Should I Get An Epidural?
"I am so glad I got an epidural. I enjoyed my labor so much!"
"Oh no! Epidurals are terrible. I got one and it slowed down my labor, and I ended up with a c-section."
"Childbirth is supposed to be a natural process. Epidurals get in the way of that."
"You're crazy if you don't get an epidural. Why go through pain if you don't have to?"
Raise your hand if you've heard someone say something similar to one of these above? I know I have.
It's hard to find straightforward & evidence-based information on epidurals. I see a lot of blogs or social media posts that are opinion, misunderstand research studies done on epidurals, or are straight-up untrue.
So, I'm writing this blog post to be as objective and unbiased as possible about epidurals. Moms and dads deserve the truth! We are going to cover:
What epidurals are (and what they aren't)
The benefits of epidurals
The risks of epidurals
How to decide if you want to get one or not
(and if you want more evidence-based and unbiased birth information, you should check out our online & on-demand Birth Class for Couples. We teach couples how to make birth decisions with confidence - Click this link to sign up)
What is an epidural?
An epidural is regional anesthesia, meaning that it provides pain relief to a specific part of your body. During childbirth, this would be the lower half of your body. Usually, a combination of medications is used: a local anesthetic combined with an opioid. The specific combinations of medications depend on your anesthesiologist and hospital.
The process of receiving an epidural is pretty simple. You'll need IV fluids, so if you're not receiving those yet, that will be the first order of business. Next, you will be told to lie down on your side or sit at the side of your bed with your feet dangling off. You'll need to be very still. (This can be hard if you're having intense contractions... A great job for dad to do is keeping you still and relaxed by facing you as you get the epidural. It also helps him not see the needle.)
They will first inject a local anesthetic to numb an area on your back. Next, they will insert a large needle into the epidural space in your spine. Last, they will thread a small catheter tube into the needle. This tube will stay in place, delivering either bursts or a continuous stream of medication. You should start feeling the effects 10-20 minutes after the catheter is inserted.
You can also get a Combined Spinal-Epidural, which gives you a spinal block that works quickly (but only lasts an hour or two) along with an epidural that will provide pain relief more long-term. Every hospital is different, so be sure to ask your OB what your options are at your specific birthing place.
What is an epidural NOT?
An epidural is not an indication of your weakness. You didn't fail if you get an epidural.
An epidural is also not a childbirth requirement. You can have a baby without one. Many women do it and love it.
Getting an epidural or not getting one is not a moral issue. You're not a better or worse mom either way. It's okay if you just want an epidural.
Some moms have a bad experience with epidurals (I am one of them). That also needs to be validated - they're not for everyone!
Also, it's hard to have an unmedicated birth without physical and emotional support. For many reasons, some moms don't have the support they need to birth without an epidural. An epidural helps them have a peaceful birth.
I just wanted to get that out of the way. There are many reasons to get an epidural. There are many reasons to not get an epidural. Both are just fine!
The benefits of an epidural
It is the most effective pain relief option. Epidurals are extremely effective at lessening mom's pain during labor. However, there are some things to know:
Epidurals dull the sensations of pain, but they do not make labor completely pain-free. Most moms feel at least some pressure during contractions, especially as the baby gets lower in the pelvis.
Epidurals can fail. They can also only go to one side of the body. This isn't to scare you, but to make you aware. It's surprising how many moms I know have had this happen! And this is why we always say that even if you plan on getting an epidural the minute you step foot into the hospital, you should know how to manage contractions without one. (We teach all about this in our birth class, by the way 😉)
Epidurals are generally safer for babies than IV opioids. Research shows that epidurals affect babies less than opioids. This isn't to say that IV opioids are unsafe. Typically the doctor will stop administering the IV opioids as delivery comes closer, which greatly lowers the effect on the baby after birth. On the other hand, Epidurals don't cause side effects in babies as much as opioids. (There are potential side effects, which we will discuss in the "risks" section).
