What is epidural anesthesia?
is considered the most effective and easily adjustable pain medication for
childbirth.1 It can be used to partially or fully numb
the lower body, either allowing you enough feeling to push with your
contractions or blocking all feeling for a cesarean delivery if that becomes
necessary. With a low dose of medication (light epidural), you may also be able
to walk around, which can make you more comfortable.
medication is given through a very thin tube (epidural catheter) into the area
surrounding the spinal cord, within its outer membrane (epidural space ). From the
epidural space, medication goes through the membrane directly to the
spinal nerves that cause feeling in the lower body.
Meanwhile, you remain alert, because the medication doesn't travel through your
blood to your brain and
central nervous system.
pain medication doesn't go directly into your bloodstream, your baby is
unlikely to be affected. (Research data aren't yet clear enough to say that
there are no effects.)2 By comparison, when medication
is given through a vein (intravenous, or IV) or by injection
into a muscle (intramuscular), it travels to your baby across the
placenta after an hour or so. If your baby is born
before the medication wears off, he or she may suffer side effects such as
breathing difficulty and grogginess (which are reversed at birth with another
A combination spinal-epidural anesthesia is gaining more use for labor and delivery. Before the
epidural line is installed, medication is injected into the spinal fluid around
the spinal cord. This spinal injection acts more quickly than the epidural
will. Then the epidural line is placed and used for ongoing anesthesia needs.
What are the benefits of epidural pain relief?
- Once an epidural line is installed, you can
quickly receive pain medication if and whenever you need it during labor and
- With an epidural, your pain medication dose can be given
continuously and adjusted as needed, rather than wearing off during labor. In
some hospitals, you can safely give yourself more pain medication when you need
it by pushing a button attached to a medication pump.
anesthesia is unlikely to affect (depress) the central nervous system, so you
and your newborn can be alert after delivery.
- If you were to
develop a need for a cesarean delivery, the epidural medication could be used
to quickly numb the area below your waist for the surgery.
What are the drawbacks and risks of epidural pain relief?
With an epidural, you may not be free to leave your bed
to walk or use the bathroom. Talk to your health professional about:
- Having medication light enough that you can
walk or at least stand. Walking and changing positions helps you feel more
comfortable during labor.
- Whether the required
fetal heart monitoring and IV line can be adjusted to
Epidural anesthesia using standard medication doses
increases your risk of:
- Having a prolonged labor. The average
epidural labor takes an extra hour to deliver the baby.2 (Some studies suggest that epidural labors are no longer than
average labors when medication is not given until the cervix is at least
a drop in blood pressure (hypotension), which can lower your baby's heart rate.
This is why you receive fluids through an intravenous (IV) line beforehand and
why you're encouraged to lie on your side, which improves blood
- Being unable to feel your contractions and to push. This
increases your risk of needing an assisted (forceps or vacuum) delivery and
possibly your chance of needing a cesarean section you wouldn't otherwise have
- Having your baby move into the
wrong position (malposition) because of slack pelvic muscles and a slack
uterus. This increases your risk of needing an assisted (forceps or vacuum)
delivery. Some experts question whether malposition may happen first, causing
pain that leads a woman to ask for an epidural.2 Talk
to your health professional about his or her experience with this
- Having a seizure related to the medication. This is very
After childbirth with an epidural, you may
- Back soreness at the catheter site during
recovery. This is uncommon. Some women fear that an epidural causes chronic
back pain-studies have not shown a connection between new back pain and
- Severe, prolonged headache
after delivery, when the spinal cord sheath has accidentally been punctured
during the procedure. A puncture occurs in about 3% of women receiving an
epidural. About 70% of these women develop the headache after childbirth. The
puncture is repaired by an anesthesiologist, using another injection in the
puncture area. This usually relieves the headache.
Spinal-epidural anesthesia carries
the same types of risks as an epidural alone.3
For more information, see the topic
Labor, Delivery, and Postpartum Period.