Is it ever too late to get an epidural in labor?

The Myth of the Epidural Window of Opportunity

Woman getting an epidural
Photo © Kaushik Ghosh/Getty Images

A very long time ago on a television show called Mad About You (check Netflix), there was an episode where the main character, Jaime, was giving birth. During this episode, she had wanted to go unmedicated and then changed her mind at the very end. This lead to her husband telling her that the "window" of opportunity to get an epidural had been closed for Jaime. Ever since then, women have been very nervous that they too will find that there is a window of opportunity that they've missed if they wait too long.

The good news is that is generally a myth.

Most hospitals and anesthesiologists want you to be as comfortable as possible. And let's face it, they make money when you have an epidural. So... it's in their best interests to keep you comfortable and happy, which means giving you an epidural when you want one, even if it is later in labor. That said, sometimes there are some issues with epidurals given very close to the birth. This can include:

1. It can be harder to hold still during the procedure.

For some women, it may be more difficult to hold still during the administration of an epidural in very late labor, say after eight or nine centimeters. This is because the contractions are coming closer together than in earlier. Using your doula or your nurse to help you remain calm and focused, you should have no problems. (Most hospitals require that your husband or partner leave in most hospitals for the administration of the epidural.) Your anesthesiologist and nurse are excellent at helping you hold still and timing the placement in between contractions.

2. It may be harder to get in an upright position for the placement of an epidural.

If an epidural is delayed until you are pushing, it may be harder to use an upright position for the placement of the epidural. If this is the case, you may need to lay on your side to get the epidural. This is because your baby is likely to be further down into the birth canal making it harder to sit up.

3. The epidural may not take as effectively very close to delivery.

When you're having a baby and you're really just minutes away, you may still wind up getting an epidural. Sometimes, it is because the baby surprises everyone and makes a speedy exit, sometimes, it's just how the timing works. In these cases, the epidural may not have a chance to be as effective as if it had been placed earlier, simply because the medications do take a bit to reach their peak effectiveness. 

So the bottom line is that you shouldn't be refused an epidural unless your baby's head is crowning (coming out) or you have a medical reason why you can't have an epidural. Choosing when or if you will have an epidural should be something that you alone decide. You can make that decision ahead of labor, and even change that decision during labor.

There is the possibility that the medication will not take effect prior to your baby being born, but there is no way to accurately gauge that without a crystal ball. If you are really in need of immediate relief you can use IV pain medications instead of or until you can get the epidural.

Delaying an epidural may also reduce some of the risks associated with this procedure.

Sources

Sng BL, Leong WL, Zeng Y, Siddiqui FJ, Assam PN, Lim Y, Chan ESY, Sia AT. Early versus late initiation of epidural analgesia for labour. Cochrane Database of Systematic Reviews 2014, Issue 10. Art. No.: CD007238. DOI: 10.1002/14651858.CD007238.pub2.

Torvaldsen S, Roberts CL, Bell JC, Raynes-Greenow CH. Discontinuation of epidural analgesia late in labour for reducing the adverse delivery outcomes associated with epidural analgesia. Cochrane Database of Systematic Reviews 2004, Issue 4. Art. No.: CD004457. DOI: 10.1002/14651858.CD004457.pub2.

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