Epidurals can help mom sleep, relax, and even help labor progress. Have you ever heard that epidurals can stall out labor? While this is true, the opposite is also true too. Epidurals can help labor progress! The reason why is because when mom is tense or is fighting against contractions, all that tension is simply putting a halt to oxytocin flow, and can even literally prohibit the baby from moving down. Epidurals can help a tired mom rest and sleep. Especially when given after active labor has begun, a mom may wake up and find that they've progressed from 6 to 9 centimeters and are about ready to push! What a nice surprise.
Epidurals make it easier to administer emergency meds for a c-section. This isn't necessarily a benefit for mom; it's a benefit for healthcare providers. But, it's true. If you need an emergency c-section, you will already be mostly numb and ready to go.
Side note: if you're told that you must get an epidural because of this reason (and you don't want one), you should ask more questions or get a second opinion. Just because something is easier for a doctor doesn't mean that it's the right thing for you. You have the right to informed consent or refusal, which means that you can say no.
The risks of an epidural
You are more likely to receive Pitocin. Pitocin is an artificial form of oxytocin (the hormone that kickstarts labor). According to a Cochrane review, receiving an epidural can lengthen your labor. If your labor goes too long, your doctor may want to utilize Pitocin to stimulate your contractions. There are risks to using Pitocin (another topic for another day, friends!).
Your blood pressure may drop. This has been shown to occur in about 14% of women.
You may get a fever. The cause of this is unknown, but around 23% of women will spike their temperature during labor with an epidural, compared to about 7% of women without an epidural.
You may have a spinal headache. This is a far less common side effect, but I do hear about this anecdotally fairly often. Headaches are common for women in general after birth as hormones fluctuate, so not all headaches may be directly caused by epidurals.
You are less able to move around. This may seem obvious and no big deal, but in the world of childbirth, movement is very important. Frequent position changes help the baby's head navigate your pelvis with ease. Getting into upright positions has been shown to dramatically decrease the length of labor. As you can imagine, an epidural can make that difficult. (But not impossible! We have a special section all about positions to get into with an epidural in our birth class. You should also get your nurse to help you, too).
You will be monitored more. This isn't a bad thing for everyone, but if you don't like IVs or being hooked up to monitors, then you may want to steer clear of epidurals.
Your labor may slow down. As I pointed out above, this isn't always true, but less movement = slower labor. You can counteract this by switching your position at least every 30 minutes. You may also ask if the labor and delivery nurses at your hospital are trained to use peanut balls or trained to utilize Spinning Babies methods. You can also counteract this by waiting until active labor to get your epidural.
You have a higher chance of needing forceps or a vacuum-assisted birth.
A quick note: when we talk about risks, we are not saying that what I list will happen to everyone. Risks are risks - some are more common than others. Some can be completely avoided. Just because there's a risk doesn't mean that you shouldn't do it. It all has to do with your values... which leads me to my next point...
How to decide if you want an epidural or not
Ah, the big question! Should you get one? Or not?
I cannot answer that for you 😁 We go through this decision-making process extensively in our birth class, because this decision affects many other decisions - such as where you birth, how involved your birth support needs to be, etc.
But I'll give you something to chew on: if you are at all interested in having a baby without an epidural - I say go for it! Take a birth class, like ours. Plan for a completely unmedicated birth. Do all the prep work, practice your breathing & birthing positions, get your partner on board and involved. Choose the most supportive birthing place & provider that you can. Do the dang thing!
"Worst" case scenario? You get an epidural. And remember, you're not a failure if you get one.
I hope this was a helpful tool for you as you decide to birth with or without an epidural. This is one of the biggest decisions you'll need to make about your childbirth experience.
If you need a birth class to take with your partner or just need someone to ask a question to... we are here for you! Contact us via email (below) or on social media: @balanced.birth.couple on IG & TikTok.