Epidural Anesthesia

How to Get an Epidural

Woman getting an epidural in labor
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Epidural anesthesia is the number one form of medicinal pain relief in labor and birth today. An epidural, as it's more commonly called, is a regional anesthesia. This means that it numbs an area of the body, unlike general anesthesia which totally removes pain and consciousness from the whole body. An epidural numbs from about the area of the nipples (for a cesarean) or umbilicus (belly button) (for a vaginal birth)to toes. This allows you to stay wide awake but still have no feeling of pain from the contractions in labor or during the birth.

What you can actually feel will vary from mother to mother and birth to birth. This is partially to do with the medications used in the epidural but also your anatomy and where you are in labor. Some mothers want to feel nothing, while others find this very frightening. So an epidural can allow you to have the feeling of sensation, so to feel contractions, but not experience pain. Since an epidural can also be used during a cesarean section (c-section), this is where you would want to feel nothing. Talk to your anesthesiologist about the amount of feeling that you'd prefer. They can work with you to help you achieve the perfect epidural.

To get an epidural there are few things that you will need to do. The basics are:

Epidural Availability

Be sure that you are delivering at a hospital with epidural availability. Some hospitals have epidurals only available at certain times, while other hospitals have 24 hour epidural anesthesia coverage. Be sure to ask your hospital about this coverage.

Talk to Your Doctor or Midwife

Let them know what your plans are for pain medications. Ask for their help in determining when the best time is for you to receive the epidural. They may or may not be able to guide you specifically during the labor.

Talk to Your Support Team

It is imperative that you let your partner, doula and anyone else coming to your baby's birth know that you'd like an epidural. Talk about when you think that would be or what you would feel before getting it. One example might be like: I'd like an epidural as soon as I am not handling the contractions well. Or: I'd like an epidural as soon as I can get one at the hospital.

Let the Hospital Know

There may be a requirement that you take a special epidural class before your baby is born. Or you may have a special need to talk to the anesthesia department prior to your baby's birth. Ask on your hospital tour.

Prepare for Anything

It's always best to have back up plans. Sometimes labor goes faster than you'd expect and you don't have time to get an epidural, know what to do to help calm yourself. Or perhaps you have to wait longer than you thought because it's a busy day on the labor and delivery floor. Having a backup plan is always a good idea.

An epidural is not without risks -- this is true for any medical procedure or medication. However, the vast majority of epidurals will be without complication. The complications that are most common or are most drastic are guarded against. The safety measures put in place will vary from hospital to hospital but can include:

  • IV fluids mandatory prior to the epidural
  • Blood pressure monitoring
  • Maternal heart monitoring
  • Fetal monitoring
  • Trained staff to stay with the mother during critical periods
  • Medications on hand for treatment of complications

If you have decided that you want an epidural for your labor, you will need to know what the requirements are at the hospital you are giving birth at. Some hospitals have limitations on when you can receive the epidural. This might be a minimum dilation or a maximum dilation. You would find this out by taking a hospital tour, talking to the anesthesiology department, or in your childbirth class.

Taking a childbirth class is still a great idea if you are planning an epidural. There is much to be learned from a class, including the basics of epidural anesthesia. One of the things that you can also learn is alternative ways to deal with labor pain. This is perfect for the period of time it takes you to get to the hospital and to get an epidural.

That said, there are reasons that you might not be able to get an epidural. This is something you should know well before labor, if you are at risk. Ask your doctor what you need to know before labor to ensure that there are no surprises.

Once the epidural is in place, you should be able to rest or relax and do whatever you want from your bed. If you have been awake for awhile, a nap is a great idea. Some moms use this time to finalize baby names or play on social media, watch TV, etc. Your labor nurse will help you know when it is time for you to push.

You will have a vaginal exam every couple of hours or when you feel like you need one. Pushing usually starts when the baby is fairly far down, as opposed to starting to push simply because you are completely dilated. This is known as laboring down. Many women can feel some to push, while other moms want to turn off the epidural for pushing. This is generally not recommended because of added pain due to the change in hormonal response.

The epidural can be used for even complicated deliveries, including those that require a vacuum extraction or forceps. You can even use an epidural for a cesarean birth.

Once the baby is born, you will also be able to use the epidural for pain relief in the immediate postpartum period. Normally the epidural will be turned off after the birth. How long it takes you to get feeling back in your legs can vary. Some women are able to move around within an hour after birth, while other moms will take a few hours. Once the epidural has worn off, you will be switched to oral pain medications.


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Obstetric outcomes and maternal satisfaction in nulliparous women using patient-controlled epidural analgesia. Haydon ML, Larson D, Reed E, Shrivastava VK, Preslicka CW, Nageotte MP. Am J Obstet Gynecol. 2011 Sep;205(3):271.e1-6. Epub 2011 Jun 17.

A retrospective case-controlled study of the association between request to discontinue second stage labor epidural analgesia and risk of instrumental vaginal delivery. Toledo P, McCarthy RJ, Ebarvia MJ, Wong CA. Int J Obstet Anesth. 2008 Jul 8.

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