Pregnancy: Should I Have an Epidural During Childbirth?

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Pregnancy: Should I Have an Epidural During Childbirth?

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Pregnancy: Should I Have an Epidural During Childbirth?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Pregnancy: Should I Have an Epidural During Childbirth?

Get the facts

Your options

  • Have an epidural to control pain during childbirth.
  • Don't have an epidural. Instead, use other methods to control
    the pain.

Key points to remember

  • An epidural is medicine that numbs your lower body so that
    childbirth doesn't hurt as much. The dose can be changed to make you partly
    numb or completely numb, depending on how much pain you're
    feeling.
  • For most women, this is a personal decision that depends
    on two things: how worried you are about having pain and how important natural
    childbirth (labor without pain medicine) is to you.
  • An epidural is
    considered the most effective and easily adjustable type of pain relief for
    childbirth.
  • Epidurals are very common. But there are some risks and
    possible side effects you should know about.
  • Labor pain is unpredictable. You may have more pain than you
    expected. You may plan to have natural childbirth and then decide you need pain medicine.
FAQs

What is an epidural?

An
epidural is pain medicine that you get through a very
thin tube (catheter) inserted into your back. Your lower body becomes partly or
totally numb, depending on how much medicine is used. But you stay awake and
alert.

Some hospitals and birthing centers offer a "light
epidural" or "walking epidural." This is a light dose of medicine that makes it
possible for you to walk around and to push during contractions. Ask your
doctor if your hospital or center offers a "light epidural."

Sometimes you can't get an epidural:

  • Your labor may happen so fast that there
    isn't time for an epidural.
  • You may be in a smaller hospital that
    doesn't offer them. If you think you may want an epidural, find out ahead of
    time if they are offered at the hospital or birthing center where you're
    planning to go.
  • You may have a health problem that means you can't
    have an epidural.

What are the benefits of having an epidural?

  • Epidurals are considered the most
    effective and easily adjustable type of pain relief for childbirth.
  • After an epidural is started, you can quickly get
    pain relief if and when you need it during labor and delivery.
  • The
    medicine in an epidural doesn't make you sleepy, so you are awake and alert for
    the delivery.
  • If you were to end up needing a
    C-section, the epidural could quickly numb the area
    below your waist for the surgery.

What are the risks of having an epidural?

  • Drop in blood pressure. This can lower
    your baby's heart rate. To help prevent this, you receive fluids through an IV
    beforehand and are encouraged to lie on your side, which improves blood flow to
    the baby.
  • Being unable to feel your contractions and to push. This increases your risk of needing an
    assisted delivery (forceps or vacuum).footnote 1
  • Seizure. This is very rare.

What are the side effects?

After delivery with an
epidural, you may have:

  • Back soreness at the
    catheter site. This isn't common. Some women fear that an epidural causes
    long-term back pain. But studies have not shown a connection between new back
    pain and epidural use.footnote 1
  • A severe, prolonged headache. This can happen when the spinal cord sheath
    has accidentally been punctured during the epidural. The puncture happens to
    about 1 out of 100 women. That means the puncture does not happen to 99 out of 100 women.footnote 2 After the puncture is
    fixed with a different medicine, the headache usually goes away.

What other methods are used to control labor pain?

  • Pain medicines.
    You can get a shot of pain medicine or get it through an
    IV. The most common medicines used are opioids, also
    known as narcotics. These medicines:

    • Help you relax between
      contractions.
    • Decrease the pain (but they don't take it away
      completely).
    • Have side effects, including drowsiness, nausea, and
      vomiting.
    • Are less likely than an epidural to cause you to have a
      forceps or vacuum delivery.footnote 3
  • Natural methods.
    There are also several ways to control pain without using medicine. They
    include:

    • Distraction. Walk,
      play cards, watch TV, take a shower, or read to help take your mind off your
      contractions.
    • Massage. Massage of the
      shoulders and low back during contractions may ease your
      pain.
    • Imagery. For instance, think of
      contractions as waves rolling over you. Picture a peaceful place, such as a
      beach or mountain stream, to help you relax between
      contractions.
    • Focused breathing. Breathing
      in a rhythm can distract you from pain. Childbirth education classes teach you
      different methods of focused breathing.
  • Nitrous oxide. You give yourself nitrous oxide (a gas) through a mask when you need pain relief. Nitrous oxide is not available in many places.

