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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
- 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.1
- 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. If you plan to have natural childbirth and then decide that you need pain medicine, you shouldn't feel that you have "failed."
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.
- Epidurals are considered the most effective and easily adjustable type of pain relief for childbirth.1
- 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.
- Longer labor. On average, an epidural adds an extra hour to labor.2 But some studies suggest that this doesn't happen if you wait until your cervix is at 4 cm before you have the epidural.3
- 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) and possibly your chance of needing a C-section that you wouldn't otherwise have needed.2
- Seizure. This is very rare.
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.2
- A severe, prolonged headache. This can happen when the spinal cord sheath has accidentally been punctured during the epidural. The puncture happens to about 3 out of 100 women. That means the puncture does not happen to 97 out of 100 women. After the puncture is fixed with a different medicine, the headache usually goes away.
- 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.4
- Natural methods.
There are also several ways to control pain without using medicine. They
- 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.
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
What is usually involved?
What are the benefits?
What are the risks and side effects?
- 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 and take longer.
- 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
- Longer labor.
- 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.
- 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!
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.
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.
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.
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.
I think it's fine to use pain medicine during labor.
I'm against using medicine during labor.
I'm not worried about the risks involved with an epidural.
I'm worried about the risks involved with an epidural.
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.
My other important reasons:
My other important reasons:
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
What else do you need to make your decision?
Check the facts
If you decide to have an epidural to control pain, are you doing the wrong thing?
- YesSorry, that's not 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."
- NoYou'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."
- I'm not sureIt may help to go back and read "Key points to remember." No one can criticize you for wanting to have the best experience possible. If you decide you need pain medicine, you haven't "failed."
Is an epidural the best type of pain relief for childbirth?
- YesYou're right. An epidural is considered the most effective and easily adjustable type of pain relief for childbirth.
- NoSorry, you're wrong. An epidural is considered the most effective and easily adjustable type of pain relief for childbirth.
- I'm not sureIt may help to go back and read "Key points to remember." An epidural is considered the most effective and easily adjustable type of pain relief for childbirth.
Is an epidural completely safe, with no risks or side effects?
- YesNo, that's wrong. Although epidurals are very common, they do have risks and possible side effects.
- NoYou're right. Although epidurals are very common, they do have risks and possible side effects.
- I'm not sureIt may help to go back and read "What are the risks of having an epidural?" and "What are the side effects?" Epidurals do have risks and possible side effects.
Decide what's next
Do you understand the options available to you?
Are you clear about which benefits and side effects matter most to you?
Do you have enough support and advice from others to make a choice?
How sure do you feel right now about your decision?
Use the following space to list questions, concerns, and next steps.
Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
|Primary Medical Reviewer||Sarah Marshall, MD - Family Medicine|
|Specialist Medical Reviewer||Kirtly Jones, MD - Obstetrics and Gynecology|
- American College of Obstetricians and Gynecologists (2004, reaffirmed 2008). Pain relief during labor. ACOG Committee Opinion No. 295. Obstetrics and Gynecology, 104(1): 213.
- American College of Obstetricians and Gynecologists (2002, reaffirmed 2010). Obstetric analgesia and anesthesia. ACOG Practice Bulletin No. 36. Obstetrics and Gynecology, 100: 177–191.
- Poole JH (2003). Analgesia and anesthesia during labor and birth: Implications for mother and fetus. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 32(6): 780–793.
- Cunningham FG, et al. (2010). Forceps delivery and vacuum extraction. In Williams Obstetrics, 23rd ed., pp. 511–526. New York: McGraw-Hill.