t happen as often as you think, however, and it doesn’t cause any harm (aside from the frustration you may feel that it didn't work and the natural pain of labor).

Still, one 2008 study from Reviews in Obstetrics and Gynecology found that about 12% of epidurals fail, although out of that 12% nearly half were able to be adjusted to ultimately provide pain relief.

Side Effects

Even though epidurals are currently used in about 70% of deliveries and are generally considered safe, they aren’t completely free of side effects. There is a chance you could experience one of the following symptoms:

  • Headache
  • Back pain
  • Low blood pressure
  • Incontinence or difficulty urinating
  • Nausea or vomiting
  • Itching
  • Injection site pain

Keep in mind, though, that it’s not common for women to have all of these side effects with a single epidural — and that they are largely temporary. While minor complications do occur, it’s unlikely any of your worst fears (like the ones listed above!) will come true.

According to a 2014 study published in Interventional Pain Management, any complications from epidurals are extremely rare, occurring in as few as two percent of injections. They are also usually short-term and mild; severe complications or ones that cause long-term or permanent side effects are even less common.

Why You Might Want an Epidural

For first-time moms in particular, labor and delivery is just one big question mark after another. You have no idea what to expect in terms of the pain or the actual process of giving birth, and the anxiety about how badly labor and delivery might hurt can not only cause additional stress during your baby’s birth but even make it an unpleasant experience. 

In these cases, you might want to get an epidural to reduce the burden on both your body and your mind during labor. Knowing you can do something, even if it’s hard, because you’ll have pain relief can give you a more confident outlook and help keep you calm during labor. 

You know your body best: if you want an epidural, rest assured that it’s a safe and well-studied procedure that rarely results in serious or long-term complications. 

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Article Sources
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  2. Johns Hopkins Medicine. Epidurals for Labor Fact Sheet. Published November 20, 2018.

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