Why might your doctor recommend an epidural?

This
is usually a personal decision, but an epidural might be recommended in certain
situations, such as when:

  • Your labor pain is so intense that you feel exhausted or out of
    control. An epidural can help you rest and get focused.
  • You have a
    higher than average chance of needing a
    C-section. If you do need surgery, the epidural would
    already be in place and you could be quickly numbed.

Compare your options

Compare

What is usually involved?

What are the benefits?

What are the risks and side effects?

Have an epidural

Have an epidural

  • A large needle is used to place
    a small tube, called a catheter, in your lower back. The needle is removed, and
    the catheter is taped to your skin.
  • The medicine leaves you partly or completely numb below the
    waist, depending on how much is used.
  • You will probably have to
    stay in bed and have your bladder emptied with a
    urinary catheter.
  • You can probably move
    your legs and feel when it's time to push. But pushing may be harder.
  • An epidural works very well to
    relieve pain.
  • The medicine doesn't go into your bloodstream, so you remain
    awake and alert throughout labor and delivery.
  • The risks of an
    epidural include:

    • A drop in blood pressure.
    • Being too numb to push
      and needing an assisted delivery.
    • Having the baby move into the
      wrong position.
  • The possible side effects include:
    • A sore back.
    • A severe headache.
Do not have an epidural

Do not have an epidural

  • You use other ways to
    control pain, such as
    pain medicines or
    natural methods like breathing techniques, massage,
    and distraction.
  • You avoid the risks and
    side effects of an epidural.
  • Without pain medicine, you have a natural childbirth.
  • Labor may
    be more painful.
  • Too much pain can tire you out so much that you may need other
    methods to help you deliver.

Personal stories about epidural use during childbirth

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

When I had
my first child, I didn't use pain medicine at all. I was very firm about not
using any, and luckily I didn't have terrible pain. For this pregnancy, I had
an OB who encouraged me to plan ahead "just in case." It's a good thing I did,
because I had such unbearable back labor that I had to have some kind of pain
relief. I'm glad I'd already gone over my options and decided that a light
epidural would be acceptable if needed. Having that relief, but still being
able to feel enough to push, made all the difference in the world!

Carmen,
29

I am so nervous about the idea of having a
needle in my back that I just couldn't consider an epidural. Actually, I
couldn't come up with any type of pain medicine that I was comfortable with
taking. Women have had babies for centuries without pain medicine, and I
managed to, too.

Theresa, 34

Pain shuts me down, but I really want to
feel good about having my baby. I've talked to my nurse-midwife about the risks
and benefits of having an epidural, and it seems like the perfect fit for me.

Anne,
37

I didn't really think too much about how I
was going to handle labor pain. When I was in the middle of labor, they told me
I could have an epidural, and I just said yes. I didn't like it at all. I
couldn't feel enough to push. Then, I had a bad headache for days afterwards.
Of course, it only matters that my baby is healthy, but I won't have an
epidural again.

Courtney, 22

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have an epidural

Reasons not to have an epidural

I have a low tolerance for pain. I'm worried that I won't be able to control it without medicine.

I have a high tolerance for pain, so I think I can control it without medicine.

More important
Equally important
More important

I think it's fine to use pain medicine during labor.

I'm against using medicine during labor.

More important
Equally important
More important

I'm not worried about the risks involved with an epidural.

I'm worried about the risks involved with an epidural.

More important
Equally important
More important

I'm not worried about needing an assisted delivery because of an epidural.

I'm very worried that an epidural might require an assisted delivery.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having an epidural

NOT having an epidural

Leaning toward
Undecided
Leaning toward

What else do you need to make your decision?

Check the facts

1, If you decide to have an epidural to control pain, are you doing the wrong thing?
2, Is an epidural the best type of pain relief for childbirth?
3, Is an epidural completely safe, with no risks or side effects?

