Requesting an epidural is an important choice — and choosing it too early or too late can have consequences. When is too late to get an epidural? Can you request an epidural at 7 centimeters (cm)? Let’s find out.
First off — who am I, and why do I know this? Hi, I’m Hilary — The Pregnancy Nurse 👩⚕️. I have been a nurse since 1997 and I have 20 years of L&D nursing experience, I am also the curly head behind Pulling Curls and The Online Prenatal Class for Couples. 🩺 I’ve given probably THOUSANDS of epidurals, and seen even more than that at this point — so I’m a good one to answer this question for you today.
Are you worried about pain at birth? That’s REALLY normal. I would recommend taking a prenatal class from someone who has a lot of experience with many different types of birth. This class goes over all your pain management options, and walks you through the entire epidural process. You don’t want to miss chapter 7. Get ALL the information you need for your upcoming birth in one spot (with someone you can trust).
Can I Get an Epidural at 7 Centimeters?
It’s a good question. I often had patients ask me when was “too late.”
I also have a full video on when I recommend you get the epidural.
What’s in This Article (click on an area to jump ahead)
What is an Epidural?
Modern medicine uses analgesia, often saved for the operating room (OR) to help women have a better birth experience, and is used very frequently in the United States in vaginal births. It is given by an anesthesiologist, not your regular health care provider (midwife or OB).
It is when medication is injected by an epidural needle into the epidural space. They also insert a small tube (called an epidural catheter) into that space It is called epidural anesthesia.
Before doing all of that they will put on some local anesthetics into your lower back so you only feel the pressure of the needle (similar to when they numb you at the dentist or for stitches).
A lot of women worry that this will paralyze them as it is very close to the spinal cord, but the epidural needle is not in the spinal canal space and that risk is very minimal (but they will go through it when the anesthesiologist places your epidural block).
The epidural analgesia that they inject (and then it flows through that tube they place in your back) will help numb your spinal nerves, so you don’t feel as much pain during labor.
This should last a long time and it very safe.
However, there is the largest risk of the epidural placement in pregnant women is a small amount of spinal fluid leaking, which can cause a severe headache (called a spinal headache). This can be fixed by anesthesia (and it is different from a regular hadache). This happens in only very rare cases (and makes it so your positioning is important during the placement).
You might also be at an increased risk for low blood pressure as you relax from all the pain relief (which is why we will monitor your blood pressure frequently during labor). If this happens, the baby’s heart rate can drop as well (but again, we are monitoring it and we have a medications that can reverse this) and may require medical intervention.
This can also be a perk for women experiencing high blood pressure during their third trimester (and that relaxation can be good for anyone with preeclampsia as well).
Other common side effects include drowsiness, and itching.
The epidural injection is mean to take away about 80% of the pain in your lower body (from about your rib cage down). The lower part of your body will also likely be difficult for you to move (and you can’t get out of bed).
Alternatives to the epidural would be IV pain medication, nitrous oxide (not in use at all US hospitals yet), local anesthetics or natural pain management.
The epidural is most often used for vaginal births, and spinal anesthesia is used for cesarean deliveries (I have a whole post on cesarean anesthesia). BUT the epidural can be used during an emergent cesarean to help provide adequate pain relief as well.
If you’re interested in more information on the epidural procedure << I have a whole post on that on my sister site.
Why could it be “Too Late” to get an epidural?
**Please keep in mind that some women with a previous back injury or are on blood thinners may NOT be able to get an epidural at all — so check with your healthcare provider about your specific circumstances.
Well, it is REALLY hard to sit still if the baby is actually coming out and get the epidural placed.
Also, it would be fairly useless at that point, you’re in too much pain for it to be effective before it would be useless. It does take a few minutes for it to have full effect.
Plus, the epidural does come with risks along with great pain management — so, making sure it’s WORTH the risk (especially if it will only be “in” for a few minutes) is something to discuss with your team.
