Epidurals in Labor: When Is It a Good Idea?
When you think about birth, you may already have an idea of whether or not you want an epidural.
Maybe you're hoping to labor without medication. Maybe you know you would like an epidural. Or maybe you're keeping your options open and want to understand what it actually looks and feels like before you're in the middle of labor.
Our philosophy at The Breezy Doula is simple: you don't have to decide today. You just need to understand your options.
An epidural is not a failure. It is a tool, and for many families, it can be an incredibly helpful one.
First, Let's Talk About Rest
Labor is physically demanding. Contractions require your body to work hard, and as labor progresses, you may reach a point where you desperately need a break.
Sometimes the best thing you can do in labor is rest.
This is especially important during a long labor or when you are experiencing intense contractions but still have a lot of work ahead of you.An epidural can provide a significant period of pain relief that allows some birthing people to relax, close their eyes, and conserve energy.
If you're exhausted and thinking, "I don't know how much longer I can do this," that may be a good time to consider whether an epidural could give your body the rest it needs. There isn't one universally "best" time to get an epidural. Current anesthesia guidelines support offering neuraxial pain relief based on the individual person's needs rather than requiring them to reach a particular cervical dilation.
So instead of thinking, "Am I too early for an epidural?", consider asking: "What does my body need right now?"
If you need rest, relief, or a chance to reset, an epidural may be a very reasonable choice. Trust those instincts.
What Exactly Is an Epidural?
An epidural is a form of regional anesthesia that provides pain relief to the lower half of your body while allowing you to remain awake and alert.
Medication is delivered through a tiny catheter placed in the lower back. The medication generally reduces the sensation of pain while still allowing you to experience pressure during labor and pushing.
You aren't being "put to sleep." You also are not paralyzed. You're still present for your baby's birth and can often still feel pressure. Think of your legs just getting very heavy like they do when they ‘fall asleep’. You are still able to do a ton of positions with an epidural too!
The goal is to make the sensations of labor much more manageable.
What Does Getting an Epidural Actually Feel Like?
We want our families to know what to expect because the unknown can sometimes feel scarier than the procedure itself.
When you decide you want an epidural, your medical team will typically:
Place or use an IV so you can receive fluids and medications.
Have you sit up or lie on your side and curl your back. Think bad posture or doing the ‘cat’ part of ‘cat/ cow’
Clean your lower back.
Numb a small area of skin with local anesthetic.
Insert a needle into the lower back and guide a tiny catheter into the epidural space. This part can send a shooting sensation down your leg as they find the correct placement.
Once they are in the right spot, your provider removes the needle while leaving the catheter in place.
Secure the catheter so medication can continue throughout labor.
The hardest part for many people is simply holding still during a contraction while the epidural is being placed. Your birth partner can hug you during insertion and keep you steady.
Your anesthesia team will talk you through the process.
Once the medication is working, your legs may feel warm, heavy, tingly, or numb depending on the medication and dose. You may still feel pressure and tightening even though the pain is significantly reduced.
It can take around 15 minutes for the medication to take effect. They will also provide you with a dosing button to provide more medication if needed. Typically the first dose is the highest one and that can wear off after a couple of hours (this does not mean you will go back to the same contraction intensity as when you needed to get the epidural, but you may feel just a bit more).
The Breezy Doula Tip: Create a Code Word
Here's one of our favorite tricks for families who are considering an epidural but don't necessarily want one immediately.
Choose a code word before labor begins. A lot of families have chosen foods they don’t like or an insect.
Maybe it's:
"Pineapple." Or "Spider"
Or something completely random that you would never normally say during labor. The important thing is that everyone knows what it means.
You may have moments during labor where you say: "I want an epidural!" But then the contraction ends and you think:
"Actually...not yet."
That's completely normal. Labor can make you think about pain relief long before you're actually ready to make that decision. Instead, talk with your partner and doula ahead of time:
"If I say our code word, that means I'm ready for you to call the nurse and ask for the anesthesia team."
