All products are independently selected by our editors. If you buy something, we may earn an affiliate commission.
Childbirth hurts. No ifs, ands, or buts about it. Thanks to modern medicine, there are some great pain control options out there to make delivering a baby way more bearable—in some cases, virtually painless. The majority of pain relief during labor is achieved through an epidural, an anesthetic that numbs you from the waist down. But whether the benefits of pain medication outweigh the risks is a controversial topic that leaves many women opting to brave childbirth without it.
While about 61 percent of women in the U.S. have an epidural during childbirth, many go into the delivery room planning to not have one. For some, it’s because they want to get the full, unfiltered birthing experience. “They feel it’s an empowering process,” to give birth without the help of pain-reducing medications, Jacques Moritz, M.D., an ob/gyn at New York Presbyterian and Weill Cornell Medical Center, tells SELF. Other women want to avoid the epidural because they’re concerned about anesthesia’s safety for the mother and baby, or reports that it may cause immediate or lasting medical issues, Raymond Hinson, M.D., attending anesthesiologist in the department of anesthesiology at Montefiore Health System, tells SELF. There’s also a lot of controversy as to whether having an epidural increases the chance that a woman will end up needing a C-section.
The decision to have an epidural or not is very a personal one, and your choice may even change mid-delivery. Here’s what you need to know about the risks and rewards to help you make the best decision for you.
“While births without this type of medical intervention have occurred for millennia, generally speaking, epidurals have the power to change the experience from one that is usually sweat-drenched and jaw-clenching, to one that is relatively relaxed and serene,” Hinson says. An epidural is administered via a needle in your back, which is inserted into the membrane surrounding your spine. A catheter is threaded through, and the dosage can be increased or decreased with a push of a button throughout labor and delivery. Voila! On-demand pain relief. It is typically given when when the woman is in the active stage of labor—4 or 5 cm dilated and experiencing regular contractions—but can be administered at almost any point during labor.
Epidurals are also helpful if the baby gets stuck and needs to be pulled out using forceps or other instruments, “because then you won’t feel anything” during these particularly painful delivery methods, Moritz says. There are other pain control options, like narcotics, local anesthetic injections, other types of spinal injections, and even nitrous oxide (laughing gas), but when it comes to balancing efficacy and safety, the epidural is usually the best choice.
Older studies examining the connection between epidurals and C-sections suggested that getting the drugs increases the chances the birth will end with a C-section as much as 12-fold, according to the American College of Obstetricians and Gynecologists. The risks were thought to be even greater if an epidural was given before the woman was 5 cm dilated. The main concern was that the epidural would make pushing less effective and lengthen labor, which can lead to abnormal fetal heart rate and low oxygen levels. Longer labors often lead doctors to perform C-sections. However, a handful of randomized studies and meta-analyses done in the past decade have found that there’s no evidence to say epidurals increase the need for a C-section, no matter when they’re given. ACOG now says that women shouldn’t let fear of an emergency C-section influence the method of pain relief they choose. The organization also released updated guidelines in 2014 to say it’s OK for women with low-risk pregnancies to spend more time in labor as long as they’re being monitored, in an effort to reduce the number of unnecessary C-sections.
Research shows that having an epidural makes the pushing part of labor longer, because it causes numbness from the waist down, making it harder to push effectively. A recent study found that for some women it may prolong labor by up to two hours. But it’s important to remember that there are many other factors that can prolong labor, and those women in the study may have had epidurals because they were experiencing more challenging births to begin with.
More advanced anesthesia options have made this less of a problem in recent years. “They’re now very good at maintaining motor function but blocking pain response,” Michael Cackovic, M.D., an ob/gyn at the Ohio State Wexner Medical Center, tells SELF. Epidurals are also controllable throughout the process. “When it’s time to push, we can turn it down or even off and let some sensation come back so you can feel what’s going on and get into pushing,” Moritz says. “In general, we try to see if you can avoid it in the early part of labor, because it can stop contractions and you’d need pitocin, a medication to [induce labor],” he adds. “We want to wait until you’re really in labor, preferably in the active part of labor, 3 or 4 cm dilated” to make sure the body is contracting normally.
