Weighing the Risks and Benefits of Epidural Injections During Childbirth

We've all heard stories about the pain of childbirth. For pregnant women on the path to delivering their first child, anticipating its intensity is a common source of anxiety. This stress may be heightened further because of confusion about which forms of pain relief, such as epidural injections, are safe or appropriate during delivery.

There is no one right way to manage pain in childbirth, and what is right or needed for each mother and child varies. Every mom and every delivery is different, making it so important to discuss medical and nonmedical pain management options with your obstetrician or midwife well before your due date.

The progress of labor may be a significant factor in determining which forms of pain management are appropriate. Some labors proceed too quickly to include an epidural injection, while some women may decide against medical pain relief prior to going into labor only to change their minds when the contractions start. That's okay, too!

What Is an Epidural?

Epidural injections are a safe, effective, and commonly used form of medical pain relief during childbirth. The anesthesia blocks the pain below the waist while you remain alert and able to participate in delivering your child. The epidural provides enough pain relief to allow many women to get some rest during labor, helping to mitigate fatigue and exhaustion, and it may also help to recharge labor that has stalled.

An epidural blocks pain signals from the lower portion of the body by numbing nerves in the spine. The anesthetic is injected into the epidural space surrounding the spinal cord in the lower portion of the spine. This usually involves inserting a catheter into the back so the dosage of the pain medication can be adjusted gradually; the catheter is removed after the baby is born.

While epidurals are safe for most women and their babies, this form of pain management should not be used in women who have neurological disorders, heavy bleeding, blood-clotting issues, some kinds of lower-back surgeries, or allergies to anesthetics.

What Are the Risks of Getting an Epidural?

The side effects of an epidural may include some tenderness at the insertion site in the back; a numb, tingly, or heavy sensation in the legs; a slight drop in blood pressure (this can be addressed through fine-tuning of the anesthetic or using other medications); mild temperature elevation; mild itching; slight sedation; some difficulty urinating; and, very rarely, headaches. Most of these issues should resolve shortly after the baby is born, although the tenderness at the site of the epidural and the headaches may last a couple of days.

On average, the process of labor and delivery tends to take a little longer in women with epidurals. And despite some myths to the contrary, an epidural has no effect on the risk of undergoing a cesarean section.

Planning Ahead

Childbirth classes provide training in a number of nonmedical techniques that can help women through the intensity of childbirth. These include distraction, massage, breathing, focusing, relaxation, and visualization. There are also a few other medical options for pain relief during childbirth, which should be discussed with your doctor or midwife well before it's time for delivery.

It's a good idea to research your options, have discussions with your care team, and have a plan for pain management, but it's also important to remain flexible. Sometimes, what your body needs or what the baby needs is at odds with what you planned, and you might need to change your mind. Changing course midstream is a regular occurrence in parenthood, and for some women, that starts in the delivery room. The best way to be prepared is to get educated and keep your options open.