Answers to questions about epidural for labor

An OB/GYN answers questions about epidural anesthesia — how it works, what to expect and how it compares with other pain relief.

As mothers-to-be develop a birth plan, there are many options to consider, including pain relief. If you plan to deliver vaginally, there are more supportive tools than ever to help manage pain. One of the most popular options is epidural anesthesia, commonly called an epidural.

Kris Ellen Barnsfather, M.D., OB/GYN with Norton Women’s Care, answers all your questions about epidurals so you can decide if this type of pain management is the best option for you.

What is an epidural?

An epidural is placed by an anesthesiologist.  It is a catheter in the epidural space in the lumbar area of the spine that allows medication to be administered continuously if needed. The epidural space is filled with fluid and surrounds the spinal cord. The location of the anesthesia controls which part of the body’s pain receptors are affected.

The medication blocks the nerves from feeling pain, allowing you to deliver your baby with minimal discomfort and limited side effects for both you and the baby. With a low dose, moms can typically move their legs.

“An epidural is one of the most common options for pain relief during labor, providing comfort while allowing you to remain fully awake,” Dr. Barnsfather said.

How painful is labor without an epidural?

 The level of pain felt during labor varies depending on factors such as the size of the baby and strength of contractions along with mom’s pain tolerance. While some laboring mothers request little or no pain relief, others find that pain relief gives them better control.

“Communication up front is key,” Dr. Barnsfather said. “Have a conversation with your OB/GYN about what you’re comfortable with from a pain tolerance standpoint, and talk about what your individual pregnancy may require.”

How long does an epidural take?

A thin plastic tube or catheter is placed in your back, allowing you to receive pain relief medicine as needed. This process only takes a few minutes. The skin is numbed first, so you’ll feel just a stick/burn and some pressure. You should begin feeling the effects of the medicine in 10 to 20 minutes. The catheter will stay in place throughout your labor and delivery.

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More mothers in Louisville and Southern Indiana choose to deliver their babies at Norton Hospital or Norton Women’s & Children’s Hospital than at any other hospital system in the area.

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The pressure of contractions may still be present, but they should not feel painful. As the doctor adjusts the dosage, your legs may feel weak, numb or heavy. However, the epidural will not reduce your ability to push. Should you need a cesarean birth (C-section), a stronger dose can be given.

After delivery, the epidural will begin to wear off, and you may experience weak or tingly sensations in your legs for several hours. Your back also may be sore where the epidural was inserted, but that should subside within a few days.

What are the possible side effects of an epidural?

While epidurals are a relatively safe and effective pain relief option, they do come with some potential side effects, such as decreased blood pressure, headache, nausea or vomiting, or mild itchiness.

Ample research has shown that an epidural is safe for you and your baby. On rare occasions, however, distress may occur. Typically this would be the result of your lowered blood pressure causing a slower heartbeat in your baby.

“If you are on medications or have previous conditions, be sure to speak with your doctor about this,” Dr. Barnsfather said. “In rare cases, some pre-existing conditions, especially blood disorders, may present an increased risk for patients receiving an epidural.”

When can I get an epidural?

“While it is best to identify your plans to receive an epidural in advance of your delivery, you may decide as your pain increases during labor,” Dr. Barnsfather said.

Norton Healthcare has the region’s only anesthesiologists dedicated exclusively to obstetrics, with an on-site team ready to provide the right level of comfort 24 hours a day. Should you decide to have an epidural during labor, the team is available and ready to assist.

Can I get an epidural for a C-section or VBAC (vaginal birth after C-section) delivery?

 “Yes. In fact, most scheduled C-sections will have a similar form of anesthesia called a spinal,” Dr. Barnsfather said. “It only last for a couple of hours, but doesn’t require a catheter to be placed. It is a one-shot dosing. Many providers recommend having an epidural if you are attempting a trial of labor after a previous C-section (TOLAC) as having a vaginal birth after C-section (VBAC) comes with a small risk of uterine rupture during labor.”

Does an epidural affect the baby? 

According to Dr. Barnsfather, the anesthetic given during an epidural could possibly make the baby a bit sleepy, just as it might make mom a bit sleepy at first.

“There is a small chance for a drop in blood pressure for mom when she gets an epidural, so we give extra fluids in preparation for that. There is no direct physical harm that can come to baby from an epidural,” Dr. Barnsfather said.

Can you use multiple types of pain management during labor?

You can use nitrous oxide alone or while in a labor tub, and then you still can have an epidural as well. However, if you decide you want an epidural, you will have to exit the tub for the remainder of your labor and delivery.

“We can use pain medicine through the IV to mom, and we can also give a pudendal block, which numbs the pubic area on mom as baby is delivering,” Dr. Barnsfather said. “We always recommend environmental options like music therapy, back rubs and favorites from home that help us to be in our ‘happy place.’ The birthing ball and walking is an option to help manage the pain as well.”

How does an epidural compare with nitrous oxide or a labor tub? Are there other forms of pain management?

An epidural delivers medicine at a rate that works best for you during labor, and it is removed after delivery.

“Nitrous oxide is a gas that you inhale during the contraction to block the pain being recognized in your brain,” Dr. Barnsfather said. “It is very short acting and has to be repeated with each contraction. The mom controls when she uses it and it, too, will be stopped after birth.

“The epidural numbs the pain signal, and the nitrous makes you ignore it,” Dr. Barnsfather said. 

While an epidural could be the right option for you, it’s best to discuss your preferences, expectations and limitations with your OB/GYN in advance.

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