Why Can’t You Get an Epidural After a Point During Childbirth?

You may be wanting to get an epidural, but not sure at what point you CAN’T get during childbirth and why.  Are the staff just being mean?  Today we’ll learn from an expert L&D nurse why (and when) you can’t get an epidural after a certain point.

But first, how do I know so much about epidurals? Hi — I’m Hilary, The Pregnancy Nurse®. I’ve been a nurse since 1997 and I have 20 years of bedside labor and delivery experience. In that time, I’ve seen a lot of anesthesiologists work and helped thousands of patients get an epidural. I’m an expert in this one, so I’m excited to help you understand it!

Why cant you do an epidural after a certain point?

Because at a certain point it either won’t take effect before baby is born, you can’t sit still to get it, or you can’t sit at all (because baby’s head is coming out where you sit).

I have seen that some people say that once you’re complete you can’t get an epidural but it is a LOT more complicated than that, so keep on reading!

When can you not get an epidural?

It depends on how fast your labor is going and what number baby you are on.

If your labor is going very fast (say, you went from 6 to 9 cm in an hour) it shows that you will likely hit complete really quickly as well.  If baby is low in your pelvis that means baby may be born before we can get set-up and go for an epidural.  Plus, it needs about 20-30 minutes to really take effect after that, so there really wouldn’t be time for it to work.  We’d also require you of all the hard work to sit still and manage the pain while getting it placed.

While I believe that every person should be able to at least “try” to get an epidural (we bring in the anesthesiologist and set everything up, but if baby starts to come out, we have to stop), not every healthcare professional agrees.  Mostly because we may be doing more hard with all the prep and things than we are good.

Also, if it is your first baby you likely have a good amount of pushing time ahead of you.  Meaning that I have even gotten epidurals for patients who’s cervix is complete (10 cm — it’s all behind the baby’s head), because they still had a while before baby would be born.

So it is not true to say that if you’re complete you can’t get an epidural, there’s a whole lot more to it.

Honestly, at about 8 cm it is starting to get too late if it is your second+ baby, but you have a wide timespan if it is your first baby, as long as anesthesia is cooperative.

And yes, it is sort of complicated — much like a lot of labor. I really simplify all these kinds of things in here to prepare both of you easily!

Can you have an epidural at any point in labour?

Studies show that an epidural works best when the patient requests it, as long as they are in active labor or are being induced. You can read the study here.

That study tested people not until they were 3 cm though. I would agree to the fact that patients who continue to have their full mobility until about 3-4 cm do better (meaning I tried to get patients to wait until they were at least 3 cm to get an epidural).

I just have found that patients who get an epidural prior to 3-4 cm tend to be more likely to get a c-section.  Now, that could be because their baby was already not in a great spot (and was never going to find their right position for delivery) and labor was very painful but not opening the cervix because of that.  That is very likely, but there is no way to know if that is the case.

The main thing you need before getting an epidural is an order from your provider (your doctor or midwife).  The nurse can’t give you an epidural without it.  You also need an available anesthesiologist, and that varies depending on your hospital and what they are doing at the time.

Pro Tip:  I love to give my patients a heads-up if the anesthesiologist is going into the operating room for a period of time.  It would mean for about an hour they are unavailable to give the epidural.  This isn’t true at all labor and delivery units (some have a CRNA and an anesthesiologist depending on how busy they are) but may be true where you are delivering.  You can ask your nurse to let you know if there will be a time when the epidural wont’ be available, so you have a chance to make a choice ahead of time.

What happens if epidural is given too early?

A few things can happen;

1. You’re not actually in labor and we’d send you home…
2. It can prolong your labor
3. Nothing, it’s fine.

Ok, so let’s address these:

You’re not actually in labor and we’d send you home…

I have had a patient who we THOUGHT was in active labor, but her contractions disappeared and the cervix wasn’t opening and we decided to stop the epidural and send her home.  She came back a few days later (I want to say 5) and did have a vaginal delivery.  Her body just wasn’t in labor.  SO, we definitely want to be SURE that you are in labor before we give you the epidural.

It Can Prolong Labor

This study shows that getting the epidural prior to 6 cm can prolong labor, although they found it not statistically significant.  And, possibly more important it didn’t lead to a c-section or neonatal issues.  The study recommends that people should be able to get the epidural when they want it.

Nothing, it’s fine.

Like I said just now, people can get an epidural quite early.  I have a whole post on if you can get an epidural before your induction and I’ve had quite a few friends do just that (but it was most often their 2+ baby).

Oh, and if you’re worried about the epidural — be sure to grab my packing list:

What Happens if I Get the Epidural Too Late?

A few things can happen:

1. You won’t have time for it to take effect
2. You won’t be able to sit still as the epidural needle is in your back (which could lead to BIG issues, as you can imagine)
3. It works and you get some pain relief.

The epidural doesn’t work immediately, and it takes about 20 minutes of prep of informed consent and set-up before the epidural can be placed.  So, in total it takes about 40 minutes to an hour until you feel an effect.

Staff keeps that in mind as they try to get you an epidural, and it’s important you know those fact as you decide if it’s right for you.

What are the rules for an epidural?