Decide what's next

1,Do you understand the options available to you?
2,Are you clear about which benefits and side effects matter most to you?
3,Do you have enough support and advice from others to make a choice?

Certainty

1.
How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure


Your Summary

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Your decision 

Next steps

Which way you're leaning

How sure you are

Your comments

Your knowledge of the facts 

Key concepts that you understood

Key concepts that may need review

Getting ready to act 

Patient choices

Credits and References

Credits
Author Healthwise Staff
Primary Medical Reviewer Kathleen Romito, MD - Family Medicine
Primary Medical Reviewer Adam Husney, MD - Family Medicine
Specialist Medical Reviewer Kirtly Jones, MD - Obstetrics and Gynecology

References
Citations
  1. Anim-Somuah M, Smyth RM, Jones L. (2011). Epidural versus non-epidural or no analgesia in labour. Cochrane Database of Systematic Reviews (12). DOI: 10.1002/14651858.CD000331.pub3. Accessed November 14, 2017.
  2. American College of Obstetricians and Gynecologists (2017). Practice Bulletin No. 177: Obstetric analgesia and anesthesia. Obstetrics and Gynecology, 129(4): e73–e89. DOI: 10.1097/AOG.0000000000002018.
    Accessed November 14, 2017.
  3. Cunningham FG, et al. (2010). Forceps delivery and vacuum extraction. In Williams Obstetrics, 23rd ed., pp. 511–526. New York: McGraw-Hill.
Other Works Consulted
  • Likis FE, et al. (2012). Nitrous oxide for the management of labor pain. Comparative Effectiveness Review No. 67 (AHRQ Pub. No. 12-EHC071-1). Rockville, MD: Agency for Healthcare Research and Quality. http://effectivehealthcare.ahrq.gov/ehc/products/260/1230/CER67_NitrousOxide_ExecutiveSummary_20120817.pdf. Accessed September 29, 2014.
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Pregnancy: Should I Have an Epidural During Childbirth?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
  1. Get the facts
  2. Compare your options
  3. What matters most to you?
  4. Where are you leaning now?
  5. What else do you need to make your decision?

1. Get the Facts

Your options

  • Have an epidural to control pain during childbirth.
  • Don't have an epidural. Instead, use other methods to control
    the pain.

Key points to remember

  • An epidural is medicine that numbs your lower body so that
    childbirth doesn't hurt as much. The dose can be changed to make you partly
    numb or completely numb, depending on how much pain you're
    feeling.
  • For most women, this is a personal decision that depends
    on two things: how worried you are about having pain and how important natural
    childbirth (labor without pain medicine) is to you.
  • An epidural is
    considered the most effective and easily adjustable type of pain relief for
    childbirth.
  • Epidurals are very common. But there are some risks and
    possible side effects you should know about.
  • Labor pain is unpredictable. You may have more pain than you
    expected. You may plan to have natural childbirth and then decide you need pain medicine.
FAQs

What is an epidural?

An
epidural is pain medicine that you get through a very
thin tube (catheter) inserted into your back. Your lower body becomes partly or
totally numb, depending on how much medicine is used. But you stay awake and
alert.

Some hospitals and birthing centers offer a "light
epidural" or "walking epidural." This is a light dose of medicine that makes it
possible for you to walk around and to push during contractions. Ask your
doctor if your hospital or center offers a "light epidural."

Sometimes you can't get an epidural:

  • Your labor may happen so fast that there
    isn't time for an epidural.
  • You may be in a smaller hospital that
    doesn't offer them. If you think you may want an epidural, find out ahead of
    time if they are offered at the hospital or birthing center where you're
    planning to go.
  • You may have a health problem that means you can't
    have an epidural.

What are the benefits of having an epidural?

  • Epidurals are considered the most
    effective and easily adjustable type of pain relief for childbirth.
  • After an epidural is started, you can quickly get
    pain relief if and when you need it during labor and delivery.
  • The
    medicine in an epidural doesn't make you sleepy, so you are awake and alert for
    the delivery.
  • If you were to end up needing a
    C-section, the epidural could quickly numb the area
    below your waist for the surgery.

What are the risks of having an epidural?

