I’m not going to lie to you. Sometimes an epidural is in order. Let me make this clear from the beginning: needing an epidural does not mean that you failed, are a wimp, are not strong, or are not going to have a natural birth! Birth with analgesia is still considered natural.

That said, let me elaborate. Nobody – and I repeat, NOBODY – can imagine what labor pain is like before experiencing it. We can anticipate and we can plan, but only when labor pangs actually start will you truly understand. And this is not to scare you, but to prepare you. Labor is a wild whirlwind of physical and mental feelings and sensations. It can only be described as wonderful, overpowering, wild, and unpredictable.

There are many reasons why an epidural can be wonderful and make your birth a beautiful experience. One good reason is simple and obvious: you are in too much pain without it.

Other reasons include:

  • Your baby is facing nose up or “occiput posterior” (OP), which can sometimes cause what is commonly called “back labor” and frequently causes a prolonged 2nd stage of labor (and the 2nd stage is often the most painful part of the process).
  • You are attempting a VBAC and are now in active labor. In case of an emergency, you want to be ready for anything—including the possibility of a C-section.
  • You have been in the early/latent phase of labor for days on end, have not slept for what seems like forever, and need some rest so you will be able to push adequately.
  • You went through sexual trauma and are unable to relax your pelvic floor. Anything going on in your genital area causes you tremendous pain and anxiety. 
  • You are completely dilated, and yet, your baby is not coming down the birth canal (called the “descent”). Though the descent is not yet occurring, you can’t stop pushing and wasting precious energy.
  • The idea of contractions freaks you out, and you are not interested in experiencing them.
  • You are being induced and want to know you have an option in case the medications we use cause you to have pain you feel is unbearable.
  • You have had a really great experience in the past with an epidural in place and want that same experience again.

I could go on and on. There are as many reasons for an epidural as there are patients.

Contrary to popular belief, the medications in the epidural do not make your baby sleepy, and you can generally move around again freely about 2 to 3 hours after the epidural (pump) has been turned off. You can breastfeed immediately after delivery, despite an epidural. Complications from epidurals are extremely rare, and pushing with an epidural is generally not a problem because you will still be able to feel pressure (rectal pressure, that is!) despite not feeling any pain or contractions. But if pushing is hard due to loss of sensation, we can decrease or even completely discontinue the epidural just before the time of pushing. We can then cause a slow return of just enough feeling to be able to push and generally return you to full sensation not long after your baby has been born.

So even though epidurals are not for everyone, they are a great option for those who need them for any of a large plethora of reasons.

Many myths surround the epidural. Myths tend to cause fear, so let me debunk some of these: excellent data shows that epidurals slow your labor only by mere minutes, not by hours. In general, epidurals do not increase C-section rates. New data suggests you are better off getting the epidural after reaching 3cm dilation, in order NOT to increase your C-section rate, especially during induction of labor. Epidurals do not cause chronic back pain, and they do not harm your baby.

If you decide you want an epidural, count about 30 minutes from the moment you tell your nurse to actually getting the epidural placed (sometimes there is an emergency going on and you may have to wait slightly longer). This is because, prior to starting, the anesthesiologist will require you to receive hydration, via I.V. fluids that help prevent a drop in your blood pressure. When receiving an epidural, you must sit up with your legs dangling down, typically aided by your nurse, while curving your lower spine out toward the anesthesiologist and sitting still for a few minutes straight. If you have a contraction while receiving the epidural, breathe through them as well as you can. Once the catheter has been placed, you will receive a medication “bolus,” and then, the catheter will be attached to a pump that is under your direct control.

After the epidural has taken full effect, you may no longer be able to feel or even move your legs. So now what do we do? We don’t want you stay flat on your back until you have the baby. So your nurse will turn you around from one side to another about every 20 to 30 minutes, each time making sure you and your baby are doing well. This helps the baby turn and descend through your pelvis, while your cervix further dilates. 

Even though you can no longer feel the contractions, you can still feel “rectal pressure.” And often, the only sign that you are ready to push, that your baby is “low”, and that you are fully dilated is your having the feeling you need to go to the bathroom for a bowel movement.

Understand that not every epidural is exactly the same. Some women feel more sensation on one side than on the other, and some women still feel a small degree of pain, especially in their back. Some can move their legs, while others are completely numb and have lost all control over their legs. All of this is normal and due to the fact that the medication is infused into your spinal fluid. It also reaches a level that may be a little different on the right than on the left and that may affect some women more strongly than others.

If you have an epidural and need a repair (stitches to help your perineum heal), an epidural may help you through this as well.

If you still have any questions about giving birth with epidural, make sure to ask during your prenatal visits or to ask your anesthesiologist before placement of the epidural begins.