Risks of Getting an Epidural Too Late
The main risk is that it just won’t have time to take effect as you’re being “hit” by giant waves of pain. This is why the stage of labour you’re in can be really important to know before you place the epidural to help you with the pain of contractions.
The other risk would be moving during the placement (as you are in so much pain) and that can have more serious consequences.
So, is 7 cm too late to get an epidural?
I don’t think so, but there is something to keep in mind — and that’s what # baby you’re on. BTW, still not sure what this CM’s are — check out my post on vaginal exams on my sister site.
First time mothers — 7 cm still gives you quite a lot of time to enjoy the benefits of the epidural.
7-10 cm will still take you 2-3 hours to get through (could be more, could be less), but remember on your first baby — on average — people push for 2 hours — the pushing stage is likely much longer than it will be in subsequent deliveries So, not only will you get the relief while you’re letting baby move down into your pelvis, you’ll also have it during pushing.
One of the big benefits is that if you were to need an emergency c-section (more likely on your first time) they can dose-up the epidural for that procedure and keep you very comfortable.
If it’s your 2nd (or more) baby you likely won’t get a lot of pain relief from it, but there’s a good chance you’ll get quite a bit. 7-10 cm (when you can push) usually takes 1-2 hours, so you do have time — keeping in mind that’s the textbook case, your case could be different.
Will your nurse help you get an epidural at 7 cm.
I would hope so, and they should. Honestly, at whatever point my patient requests an epidural, I try to make it happen. It does take about 30 minutes from when the patient requests it til’ anesthesia is in the room set up to put it in.
But even if you’re 9 cm and really asking for it, I try to make it happen. I think most nurses do.
Even 10 centimeters, if you really want it and it is your first baby, they should make it happen. You’ll still have that pushing time to enjoy the pain relief with it.
So, there you have it. No, 7 cm is not too late to get an epidural. Be sure to check out all my content on labor pain management (I have a lot)
Here’s the other centimeters in case you wondered:
Epidural Availability by Centimeter:
Keep in mind your epidural is available with doctor’s orders. SO, if your doctor says you can get it at any time, you CAN get it at any time!
The American College of Obstetricians & Gynecology (ACOG) says that they say a woman who asks for an epidural during labor should not be deprived of it (which makes me think it should be made available as soon as the patient is in labor — although, this isn’t always the best choice — as I’ll talk about below).
Epidural in Early Labor
Can I get an epidural at 1 cm?
Most often this is too early to get an epidural. It would be better if you had your full movement to help your cervix open, but sometimes it is appropriate.
Although, this depends on many factors. If you are a medically necessary induction and have been going for days, you might well need one at 1 cm.
Can I get an epidural at 2 cm?
Similar to 1 cm, it is often too early to get it. Keep using movement/changes in your positioning to your benefit.
Can I get an epidural at 3 cm?
This is a bit more likely… Most doctors will order it at 3 cm.
Can I get an epidural at 4 cm?
Epidural During Active Labor
Can I get an epidural at 5 cm?
Yes, this is a great time to get it.
Can I get an epidural at 6 cm?
Yes, most often — although if you’ve had a few babies, this is the part where your labor starts to speed up — so I’d get it soon.
Can I get an epidural at 8 cm?
If it’s your first baby, yes. If it’s your 2nd baby it is time to have a frank discussion with your healthcare team.
Can I get an epidural at 9 cm?
If its your first baby, you likely can — depending more on how low the baby is.
If it’s your second baby, you need to consider if it will be in long enough to make it worth it.
Can I get an epidural at 10 cm?
If it’s your first baby, and baby isn’t low. Most often, yes.
If it’s your second baby — just push and you’ll have pain relief much faster that way.
This all being said — your body, your choice. Beyond your medical doctor’s orders, you can ask for what you want. Mother nature can also make her own choices too.
Be sure to grab my hospital packing list to get prepared for your baby: