Demystifying Epidurals: 8 Common Questions Answered

When it comes to putting together a birth plan, many moms-to-be opt to factor in an epidural. For those moms who are still undecided and want to learn more about epidurals, Dr. Lorene Wiley, OB/GYN and Medical Director for OB/GYN at Baton Rouge General and teacher with the Family Medicine Residency Program, provides insight into common questions and concerns when it comes to epidurals.

What does an epidural do?
Dr. Lorene Wiley: An epidural is a form of regional anesthesia, or neuraxial anesthesia, in which a needle is placed through the vertebrae or the bones in your back, and medicine is administered through that needle to deliver pain relief in labor. The medicine that’s in the epidural is a combination of a local anesthetic and usually an opioid. This acts to give pain relief to a woman in labor.

Can anyone receive an epidural?
Dr. Wiley: Yes and no. Epidurals are appropriate and should be offered to laboring women, regardless of how many babies they’ve had, how far dilated they are, or how high up in the birth canal the baby is, unless there’s a true contraindication to it.

Commonly, contraindications are rare, but the things that are really important are women who have bleeding disorders. We also think about women who have coagulopathies, low platelets, and there are cut-offs for how high your platelets or blood counts have to be to be able to get an epidural.

If a woman’s recently taken blood thinners, those blood thinner injection theories on why a woman wouldn’t be able to get one depending on the timing of when she’s had one. If someone were to have a big infection, like over the back or in the area where we will want to place the epidural, that will also be a contraindication. If someone had some type of brain lesion, like a brain tumor or something like that, where entering into that space of place, an epidural would cause increased pressure.

Can it be “too late” to receive an epidural?
Dr. Wiley: I usually tell my patients, as long as you can sit still, you can get an epidural. So, if you can’t sit up and sit still because the baby’s coming out, it’s a little too late, but you could be any dilation to get an epidural.

How long will epidurals last?
Dr. Wiley: When epidurals are placed, the anesthesiologist puts the needle in, they put the medicine in, and they leave a little catheter in the back, and basically, that continues to infuse medicine. An epidural can last the entire length of a woman’s labor.

Will epidurals slow down labor?
Dr. Wiley: Overall, no. There is some evidence that says that getting an epidural can actually shorten the time from when your cervix starts dilating to the time when you’re complete. An epidural can actually make that length of time shorter, because you’re more relaxed. The time from whenever your cervix is completely dilated to the time that the baby comes out, it can lengthen that amount of time. So overall, yes and no. It can shorten it, or it can extend it, but overall, it’s not a significant thing.

What are some of the risks and side effects?
Dr. Wiley: Overall, epidurals are pretty safe. There’s a low risk of morbidity and mortality as far as mom is concerned. We think about common side effects with epidurals with things like headaches, sometimes we’ll see the baby’s heart rate change, or the baby’s heart rate decrease. Even with the baby’s heart rate decreasing, there’s no increased risk of having a C-section. Itching is also commonly seen.

We think about other things like the serious risks that are associated with them; it’s very rare, this is like less than 1 percent. We think about things like blood clots inside the spine, and that’s where we kind of go back to not wanting people who have low platelets or who’ve been on blood thinners to get them. We also think about infection, so the women who’ve had infections and whatnot around their back. And nerve damage, I feel like that’s one of the big, scary ones. Everyone has heard of someone who has been paralyzed from an epidural, and that is so, so rare. A lot of times if we see anything like nerve damage, it’s very temporary and resolves within a few days.

Can epidurals not work on everyone?
Dr. Wiley: That can happen, and that also is one of the more rare things. Things we think about when that needle and that catheter are placed, like let’s say it’s not placed in the right spot, or if it were to move out of place, then that would be a reason for it not to work. Let’s say a woman comes in and her cervix is changing rapidly and she’s headed towards like a quick delivery, sometimes you might not have enough time for the epidural to actually kick in. Sometimes we’ll see, just depending on the position of the baby, because the epidural is working to decrease pain in a specific area, some people will talk about if your baby’s coming out sunny side up then you might feel like more pressure in back and more pain from the epidural because it may not work as well.

Are there other options for pain relief?
Dr. Wiley: There’s some data that says over 60 percent of women currently in the United States get epidurals. We know that is the most effective method of pain control, and it is overall safe. Other than epidurals, there are some other options, such as IV pain medicines. There’s also nitrous oxide, like laughing gas. There’s some local blocks we’ll do in the vagina, that’ll kind of help, but we know overall, epidurals are the most effective form of pain meds.

This article was originally published in Spring 2024.