  • Drop in blood pressure. This can lower
    your baby's heart rate. To help prevent this, you receive fluids through an IV
    beforehand and are encouraged to lie on your side, which improves blood flow to
    the baby.
  • Being unable to feel your contractions and to push. This increases your risk of needing an
    assisted delivery (forceps or vacuum).1
  • Seizure. This is very rare.

What are the side effects?

After delivery with an
epidural, you may have:

  • Back soreness at the
    catheter site. This isn't common. Some women fear that an epidural causes
    long-term back pain. But studies have not shown a connection between new back
    pain and epidural use.1
  • A severe, prolonged headache. This can happen when the spinal cord sheath
    has accidentally been punctured during the epidural. The puncture happens to
    about 1 out of 100 women. That means the puncture does not happen to 99 out of 100 women.2 After the puncture is
    fixed with a different medicine, the headache usually goes away.

What other methods are used to control labor pain?

  • Pain medicines.
    You can get a shot of pain medicine or get it through an
    IV. The most common medicines used are opioids, also
    known as narcotics. These medicines:

    • Help you relax between
      contractions.
    • Decrease the pain (but they don't take it away
      completely).
    • Have side effects, including drowsiness, nausea, and
      vomiting.
    • Are less likely than an epidural to cause you to have a
      forceps or vacuum delivery.3
  • Natural methods.
    There are also several ways to control pain without using medicine. They
    include:

    • Distraction. Walk,
      play cards, watch TV, take a shower, or read to help take your mind off your
      contractions.
    • Massage. Massage of the
      shoulders and low back during contractions may ease your
      pain.
    • Imagery. For instance, think of
      contractions as waves rolling over you. Picture a peaceful place, such as a
      beach or mountain stream, to help you relax between
      contractions.
    • Focused breathing. Breathing
      in a rhythm can distract you from pain. Childbirth education classes teach you
      different methods of focused breathing.
  • Nitrous oxide. You give yourself nitrous oxide (a gas) through a mask when you need pain relief. Nitrous oxide is not available in many places.

Why might your doctor recommend an epidural?

This
is usually a personal decision, but an epidural might be recommended in certain
situations, such as when:

  • Your labor pain is so intense that you feel exhausted or out of
    control. An epidural can help you rest and get focused.
  • You have a
    higher than average chance of needing a
    C-section. If you do need surgery, the epidural would
    already be in place and you could be quickly numbed.

2. Compare your options

  Have an epidural
Do not have an epidural
What is usually involved?
  • A large needle is used to place
    a small tube, called a catheter, in your lower back. The needle is removed, and
    the catheter is taped to your skin.
  • The medicine leaves you partly or completely numb below the
    waist, depending on how much is used.
  • You will probably have to
    stay in bed and have your bladder emptied with a
    urinary catheter.
  • You can probably move
    your legs and feel when it's time to push. But pushing may be harder.
  • You use other ways to
    control pain, such as
    pain medicines or
    natural methods like breathing techniques, massage,
    and distraction.
What are the benefits?
  • An epidural works very well to
    relieve pain.
  • The medicine doesn't go into your bloodstream, so you remain
    awake and alert throughout labor and delivery.
  • You avoid the risks and
    side effects of an epidural.
  • Without pain medicine, you have a natural childbirth.
What are the risks and side effects?
  • The risks of an
    epidural include:

    • A drop in blood pressure.
    • Being too numb to push
      and needing an assisted delivery.
    • Having the baby move into the
      wrong position.
  • The possible side effects include:
    • A sore back.
    • A severe headache.
  • Labor may
    be more painful.
  • Too much pain can tire you out so much that you may need other
    methods to help you deliver.

Personal stories

Personal stories about epidural use during childbirth

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"When I had my first child, I didn't use pain medicine at all. I was very firm about not using any, and luckily I didn't have terrible pain. For this pregnancy, I had an OB who encouraged me to plan ahead "just in case." It's a good thing I did, because I had such unbearable back labor that I had to have some kind of pain relief. I'm glad I'd already gone over my options and decided that a light epidural would be acceptable if needed. Having that relief, but still being able to feel enough to push, made all the difference in the world!"

