Women who plan on vaginal birth may wonder how painful the placement and infusion of epidural anesthesia is. How much does it compare to labor pain — and how much of the pain of childbirth will it take away?
Hi, I’m Hilary — The Pregnancy Nurse 👩⚕️. I have been a nurse since 1997 and I have 20 years of OB nursing experience, I am also the curly head behind Pulling Curls and The Online Prenatal Class for Couples. 🩺 I have helped thousands of moms get an epidural, and also got three of my own — so I’m pretty much an expert in this one.
This article is SO helpful about ONE small part of labor, but if you’re looking to find out more about the epidural, and pain management during labor in general I totally recommend this class. In just a few hours you can be TOTALLY prepared for your birth — bump to basinet.
I ALSO always wondered this, as the needle does look big, but overall so many women find an increased joy in their birth experience with an epidural — so how much does it hurt and will it be worth it? Let’s find out.
Let’s talk about the epidural placement procedure, because knowing what will happen will save you from a lot of the fears of the epidural. Education is always power in this case.
Epidural analgesia must be placed by someone trained. Most often this is either an anesthesiologist, or a nurse anesthetist. Most often, we wait to place an epidural until you are in active labor (when your cervix is actively dilating, most often women are 4-6 centimeters when they area in this labor stage).
Before they being they will do informed consent with you, just so that you understand the risks and benefits. Remember that most often informed consent will end with “you could die” as it is ALWAYS a risk when a procedure is taking place. However, the risk of that with an epidural is very low. Keep in mind that if your car was required to do informed consent when you got in it, it would 100% end with “you could die”.
Once you consent for the procedure, the provider will feel your lower back and hip bones to find a space that will allow them to do what they need to do. Think of it as them getting a map of the land so they know where your epidural space is.
Then, the anesthesiologist will place sterile drapes around the area. Then, they will wipe your injection site and the area around it off with a soap/sanitizing solution. This is often cold and catches many moms off guard (although the good ones say it will be cold before doing it) It is really important that this area be kept clear of bacteria (as your spinal area needs to be kept sterile also).
Then, they will inject a local anesthetic. This will likely burn a little as they place it, but it is the main “sharp” thing that you should feel during the placement. It will numb the area, so you only feel pressure as they place the epidural catheter.
They will give that a bit of time to take effect, as they mix up additional epidural medication they will use once they find the spot.
Once that area is numbed, they will use the epidural needle to find the epidural space. They are trying to find the spot between two membranes that cover your spinal nerves. They do this by moving in very small amounts, and seeing when they can inject fluid. Once they are able to inject the fluid, they know that they are in the right spot. At this point you need to remain very still and they will insert the epidural catheter. Catheter always means tube in he hospital, and the epidural catheter is just a small tube that will be inserted in your back into that spot so that it can deliver medication to numb your spinal nerves.
They will apply a LOT of tape to the epidural area to make sure that the small tube doesn’t move.
The idea is that the epidural can last a long time, and the tube will deliver continuous pain relief of the numbing medicine via a pump to keep your body about 80% numb. It is important that you keep some sensation so you can help move and know when the baby is descending.
Labor epidurals generally take 15-20 minutes to take full effect after the initial epidural medicine is injected. The whole epidural process usually takes 45-60 minutes from the provider in the room til’ they leave.
Often the initial dose is a big stronger than it will be later on (so if some of the numbness goes away a little bit, don’t worry!
Common Side Effects
There are a few possible side effects of the epidural that include itching, a lowering of blood pressure (as you relax) and sometimes shaking/shivering. All of those are normal, and there are things we can do to help some of them.
The nurse will run extra fluid before the epidural begins to help keep your blood pressure good as you relax.
As I said with all medical procedures there are risks. While they are NEAR your spinal cord, they aren’t actually in the same area (and the spinal cord doesn’t extend that low — those are only spinal nerves). So, the risks are actually less than you imagine.
The main risk is a severe headache, called a spinal headache. It happens when they go too far and break a further membrane, which allows some spinal fluid to leak out. The good news is that they can do a blood patch which can help the headache quite a bit. This doesn’t happen TOO Frequently, and healthcare providers are quick to notice a spinal headache (it is very different than other headaches).
There are other medical conditions like blood thinners, or spinal stenosis that can cause other risks — so be sure to talk with your providers about your plan if you hope to get an epidural. Your OB/midwife can likely answer a lot of questions, and if you have a specific case they can talk with anesthesia at the hospital and possibly order a consult ahead of time.
There are rare instances of issues, but in general the epidural is a very safe procedure.
Epidural vs Spinal Blocks
Some people wonder about a spinal block vs an epidural. A spinal is given in the OR for a cesarean section. However, an epidural can have extra medication placed into it in case you need a cesarean.
To normal people the epidural and the spinal look very similar. It is only small changes by the anesthesiologist that make these two different. I talk about both (plus general anesthesia) in my post on cesarean section anesthesia.
Other Options for Labor Pain
Of course, there are other options for pain management during labor — to help with the pain of contractions.
IV Pain medicine can be given to “take the edge off’ and many women find a dose or two sufficient.
Nitrous Oxide is finding a home in the United States and may be offered at your hospital. It does not require an IV for administration and similarly “takes the edge off’
Natural pain management techniques can also be used very effectively.
I talk a lot about ALL of your pain management options during an entire chapter in The Online Prenatal Class for Couples. I also have a whole bonus video on natural pain management techniques.
Other Types of Epidurals
Of course, labor isn’t the only kind of epidural given. Often they are given for surgery, and you can also be given an epidural steroid injection for pain management (most often for back or lower limb pain).
While it is a somewhat different experience than a labor epidural, essentially it’s the same and I think they hurt similarly (although because you’re not in a huge amount of pain to begin with, it does change things).
How bad does an epidural hurt?
As a mom of three I find it very similar to the IV placement. In fact, most women say that the IV hurt more (because they were in less pain when the IV was placed initially).
If it’s your first baby, or first time to have this type of anesthesia, I bet you’re wondering how bad the whole process is. Mostly, you feel the sharp bee sting when they numb you, and then you feel a lot of pressure as they find the epidural space. To me, it felt like they were using their pen to push hard on my back to find the area.
Because you have the pain signals of the contractions, many women don’t notice the pain they might otherwise feel during the epidural placement.
Also, once the needle is out, the only thing you might feel is cool fluid going up your back. There shouldn’t be any more pain associated with the epidural.
The pain of the epidural placement should not be a reason to not get the epidural. Be sure to talk with your provider if you have more questions about your specific needs and circumstances surrounding the epidural.
AND, if you’re interested in more information about labor start to finish do NOT miss your chance to take an online birth class. You don’t have to take my word for it about how great the reviews are.