Epidurals: What to Know Before You Get One

<h2>The Most Common Question I Hear From Expectant Parents</h2><p>In all the years I have spent reviewing birth injury cases and speaking with families preparing for labor, one question comes up more than almost any other: <em>Should I get an epidural?</em></p><p>It is a deeply personal decision — and one that deserves a real, honest answer. Not a dismissive "it's totally safe" and not a fear-based "avoid it at all costs." What you deserve is accurate information so you can make the choice that is right for you and your baby.</p><p>So let's talk about what an epidural actually is, how it works, what the risks are, and what questions you should be asking before you ever set foot in the delivery room.</p><h2>What Is an Epidural?</h2><p>An epidural is a regional anesthesia technique that delivers pain-relieving medication directly into the epidural space of your spine — the area just outside the membrane surrounding your spinal cord. It is the most widely used form of pain relief during labor in the United States, with roughly <strong>70–75% of women who deliver in hospitals</strong> choosing to receive one.</p><p>The procedure is performed by an anesthesiologist or a certified registered nurse anesthetist (CRNA). A small catheter (a thin, flexible tube) is placed in your lower back while you sit or lie curled on your side. Once the catheter is in place, medication — typically a combination of a local anesthetic and an opioid — is delivered continuously or in controlled doses throughout labor.</p><p>The goal is to reduce or eliminate pain from the waist down while allowing you to remain awake and alert. Most women can still feel pressure and movement, which helps with pushing during the second stage of labor.</p><h2>When Can You Get an Epidural?</h2><p>One of the most persistent myths about epidurals is that you have to wait until you are a certain number of centimeters dilated before you can receive one. <strong>This is not true.</strong></p><p>Current evidence and guidelines from the American College of Obstetricians and Gynecologists (ACOG) support offering epidural analgesia at any point during active labor, regardless of cervical dilation. If you are in labor and you want pain relief, you are entitled to ask for it.</p><p>That said, there are practical timing considerations. If you are progressing very quickly and delivery is imminent, there may not be enough time for the epidural to take full effect. And in some cases — such as certain bleeding disorders or infections at the injection site — an epidural may not be medically appropriate. Your anesthesiologist will review your medical history before proceeding.</p><h2>What Are the Risks?</h2><p>Epidurals are generally considered safe, but like any medical procedure, they carry potential risks. As a childbirth attorney, I want you to understand these risks clearly — not to frighten you, but because informed consent requires it.</p><p><strong>Common side effects include:</strong></p><ul><li><strong>Drop in blood pressure (hypotension).</strong> This is the most common complication, occurring in up to 30% of cases. It is typically managed with IV fluids and, if needed, medication. However, if not caught and treated quickly, a significant drop in maternal blood pressure can reduce blood flow to the baby — which is why continuous fetal monitoring during and after epidural placement is essential.</li><li><strong>Fever.</strong> Epidural-associated fever (a temperature above 100.4°F) occurs in some laboring women, particularly with longer labors. This can sometimes lead to additional interventions, including evaluation of the newborn for infection.</li><li><strong>Itching.</strong> A common side effect of the opioid component of the medication, usually mild and manageable.</li><li><strong>Difficulty pushing.</strong> Because an epidural reduces sensation, some women find it harder to feel the urge to push during the second stage of labor. This can occasionally lengthen the pushing phase.</li><li><strong>Postdural puncture headache.</strong> If the needle accidentally punctures the membrane surrounding the spinal cord (a "wet tap"), a severe headache can result. This occurs in roughly 1–2% of epidural placements and is treatable.</li></ul><p><strong>Less common but serious risks include:</strong></p><ul><li>Nerve damage (rare, usually temporary)</li><li>Infection at the injection site (rare)</li><li>Severe allergic reaction to the medication (very rare)</li><li>In extremely rare cases, a high spinal block — where medication spreads too far upward — can cause breathing difficulty and requires immediate intervention</li></ul><p>The key takeaway: serious complications from epidurals are rare, but they are not impossible. You deserve to know about them before you consent.</p><h2>What About the Baby?</h2><p>This is the question I hear most often from parents who are hesitant about epidurals. The honest answer is that the research is reassuring but not without nuance.</p><p>The medications used in modern epidurals cross the placenta in very small amounts. Studies have not found a consistent link between epidurals and long-term harm to the baby. However, the maternal blood pressure drop that can accompany epidural placement <em>can</em> affect fetal heart rate — which is why continuous fetal monitoring is so important after an epidural is placed.</p><p>If your baby's heart rate shows concerning changes after your epidural, your care team should respond promptly. This is not a reason to avoid an epidural — it is a reason to make sure your care team is watching the monitor.</p><h2>Questions to Ask Before You Decide</h2><p>Whether you are planning to request an epidural or hoping to labor without one, these are the questions worth discussing with your OB and anesthesiologist before your due date:</p><ul><li>Is an anesthesiologist available 24 hours a day at this hospital, or is one on call?</li><li>How quickly can an epidural be placed if I decide I want one during labor?</li><li>What is the protocol for monitoring my blood pressure and the baby's heart rate after placement?</li><li>What are my alternatives if an epidural is not appropriate for me?</li><li>If I plan to labor without an epidural, what other pain management options are available?</li><li>What is the hospital's policy on patient-controlled epidural analgesia (PCEA), which allows you to self-administer small additional doses?</li></ul><h2>Your Birth Plan and Your Right to Change Your Mind</h2><p>Here is something I want every expectant parent to hear clearly: <strong>your birth plan is a starting point, not a contract.</strong></p><p>If you plan to labor without an epidural and then decide you want one — that is your right. If you plan to get an epidural and then decide you want to try without — also your right. No one should pressure you in either direction, and no one should make you feel like changing your mind is a failure.</p><p>What matters is that you have accurate information, that your care team respects your choices, and that you feel empowered to speak up at any point during your labor.</p><p>That is what informed consent looks like. And it is what you deserve.</p><h2>The Bottom Line</h2><p>Epidurals are a safe and effective option for most laboring women. They are not without risks, and those risks deserve honest discussion — not dismissal. The best decision is the one you make with full information, in conversation with your care team, based on your own values and circumstances.</p><p>If you have questions about your rights during labor — including your right to informed consent for any procedure — I am here to help.</p><p><em>Gina Mundy is a childbirth attorney, #1 bestselling author, and advocate for safer births. Download a free chapter of her book at ginamundy.com.</em></p>