When Can an Epidural Be Given?

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!

Grab my hospital packing list before we get into it:

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.

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 tendancy 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.

And, if you want the actual guide — be sure to join this class so you can be more prepared!

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 mangement) 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.

Remember you can also use IV pain medication prior to an epidural.

Will My Doctor Order an Epidural For Me?

In the US I think a doctor would be hard-pressed 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 will have a hard 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!