This gives you the ability to make the decision ahead of time, while still allowing you to remain in control during labor. And remember: you can always change your mind.
What Are the Benefits of an Epidural?
For many families, the biggest benefit is simple:
Pain relief.
But that relief can have other benefits, too.
An epidural may allow you to:
Rest during a long or exhausting labor
Relax your body when tension is making it difficult to cope or progress
Conserve energy for pushing
Reduce the physical exhaustion associated with intense contractions
Stay awake and present for your baby's birth
Have a flexible form of pain relief that can continue throughout labor
The American Society of Anesthesiologists notes that continuous epidural techniques can provide effective labor analgesia and that neuraxial analgesia does not increase the incidence of Cesarean birth.
What Are the Risks and Downsides?
Like any medical intervention, epidurals have potential risks and tradeoffs.
An epidural can cause:
A drop in blood pressure (they give you an initial bag of IV fluids to avoid this)
Temporary soreness at the insertion site
Itching or other medication-related side effects
Difficulty moving your legs while the medication is working
The need for additional monitoring
The need for a urinary catheter (often placed once the epidural is working)
An incomplete or uneven block that may require adjustment
A headache from an accidental dural puncture, which is uncommon
Serious complications such as infection, bleeding around the spine, or nerve injury are rare, but they are possible. Your anesthesia provider can explain the risks that are specific to you.
A drop in blood pressure is one of the more common concerns, which is why IV fluids and monitoring are typically used around the placement of an epidural.
What Happens to Your Birth Once You Have an Epidural?
An epidural can change the way you move during labor.
You may have less ability to walk around or freely change positions, depending on your hospital's policies, the type and strength of the epidural, and how much sensation and movement you retain.
That doesn't mean you have to lie completely still.
Your birth team can often help you use different positions in bed, including side-lying positions, supported positions, and peanut ball positions, depending on your mobility and your provider’s recommendation. This is where having a doula can be especially helpful.
Your doula can continue helping you change positions, use comfort measures that are still appropriate, encourage relaxation, and help you and your partner work with the medical team.
Check out our In-person Spinning Babies Courses to understand what movements would be efficient during different stages of labor.
If you are not able to make it to our in person classes, we have created online asynchronous resources to help! Check out our Breezy Birth Positions Course and the Breezy Positions Guide.
An Epidural Does NOT Mean You Failed
We want to say this one loudly: Getting an epidural is not failing.
You didn't fail at birth. You didn't fail at your birth plan. You didn't fail at being "strong." You made a decision about what your body needed in that moment.
Birth preparation is about giving you enough information and tools that you can make informed decisions when things do change.
Maybe you labor without medication for 10 hours and then decide you need an epidural. Maybe you know from the beginning that you want one. Maybe you plan to avoid one but change your mind.
All of those choices are valid.
The goal isn’t about proving how much pain you can tolerate. It’s to have a birth experience where you feel informed, supported, and respected.
If You're Hoping to Avoid an Epidural
If your goal is to labor without an epidural, preparation can make a huge difference.
Start building your comfort-measures toolbox before labor begins.
Learn about:
Movement and positioning
Massage and counterpressure
Labor combs and acupressure
TENS
Hydrotherapy
Breathing and relaxation
Partner support
Environmental comfort
And remember that using these tools doesn't mean you are making a promise to yourself that you can never get an epidural. They're simply more tools in your toolbox. At The Breezy Doula, we use comfort measures and positioning techniques throughout labor to help families stay comfortable, grounded, and confident in their choices.
If you want to learn more, check out our Comfort Measures Guide or explore our HypnoBirthing® and Spinning Babies® classes to build your birth toolbox before labor begins.
Most importantly, remember:
There is no prize for having the most painful birth. There is only your birth, your body, your baby, and the choices you make along the way.
And whatever you choose, we're here to support you.
