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To get an epidural or not get an epidural?
That is only one of the many questions when preparing to give birth.
For me, the answer was easy: Four years before my daughter was born, I suffered a horrific bout with kidney stones that landed me in the emergency room. Let me put it this way — I never knew pain like that could exist. So you’d better believe I was going into my delivery medicated.
So like many people giving birth, I had an epidural during my labor. This is “a form of regional anesthesia that involves injecting local anesthetics into the epidural space,” explains Caledonia Buckheit, M.D., a board-certified OB/GYN practicing in Raleigh, North Carolina. The epidural space “is located outside of the dura mater, which is the outermost membrane covering the spinal cord.” The way this particular form of anesthesia works is pain medications are “introduced into the epidural space,” allowing for “the nerves transmitting pain signals [to be] blocked, resulting in excellent pain management during labor.”
While I have no regrets about getting an epidural — I agree with Dr. Buckheit that it provided “excellent pain management” — how you give birth should be a personal choice: You are no less a birthing warrior if you opt for an epidural or if you choose to deliver medication-free.
In my case, it turns out I needed an epidural a lot sooner than expected because I had to be induced due to low amniotic fluid. What I wasn’t prepared for was how the labor induction alone would be more than I could handle. Because I had the epidural almost immediately, I needed two doses to get me through my 12-hour labor. Ever since then, I’ve wondered two things: Did I have my epidural too early? And, when is the best time to get an epidural?
The best time to get an epidural is when the patient feels ready for it. But even that is an ambiguous answer, so read on as Dr. Buckheit breaks down everything you need to know about having an epidural during labor.
Timing the epidural correctly
Although a patient can get an epidural at “any point,” Dr. Buckheit warns that you also don’t want to wait too long to request pain relief. Administering an epidural will not be possible “when you can no longer sit still for the procedure to place it.” She says that “typically patients will request an epidural during the active phase of labor, but some might need the pain relief even in early labor” (like this writer!).
As for the “best time to get an epidural,” Dr. Buckheit provides a two-fold answer: The timing depends on both the level of pain and the patient’s willingness to remain immobilized for the remainder of their labor. “I generally tell patients that the time to get an epidural is when moving around (walking, sitting on a birth ball, stretching, etc) is no longer helping for pain management in labor,” she says. “I frame it this way because the main downside of an epidural for labor pain management is the loss of mobility.” While walking around and sitting on a birth ball can help alleviate discomfort throughout labor, “once you have an epidural you are confined to the bed.” Patients will be able to move and change positions, “but you won't be able to stand or walk safely once you have an epidural.”
Epidural pros and cons
The most significant benefit to having an epidural during labor is “excellent pain relief,” says Dr. Buckheit. But, depending on your preferences, pain relief may not be enough to outweigh the cons.
In addition to having to undergo a procedure during labor, limited mobility is the biggest drawback to getting an epidural. So if you’re not keen on remaining in bed throughout most of your labor, an epidural may not be the right choice for you. “Because the nerves to the pelvis and lower extremities are being treated with anesthetic, your lower body sensation and motor function are impacted. Without normal sensation and strength, it is not safe (and sometimes not even possible) to stand or walk while you have an epidural,” explains Dr. Buckheit.
Epidural risks and restrictions
Pain, bleeding, or infection are potential risks associated with having an epidural, but Dr. Buckheit reiterates that risks go hand-in-hand with any medical procedure. “The anesthesia provider who places your epidural will review [the risks] with you so you understand and are comfortable with these risks before proceeding with epidural placement,” she says.
Dr. Buckheit also lists several pre-existing conditions that may prevent patients from getting an epidural: “Blood clotting issues (like extremely low platelet count), prior spine surgeries, an active infection, or anatomic differences of the back or spine are some reasons that could preclude a patient from getting an epidural.” If any of these conditions pertain to you, and you want an epidural during delivery, make sure you speak with your healthcare provider well before your due date. Your care team will help you with alternative pain relief options if necessary.
Sarene Leeds holds an M.S. in Professional Writing from NYU, and is a seasoned journalist, having written and reported on subjects ranging from TV and pop culture to health, wellness, and parenting over the course of her career. Her work has appeared in Rolling Stone, The Wall Street Journal, Vulture, SheKnows, and numerous other outlets. A staunch mental health advocate, Sarene also hosts the podcast “Emotional Abuse Is Real.” Subscribe to her Substack, the Critical Communicator, and follow her on Instagram, BlueSky, or Threads.