It really depends on your facility. They may have specific policies and procedures on when a patient gets an epidural.  The main rules are:

• You have to be able to sit still for the placement
• You can’t touch any of the sterile draping (as infection is a real worry)
• Anesthesia dictates who can be in the room during it (some allow a partner to stay, and some do not).
• You have to allow the monitoring of you and the baby for the duration of the epidural (otherwise we will have to turn it off).

Can you get an epidural after you start pushing?

If you still seem to have quite a ways of pushing left,  Yes!  Hopefully your nurse will get things set up to help you get more comfortable.  That being said, most often people relief when they start to push, so often patients may think they need an epidural until they start pushing, but they feel good being able to push against the pain and are more able to tolerate it.

I guess some facilities or doctors may not allow this, but that would be up to them.  You can always ask your provider this question and see what they say — but I will assure you that I have had patients who were complete who got an epidural after that time.

FYI, You wouldn’t be pushing during the epidural placement. They would have you sit still for the epidural and them resume pushing about 30 minutes after it is in. I would guess.

Sometimes patients need to be able to relax to let the baby come down in the right way, and an epidural can prevent a c-section by helping patients to be able to relax. This is especially true in those later centimeters as labor is more painful and people can’t relax.

Can I Get an Epidural at 7 Centimeters?

I actually have a whole post about if you can get an epidural at 7 cm.  But the cliff notes is that most often yes, you can.  BUT if it’s your second baby you’re getting to the point that you need to decide, or forego it.

I actually list all the cm dilated in that article to tell you when is good/less good to get the epidural.  You should check it out if you have more questions on how cervical dilation extends to getting the epidural.

When will I feel pain relief from the epidural?

It normally takes 10-25 minutes for the epidural to take effect from when the doctor injects the medicine in the space (and an addition 20 minutes of prep/consent before that).  Doctors give a large amount of medicine in the beginning (called a “bolus epidural injection”) and then taper it off to a steady flow of medicine once you’re comfortable.

Some doctors do what’s called a CSE — combined spinal epidural where they inject into the spinal space giving good relief very quickly initially, and then inserting a tube into the epidural space to keep you comfortable.

Pro Tip: Some providers vary in what types of anesthetic they use for the procedure, so it’s not the same at every hospital.

Can I move around after receiving an epidural?

You can move around, and should attempt to do what you can in bed, but it won’t be the same.  If you are really getting good pain relief most often your legs are too numb to hold your weight and you will be confined to the bed.  However, you should still move from side to side and use pillows or a peanut ball to change how your hips are open as you rest.

Some of you may have heard of a “walking epidural” but in general I hear that is a low-dose epidural.  It likely doesn’t give good pain relief, but will allow you to bear some weight, like to a commode by the bed.  People aren’t walking the halls with this epidural though, that would be too risky.

Most people get a foley catheter once they are numb that will drain out your urine instead of you getting up to the restroom.

Pro Tip: When they place the epidural they will insert an epidural catheter, which is a tube that they can place medicine into that spot easily.  They put a ton of tape on this so you’re still able to move around. The metal needle is removed after that is placed as well.

Have epidurals changed over time?

Yes.  In my own case I had an epidural in 2000.  At that point they would give you large pushes of medicine which would wear off, and then they would give more medicine.  It did not go in via pump.  Some of your moms may have had this type of epidural.

Pro Tip: don’t forget there are other pain management options like IV pain medication too! I talk about all your pain management options in here.

Will an epidural increase my risk of having a Cesarean section?

The question of whether epidural anesthesia increases the risk of having a cesarean section (c-section) during delivery is a controversial one.

While some studies suggest that getting an epidural may increase the likelihood of needing a c-section, many other studies have found no correlation between the two. The theory behind this is that the epidural medicine can slow down labor, which in turn may increase the chances of needing medical intervention, such as forceps or a vacuum, to assist with delivery. However, it is important to note that an epidural can also allow a mother to rest and relax, which may actually decrease the likelihood of needing a c-section by reducing stress and exhaustion.

Let me share a few of the studies if you’d like to see them yourself:

• This one showed a lower rate of c-sections vs without an epidural
• This one showed that getting it earlier didn’t increase your risk of a c-section
• And, this study contradicts both of those saying that you’re more likely to have a c-section if you get it earlier, and more likely to have a c-section vs those without an epidural
• And this study says it does not increase your risk.

Ultimately, the decision to get an epidural or not should be based on personal preference and individual circumstances. Women who choose to get an epidural should discuss the potential benefits and risks with their healthcare provider and be prepared for the possibility of needing a c-section.  Ask, if in their experience, if it is too early to get an epidural an see what they say.

Remember YOU are not the same as a study.  Hopefully your providers have a lot of experience to draw from (and other providers to ask if they have questions), and we know all about you and what’s going on with your labor to provide you a good answer for what’s best for you.

Learning to talk with your healthcare team, and being informed of your options is the best thing you can do to prepare for labor. I have all of that in The Online Prenatal Class for Couples where we prepare both of you in just a few hours for birth!

And, if you’re not quite sure you’re ready for that whole thing, check out my free prenatal class. It’s your first step toward getting in the driver’s seat of your birth.