Is an Epidural Right for You? Weighing the Pros and Cons

The lead-up to the birth of a baby is full of choices:

• Basinet or crib?
• Cloth or disposable diapers?
• Bright nursery colors? Or “sad beige”?

And about a zillion others.

And like many decisions when it comes to pregnancy and labor and delivery, choosing whether to opt for an epidural or a medication-free birth is mostly a matter of preference.

Epidurals have their benefits. So do unmedicated labors.

How do you weigh the pros and cons of an epidural? We talked with Ob/Gyn Selena Zanotti, MD, so you can make an informed choice.

Epidural pros

There are some plus sides to choosing an epidural. And some of them may surprise you.

Let’s take a look.

Pain relief

OK, this one is fairly obvious. Pain relief is pretty clearly the top reason that people choose epidurals.

An epidural is a catheter (thin, bendy tube) that’s inserted between the vertebrae in your back that delivers — you guessed it — pain-relieving medication. The medication is a local anesthetic, which can numb the nerves in your lower body.

So, yes, epidurals can relieve pain. And that relief just might allow you to get a bit of rest before baby makes their debut.

Could shorten labor

One of the big misconceptions around epidurals, Dr. Zanotti says, is the myth that epidurals can make your labor longer.

Not necessarily. Particularly during the first stage of labor (the contractions that happen before you begin to push).

“When you’re experiencing pain or discomfort, often, your first instinct is to tense up, which can keep labor from progressing,” she explains. “In those cases, an epidural can help you relax your muscles so your body can keep labor moving. So, an epidural isn’t necessarily going to prolong your labor. Sometimes, it shortens it.”

Doesn’t increase risk of a C-section delivery

This one might also come as a surprise. But large studies and meta-analyses (the pinnacle of scientific research) have shown that epidurals don’t increase your risk for a cesarean birth.

So, if a vaginal delivery is your goal, you don’t have to worry that an epidural will get in the way.

No timetable

One more myth to bust here. There’s almost no time that’s too soon or too late to choose an epidural. Unless your labor is progressing mega-fast and there’s no time to call in an anesthesiologist, you can get an epidural as soon or as late as you need.

“It used to be that you couldn’t get an epidural until you were four centimeters dilated, and you couldn’t get it too late. But it’s been looked at in so many studies and now, there’s no rule for when it’s too early or too late,” Dr. Zanotti shares. “You can get it when you’re barely dilated. You go medication-free until you’re pushing. You have the control to decide what you need and when.”

Epidural cons

An epidural is a medical intervention. And like all interventions, there can be some risks associated with it.

Let’s take a look at some of the drawbacks.

Not available to everyone

Epidurals can be an option for a lot of people. But not everyone is a good candidate.

If you have a bleeding disorder or a low platelet count, talk with your healthcare provider about whether an epidural is an option for you. You could be at a higher risk of an epidural hematoma — a potentially life-threatening condition where blood pools in the epidural space.

You may also be advised against getting an epidural if you’re allergic to anesthetic medications.

Limited movement

The thing about epidurals is that they relieve pain by numbing you — either partially or completely — pretty much from the waist down.

So, after getting an epidural, you’ll be in bed until it wears off.

“That’s why a lot of people will wait to get an epidural as long as they can or choose not to have one because they may not want to be restricted from doing things like walking around the room or using a birthing ball,” Dr. Zanotti shares.

That also means that when it comes time to push, your birthing position options may be limited.

If you choose an epidural, you may also receive a catheter to empty your bladder, as you won’t be able to get up to use the bathroom until the numbing effects wear off — typically, about two to four hours after it’s removed.

Potential for longer pushing

Remember what we said about epidurals not prolonging labor during the first stage?

Come time for the second stage — when you’re pushing to deliver the baby — an epidural can potentially slow things down.

“Some studies show there can be a slight delay during the second stage after having an epidural,” Dr. Zanotti reports. “Often, that’s because you may not be able to direct that pushing because you can’t feel what your body needs.”

You can end up pushing ineffectively. Or not know when it’s time to push.

Side effects

Like any medication or medical procedure, epidurals can have side effects. Most of them are exceedingly rare. But they can still happen.

What are some of the most common?

• Temporary soreness. The area where the epidural was placed in your back might be sore. “Researchers have spent a lot of time looking at this and there’s no evidence of long-term back problems or damage,” Dr. Zanotti says. “But it could be tender for a few days.”
• Itching. Some people may feel itchy in certain areas of their bodies or all over while the epidural is in place. If it’s a nuisance, your team can give you medication to relieve the itch.
• Nausea. An epidural can cause a slight dip in your blood pressure, which can make you feel sick to your stomach. In those situations, your team can provide medication to help.
• Drop in baby’s heart rate. If you have an epidural, your team will monitor your baby’s heart rate continuously. And while the epidural can lead to a lower heart rate for your baby, providing more IV fluids or medications can get them back on track.
• Spinal headaches. In the rare case that the epidural punctures the sac around your spinal nerves, you may leak spinal fluid. That can cause serious headaches, particularly when you change position. It usually resolves within a week or two. Talk with your provider if you experience this. You may benefit from an epidural blood patch.
• Infection and hematoma. In very rare cases (one in hundreds of thousands, Dr. Zanotti confirms), epidurals can lead to infections or pooling of blood.

“The risks of epidurals are very minimal,” she reassures. “And for people who choose to get them, it’s because they believe the benefit of pain relief outweighs that risk.”

You might just not want it

For some people, the biggest drawback to having an epidural is that they simply prefer a medication-free birth. And that’s valid.

It’s your birthing experience after all. And as long as an unmedicated birth isn’t putting you or your baby at risk, there’s no need to opt for interventions.

Non-epidural pain relief options

Epidurals may be the option you hear most about when it comes to labor and delivery. But there are other labor pain relief options — both medicinal and non-medicinal — that can help, should you choose.

That includes practices like:

• Hypnobirthing
• Guided imagery
• Progressive muscle relaxation
• Laboring in warm water

And medications like:

• Analgesic medicines
• Nitrous oxide (laughing gas)
• Pudendal block (a type of local anesthesia injected into your pudendal nerve, which sends sensations from your genitals and anus to your brain)

You have choices

Whether you should include an epidural or other medicated pain relief as part of your birth plan is, in most cases, a matter of your preference.

“People in labor have choices in what they want to do, especially when it comes to labor pain relief. Everybody is different in what they can manage — and what they want to manage,” Dr. Zanotti affirms.

Your birth plan is a roadmap for what you expect to happen and what you think you’ll want during labor and delivery. But that doesn’t mean it’s set in stone.

Things can (and often do) change during the course of labor. You may have thought you wanted medicated pain relief but decided against it later. You may have thought a medication-free labor was the route for you, but you changed your mind.

Not a problem.

While you’re weighing your options, it’s good to leave some room for doubt. Stay open to a change of plan. Be flexible. Because you can’t know for sure what you need (or don’t need) until the time comes.

“When I counsel patients about their birth plan and what they want, I always make sure they know that we’ll do everything we can to meet their goals. But we never know what it’s going to be like or what’s going to happen,” Dr. Zanotti reassures. “So, I always encourage people to keep their options open.”

Bottom line: Epidurals are safe and effective for most people. But they can come with some (mostly minor) risks. Talk with your healthcare provider about your options.

In most cases, there’s no right or wrong answer. And the choice is entirely yours.