— Carmen,
29

"I am so nervous about the idea of having a needle in my back that I just couldn't consider an epidural. Actually, I couldn't come up with any type of pain medicine that I was comfortable with taking. Women have had babies for centuries without pain medicine, and I managed to, too."

— Theresa, 34

"Pain shuts me down, but I really want to feel good about having my baby. I've talked to my nurse-midwife about the risks and benefits of having an epidural, and it seems like the perfect fit for me."

— Anne,
37

"I didn't really think too much about how I was going to handle labor pain. When I was in the middle of labor, they told me I could have an epidural, and I just said yes. I didn't like it at all. I couldn't feel enough to push. Then, I had a bad headache for days afterwards. Of course, it only matters that my baby is healthy, but I won't have an epidural again."

— Courtney, 22

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have an epidural

Reasons not to have an epidural

I have a low tolerance for pain. I'm worried that I won't be able to control it without medicine.

I have a high tolerance for pain, so I think I can control it without medicine.

             
More important
Equally important
More important

I think it's fine to use pain medicine during labor.

I'm against using medicine during labor.

             
More important
Equally important
More important

I'm not worried about the risks involved with an epidural.

I'm worried about the risks involved with an epidural.

             
More important
Equally important
More important

I'm not worried about needing an assisted delivery because of an epidural.

I'm very worried that an epidural might require an assisted delivery.

             
More important
Equally important
More important

My other important reasons:

My other important reasons:

   
             
More important
Equally important
More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having an epidural

NOT having an epidural

             
Leaning toward
Undecided
Leaning toward

5. What else do you need to make your decision?

Check the facts

1.
If you decide to have an epidural to control pain, are you doing the wrong thing?

  • Yes

  • No
  • I'm not sure

You're right. No one can criticize you for wanting to have the best experience possible. If you decide you need pain medicine, you haven't "failed."

2.
Is an epidural the best type of pain relief for childbirth?

  • Yes
  • No

  • I'm not sure

You're right. An epidural is considered the most effective and easily adjustable type of pain relief for childbirth.

3.
Is an epidural completely safe, with no risks or side effects?

  • Yes

  • No
  • I'm not sure

You're right. Although epidurals are very common, they do have risks and possible side effects.

Decide what's next

1.
Do you understand the options available to you?

2.
Are you clear about which benefits and side effects matter most to you?

3.
Do you have enough support and advice from others to make a choice?

Certainty

1.
How sure do you feel right now about your decision?

         
Not sure at all
Somewhat sure
Very sure

2.
Check what you need to do before you make this decision.

  • I'm ready to take action.
  • I want to discuss the options with others.
  • I want to learn more about my options.

 

Credits
By Healthwise Staff
Primary Medical Reviewer Kathleen Romito, MD - Family Medicine
Primary Medical Reviewer Adam Husney, MD - Family Medicine
Specialist Medical Reviewer Kirtly Jones, MD - Obstetrics and Gynecology

References
Citations
  1. Anim-Somuah M, Smyth RM, Jones L. (2011). Epidural versus non-epidural or no analgesia in labour. Cochrane Database of Systematic Reviews (12). DOI: 10.1002/14651858.CD000331.pub3. Accessed November 14, 2017.
  2. American College of Obstetricians and Gynecologists (2017). Practice Bulletin No. 177: Obstetric analgesia and anesthesia. Obstetrics and Gynecology, 129(4): e73–e89. DOI: 10.1097/AOG.0000000000002018.
    Accessed November 14, 2017.
  3. Cunningham FG, et al. (2010). Forceps delivery and vacuum extraction. In Williams Obstetrics, 23rd ed., pp. 511–526. New York: McGraw-Hill.
Other Works Consulted
  • Likis FE, et al. (2012). Nitrous oxide for the management of labor pain. Comparative Effectiveness Review No. 67 (AHRQ Pub. No. 12-EHC071-1). Rockville, MD: Agency for Healthcare Research and Quality. http://effectivehealthcare.ahrq.gov/ehc/products/260/1230/CER67_NitrousOxide_ExecutiveSummary_20120817.pdf. Accessed September 29, 2014.

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