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It’s no secret that delivering a baby can be painful, yet the decision about whether or not to use an epidural is a personal one for you and your family.

An epidural is used to block nerve signals (like the ones responsible for feelings of pain) from the lower part of your spine.

It’s administered through a catheter that is run through a large needle inserted into the epidural space that surrounds your spinal cord. The catheter remains in place during labor and delivery to continue delivering the medication.

Depending on the health of baby and your pregnancy, and the specifics of your labor and delivery, epidural may not be option for you.

You may also change your mind about whether or not to use an epidural in the moment. But understanding the pros and cons can help empower you to feel like you’re able to make the best decision for you and your baby.

Did you know?

Epidurals are most commonly known for their use during labor, but can also be used during lower body surgical procedures, such as surgery on the pelvis or legs. An epidural is sometimes also used to provide pain relief after a procedure.

The following are some of the pros of having an epidural.

Pain relief

Epidural is one of the most effective methods for pain relief during delivery and childbirth, and it has minimal side effects on both mom and baby.

It works quickly and can begin to relieve pain within 10 to 20 minutes. Most women who have an epidural feel little or no pain during labor and delivery.

It allows you to rest

Relief from the pains of labor can help you get more rest. This can be especially beneficial if you have a long labor.

Being able to relax and avoid pain can also provide a more positive birth experience.

It can help you stay alert

An epidural can help you stay alert so that you can take an active part in the birthing experience. It can also spare you discomfort if forceps or a vacuum are needed to help get your baby out.

If you need to deliver by C-section, an epidural allows you to stay awake during the procedure and provides pain relief during your recovery.

It may help reduce postpartum depression

A 2014 study found some evidence that epidural use may decrease risk for postpartum depression (PPD) in some women. However, results from more recent research have not found evidence to support the claims that epidural use decreases risk for PPD.

Results from another study found a possible connection between decreased incidence of PPD in women who intended to and used an epidural during labor, suggesting that having a pain management plan in place and being able to stick to that plan may help reduce risk for PPD.

It’s important to discuss labor pain management with your doctor or midwife throughout your pregnancy. They can help you come up with a plan that works for you and your goals. They can also help you come up with alternatives in case your original plans need to change during labor.

You can get an epidural anytime during labor

Even if it’s not part of your intended birth plan, it’s good to know that you can get an epidural anytime during labor if the need arises.

They’re effective for longer surgical procedures

An epidural can provide continuous pain relief during long surgical procedures, such as a C-section delivery, or while recovering from certain procedures.

If you need an epidural for a surgical procedure, you will likely get a larger dose of medication and may temporarily lose all feeling below the waist. Feeling will return once the medication is reduced or stopped.

Here we look at some of the cons of having an epidural.

It can cause low blood pressure

Epidurals can cause a sudden drop in your blood pressure. Your blood pressure is monitored throughout your labor and delivery to ensure adequate blood flow to your baby and throughout your body. If your blood pressure drops, you may need oxygen, fluids, and medication.

You may have some side effects

Some women experience side effects, including shivering, fever, or itchiness. After the removal of the epidural, you may feel nauseous or dizzy, and have back pain and soreness where the needle was inserted.

About around 1 percent of women will experience a severe headache. This is a rare side effect that’s caused by a leakage of spinal fluid. If the headache persists, a blood patch is performed, which involves injecting some of your blood into the epidural space to relieve the headache.

Though very rare, permanent nerve damage is possible if the spinal cord is damaged by the needle or catheter, or by bleeding or infection in the epidural area. Anesthesiologists undergo extensive training and the risk of permanent damage is very low.

It may make pushing more difficult

Some women find pushing more difficult with an epidural. This can increase your chance of needing interventions, such as forceps, medication, or a C-section.

It may increase your risk for a perineal tear

Research shows that perineal tears are more common in women who have epidurals. Other factors that increase your risk for perineal tear include:

  • baby with heavier birth weight
  • episiotomy
  • labor induction

Your lower half may be numb for a while after giving birth

You may experience some numbness in your lower half for a few hours after giving birth. Because of this, you may need to stay in bed until the numbness wears off.

You may have trouble urinating

Having an epidural also increases your chances of needing a urinary catheter to empty your bladder. This is only temporary. The urinary catheter can be removed once your numbness has resolved.

Risk of respiratory distress for your baby

Some evidence suggests that babies whose birth mothers have an epidural are more likely to develop respiratory distress immediately after birth. Though other studies have found no evidence of epidural usage increase risk for respiratory distress in babies.

Talk to your doctor about any concerns you have about the safety of epidural for your baby before you begin labor.

More than 70 percent of women in labor use an epidural, but that doesn’t mean it’s the right choice for everyone. Like with any medical procedures, there are pros and cons to consider.

There are a number of factors that can determine what type of birth might be best for you. Every family is different and it’s impossible to predict how you’ll feel when the time comes. It’s important to keep an open mind and focus on making the experience a positive one, even if it doesn’t go how you originally planned.

Several factors can impact the level of pain you experience during delivery and childbirth. These factors may determine what, if any, medication is recommended:

  • physical and emotional health
  • pain tolerance
  • size of the your pelvis
  • size of the baby
  • the baby’s position
  • intensity of contractions

The type of birth that is “better” is not about a specific method. Rather, you’ll want to choose the best method based on your situation and individual needs.

It may be a good idea to come up with two birth plans. One plan can be your optimal plan. A second can serve as your fallback plan in case things don’t go as expected. That can help you feel less caught off guard if plans need to change mid-labor

Epidurals aren’t the only pain management option available during labor. Work with your doctor or midwife to determine which options may be best for you.

Opioids

Also called narcotics, these pain medications are given by injection or intravenously (through an IV). They don’t provide as much pain relief as an epidural, but can make the pain bearable without causing numbness.

Opioids can cause drowsiness, nausea and vomiting, and itching.

Though generally safe, opioids cannot be given right before delivery because they may slow the baby’s breathing and heart rate.

Pudendal block

This is a numbing medicine that is injected into the vagina and the pudendal nerve late in the labor, just before the baby’s head comes out. It provides some pain relief while allowing you to remain awake and push. There are no known risks to mother or baby.

Nitrous oxide

This odorless gas is also commonly known as “laughing gas.” It’s an inhaled analgesic that is administered through a handheld face mask and takes effect within one minute.

Nitrous oxide can be used continuously or as needed during labor. It doesn’t completely eliminate pain and getting relief requires inhaling it approximately 30 seconds before a contraction. Side effects may include:

  • dizziness
  • drowsiness
  • nausea
  • vomiting

Natural remedies

There are natural remedies that you can use on their own or in combination with medicine to help ease your labor pain, such as:

  • applying heat or cold to the lower back
  • massage
  • taking warm baths or showers
  • finding comfortable positions, such as crouching, standing, or walking
  • using a labor ball

Other options for procedures not related to pregnancy

If you’re having a surgical procedure on the lower part of your body, there are alternatives to an epidural. Your doctor can help you determine the best choice based on the procedure you’re having and your needs during recovery.

These may include:

  • a spinal anesthetic, which is a single injection of medication into your spine
  • general anesthetic
  • nerve block
  • opioids
  • heat and cold therapy

Epidurals are generally considered safe, but the decision to have one is a personal one. Ultimately, you’ll need to weigh the pros and cons, and decide what’s best for you and your family.

It’s also a good idea to talk to your doctor about the benefits and risks of epidurals, and other pain management options.

Developing a plan can help you feel more prepared for labor. But remember, even the best laid plans can change in the moment. That’s why it’s also a good idea to have a backup plan so that you can be prepared with an alternative birth plan that you’re still comfortable with.