Many people wonder WHEN in their labor they can be given the epidural. Today we’ll discuss that, as well as a few ways to know WHEN to pick your epidural timing.
Before we get started, HELLO! 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 families pick the right time for their epidural (and also seeing the positives and negatives of their chosen timing) so I am here to give you ALL the tips!
When Can You Get A Labor Epidural?
The short answer: When your doctor orders it. Your nurse won’t be able to give you an epidural unless they have a doctor’s order.
The longer answer: Most often we recommend it as you’re heading into active labor, which is somewhere around 4 cm. Also, remember it takes about an hour from when you ask for it for you to be feeling good with the epidural (time for the anesthesiologist to come, plus time to place it, and for the medication to work).
But, let’s dive into it a bit more….
But first, there’s more to epidurals than we’re just going to talk about in here. Jump in here with me to learn the whole thing!
What is an epidural?
I know most of you know this (and feel free to skip to the next section if you’re already well-versed on it), but an this type of anesthesia is when they take an epidural needle, and place into your lower back. Once they find the epidural space (using that needle), they thread in an epidural catheter (a small tube) to send pain medicine in that area to set-up the epidural block.
BTW I have a whole video where I “put in an epidural” on my Raggedy Anne doll in here that people find super helpful to see what happens without it being too medical
Many people worry that they could be paralyzed by this, but the needle is actually going below your main spinal cord, the epidural space is on membrane before the spinal cord area.
The main painful thing that most people is the local anesthetic they use to numb the area. Again, this is given by a very small needle in your lower back. Most people think that it feels like a bee sting, but once that is injected, you mainly just feel pressure, not pain.
The idea is to take away about 80% of the labor pain in your lower body from about your bra line, to your knees. In general it is very safe, but some medical conditions are prohibitive for epidural anesthesia (like low platelets, or being on blood thinners), so it’s a good idea talk with your provider if you have any questions. OB’s know quite a lot about epidural pain management, but they can talk with an anesthesiologist to clarify as well.
The epidural is placed by an anesthesiologist (not your OB or midwife).
Because they use that tiny tube placed into the space, they can really vary the amount of medication that is given to you so that you can both move and feel some pressure, but also be fairly pain free. This medicine dulls the pain signals that are being sent to your brain (but you may still feel pressure).
Risks of the Epidural
The main issue that I see now and then is a spinal headache, due to them moving the needle to far into your back. This is a severe headache that gets worse when you sit up (vs laying flat). Anesthesiologists can do something called a blood patch to fix this though (it sounds worse than it is). Epidurals are given frequently for labor in the united states to help reduce labor pain (they are also used in some other medical procedures).
It also can happen that you may get low blood pressure as you relax with the medication (vs being tensed up with the pain). We give IV fluids prior to the epidural to prevent this, and there are medical interventions we can give in case this happens. This can also cause fetal distress, but all of that is quickly treated by your healthcare team.
The biggest risk is likely just not moving the lower half of your body. It may be hard to move yourself, and depending on availability of staff they may not move you as much as would help. Also, when it comes to the pushing stage, it can sometimes take a while to get used to what you’re doing.
Also, something I’ve seen is that some people don’t get adequate pain relief from the epidural. Sometimes it just doesn’t take, or may nee to be put into the right place again. That’s why I recommend you learn some natural labor coping habits in here.
There are bigger risks that can have serious complications but they are very rare.
How is an epidural different than a spinal?
A spinal block goes one layer further in, close to your spinal nerves. They do not put a catheter in when they do a spinal (although they can perform a spinal, and then thread the epidural tube in after that). In general it takes effect quicker and makes you much more numb.
Most often a spinal block is given for a cesarean section as their numbing effect is so much more and longer-lasting. Every now and then we have to use general anesthesia instead of a spinal with a cesarean section, but we’d prefer not to. I have a whole post on spinal vs general anesthesia.
I also have a whole post on the epidural vs spinal.
Aren’t there other types of epidurals?
There are lots of reasons that epidurals are given. I am specifically talking about a LABOR epidural, but there are a lot of epidural injections for back or other types of pain. I even had one for tailbone pain.
Are there alternatives to the epidural during labor?
Most hospitals will offer IV pain medication, and some also offer nitrous oxide. However, neither of those is as long-lasting as the epidural. If you’re thinking early on that you’d like an epidural, it’s best to plan to get it when your provider things is best.
Also, your healthcare provider can use local anesthesia at delivery. Whether it’s a saddle block (not seen frequently) or a local anaesthetic for the tissues that are being stretched.
Why does it matter how low the baby is?
If you’ve hung around me long enough you’ll know that I LOVE movement in labor. It’s why I have labor movement cards included in my prenatal class (and talk about it more in the class).
While you still CAN move with an epidural — it requires help, and often you just aren’t up for it that frequently (I tried to turn my patients every 30 minutes when they weren’t asleep). It just isn’t the same as when you’re without an epidural.
It’s a normal human tendency to move with pain (to see if you can find a way that is less painful). It can also be a tendency to curl up in the fetal position and want to die — so, if you’re at that stage you may want to consider the epidural earlier).
When you move your hips and change the baby’s orientation, it helps baby find their best way out. They rotate, your pelvis moves, and often they can drop in easier.
That being said, if you truly aren’t able to relax your pelvic muscles, you may need the epidural to allow your pelvis to relax, and let baby descend into the birth canal. That does happen too (so stay in close contact with your providers).
What is Active Labor?
Active labor is when your cervix is actively starting to dilate. It normally happens between 4-6 cm. That means if we were to check you every hour (which we don’t need to do) we’d see about a centimeter change each of those hours (or more).
I actually have a whole post where I share about the stages of labor. It is a beginner guide to what to expect in labor.
Pro Tip: Active labor may not mean how close your contractions are, it has much more to do with what they’re doing to your cervix.
And, if you want the actual guide — be sure to join this class so you can be more prepared! It’s in lesson #8.
Why Shouldn’t I Get an Epidural Before I’m In Active Labor?
First off, I don’t think this is the right answer for everyone. There is a Cochrane study that there isn’t a measurable difference as to when women chose to get an epidural — and most often the right timing is up to the birthing person.
However, in my 20 years of nursing experience — I had MUCH better outcomes when I could help mom move and find some relaxation to get….
- Her baby more engaged into her pelvis
- Her cervix dilated at least a 2-3
before she got an epidural.
Now, this could be complicated by the fact that people who asked for an epidural at 1 cm maybe have babies that were too large for their pelvic outlet, and therefore had increased pain (and increased need for pain management) early in their labor.
I just always encouraged moms to try to labor without one until they were 3 cm or just really needed it.
Many women were so concerned about not getting the epidural that they get it too early. A great staff can tell them that they are 100% ready to get them the epidural when they want it. I actually have a whole post on what is the best time to get your epidural medication.
Will My Doctor Order an Epidural For Me?
In the US I think a doctor would be unlikely for a doctor to never order an epidural for patients (especially with that study I mentioned).
That being said, they can order that it not be given until you’re 3-5 cm and that the head be engaged in the pelvis.
I would encourage you to talk with your provider at your prenatal visits about what their orders normally are and what they will likely order for you.
Most doctors have “standing orders” that they have for all patients (and then they modify them as necessary).
But, as stated in that study — I do firmly believe we should allow birthing persons to choose an epidural when they feel it is right for them. Make sure you understand the risks and the benefits:
Benefits of an early epidural:
- Pain relief
- Relaxation of the pelvic muscles
Risks of an early epidural:
- More difficult to move
- Baby may have a harder time getting engaged to your pelvis.
REMEMBER, just because you have an epidural doesn’t mean you can’t move — but you will want your labor team to assist you in movement (and partners can help a lot with that as well).
Learn more about movement in labor in this recent podcast:
That’s some very surface level about epidurals — be sure to join me in The Online Prenatal Class for Couples to learn everything you need to know to have a confident hospital delivery!
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.
Hopefully that helped answer your questions about when you can get an epidural. If you have questions you can always leave them in the comments!
- About the Author
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A nurse since 1997, she has worked in various fields including pediatrics, geriatrics & hospice.
She has 20 years of labor and delivery experience in the San Jose, CA and Phoenix, AZ areas.
She is also the curly head behind the website Pulling Curls and is the creator of The Online Prenatal Class for Couples — the #1 hospital-based prenatal class on the internet.