The body’s response to pain relief can actually help push the baby out. Getting an epidural mid-labor can help you release a lot of tension, “and a lot of times somebody will rapidly dilate because their pelvic muscles will completely relax,” Moritz explains. This effect is more impactful if the woman waits until later in labor to receive the epidural.
Some evidence suggests that women who have epidurals are more likely to have fevers during labor, which often means the baby is treated unnecessarily with antibiotics (just in case the fever was from an infection). Overusing antibiotics is never ideal, but this is not dangerous.
It’s normal for the mother to experience a decrease in blood pressure after getting a dose of anesthesia, which can impact the baby if left untreated. “Fortunately, this occasional event is easily treated with IV medications, and medical professionals are well-versed in how to successfully handle this scenario,” says Hinson. Moritz adds that many doctors account for this ahead of time and give the mother blood pressure medication along with the epidural to remove that risk. “In even rarer instances, the baby can experience a slowing of the heart rate in the period immediately following epidural placement,” Hinson adds. A drop in fetal heart rate oftentimes prompts doctors to perform a C-section because it’s a sign of fetal distress and could be life-threatening. But when you have an epidural your doctor should be prepared for this possibility and know how to handle it—there are a few things they can do to correct this, “so patients should not be concerned,” Hinson says.
“The biggest risk to the mother is the potential for a post-epidural headache,” Hinson says. “This risk is estimated to be in the area of 1 to 3 percent.” In these rare cases, a few drops of spinal fluid leak out of the membrane and gets into the brain and spinal cord. This can cause a dull, throbbing, and oftentimes immobilizing headache that can last for a few days or up to a week. “More rarely, there is a very small risk of an infection in the spinal canal (meningitis), and unusual bleeding near the spinal canal (hematoma),” Hinson says. Cackovic notes that the hematoma risk is about 1 in 200,000, so it’s extremely rare.
In most cases, recovery isn’t impacted by having an epidural. “It wears off kind of quickly, within an hour or so,” Cackovic says, “so it doesn’t really slow you down that much.” Some women may be worried that an epidural will cause back pain, since the injection is given in the back. While it may cause temporary soreness at the site of injection (like a regular IV can), research shows that epidurals do not cause back pain.
A recent study found that women who have epidurals and, therefore, experience less pain during childbirth, are less likely to develop postpartum depression. A much larger study done just a year ago found the opposite, that epidurals actually increase the risk of PPD. It’s tough to draw a solid conclusion either way, because the connection is never so cut and dried. There are many other things that can impact postpartum depression risk, “like biological vulnerability, a woman’s support network, hormonal sensitivity, if she had fertility treatments, or if there are relationship problems,” Susan Benjamin Feingold, Psy.D., licensed clinical psychologist and author of Happy Endings, New Beginnings: Navigating Postpartum Disorders, tells SELF. “There are so many factors that it makes it hard to tease out” whether there’s indeed a causal relationship between epidurals and PPD at all.
Going against your original birth plan can be upsetting, but doctors want you to keep an open mind, because nothing is guaranteed during childbirth. The reality is that you can only do so much planning. Once the baby’s coming, anything can happen. Make sure to talk through your preferences and the potential alternative outcomes with your doctor beforehand. “It’s good to note that anesthesiologists are available to enter at any stage of labor, as we are needed, if a mother should change her mind about her birthing plan,” says Hinson. Cackovic notes that if you end up needing to be medically induced, it’s tough to avoid an epidural. “When you go into labor naturally, your uterus starts contracting and the body is ready and gently goes into it,” he explains. When you’re given medicine to induce labor, it can cause stronger, more frequent contractions—which may leave you asking (screaming) for pain medication even if you had planned to avoid it.
And that’s OK. “I’d love people to come in and push a few times and have a baby,” Cackovic says. Unfortunately, that’s usually not what happens. Just remember that asking for pain medication is not a reflection on your strength or ability as a mother. “If you don’t get an epidural, they don’t give you a special medal when you leave the hospital,” Moritz reassures. The work you put in is still just as legit, whether you felt every second of it or not.
