Epidurals Explained: Everything You Need to Make Your Choice

From the Desk of Maddy the Doula Lady

Epidurals Explained: Everything You Need to Make Your Choice

Epidural or no epidural? It's one of the biggest decisions on every pregnant person's mind. Let's cut through the noise, bust some myths, and give you the real information you need to make YOUR choice.

I've been at births where moms planned an epidural from the first contraction. I've been at births where moms swore they'd go unmedicated and changed their minds at 7 centimeters. I've been at births where moms labored without any pain medication and felt like warriors.

You know what all those births had in common?

They all ended with a mom holding her baby.

There's no trophy for suffering through labor. There's also no shame in wanting pain relief. What matters is that YOU get to make an informed decision about YOUR body and YOUR birth.

So let's talk about epidurals — what they actually are, what they actually do, and what you actually need to know.

What Is an Epidural, Anyway?

An epidural is regional anesthesia that blocks pain signals from your lower body. It doesn't put you to sleep — you're fully awake and aware. It just takes away (or significantly reduces) the pain of contractions.

How It Works

The setup: An anesthesiologist or nurse anesthetist places a tiny catheter into the epidural space in your lower back (between the vertebrae, outside the spinal cord).

The medication: A combination of local anesthetic and sometimes a small amount of opioid is delivered through the catheter continuously or on-demand.

The effect: Within 10-20 minutes, you'll start to feel numbness and pressure instead of pain. You can still feel contractions (pressure, tightening), but the sharp pain is blocked.

The duration: The catheter stays in place throughout labor, so medication can be adjusted as needed. It's removed after delivery.

The Procedure: What to Expect

Nobody loves the idea of a needle in their back. But here's what actually happens — no sugarcoating, no horror stories, just facts.

Step by Step

1. You'll get IV fluids first. Epidurals can lower blood pressure, so they give you fluids beforehand to reduce that risk.

2. You'll curl into position. Either sitting on the edge of the bed hunched forward, or lying on your side in the fetal position. The goal is to round your lower back to open up space between vertebrae.

3. Your back is cleaned and numbed. They'll use antiseptic and then a local anesthetic so you don't feel the epidural needle as much.

4. The epidural is placed. You'll feel pressure — maybe some stinging or a weird zinging sensation down one leg. Most women say it's uncomfortable but manageable, especially compared to contractions.

5. The catheter is threaded in. The needle comes out; the tiny flexible catheter stays. It's taped to your back.

6. Relief starts within 10-20 minutes. First your legs may feel warm or tingly. Then the contraction pain fades to pressure.

Doula Tip

The hardest part is staying still through contractions while they place it. I tell my clients to focus on one spot on the wall, breathe slowly, and squeeze their partner's hands. It usually takes about 10-15 minutes total — you can do anything for 15 minutes.

Let's Bust Some Myths

There's SO much misinformation out there about epidurals. Let's clear some things up.

Myth

"Epidurals cause autism / developmental delays in babies."

Fact

Multiple large-scale studies have found NO link between epidural use and autism or developmental issues. This myth refuses to die, but the science is clear.

Myth

"If you get an epidural too early, it will stall your labor."

Fact

Research shows that epidurals given in early labor (before 4cm) don't increase cesarean rates or significantly slow labor. The old "wait until you're 4cm" rule is outdated. If you want an epidural, you can ask for one.

Myth

"Epidurals always lead to more interventions."

Fact

Epidurals are associated with slightly longer pushing phases and higher rates of assisted delivery (vacuum/forceps), but they do NOT increase cesarean rates in recent studies. Context matters — sometimes an epidural actually helps a stalled labor by allowing mom to rest and relax.

Myth

"You'll be completely paralyzed and can't move at all."

Fact

Modern "walking epidurals" or low-dose epidurals provide pain relief while preserving some sensation and movement. Many women can still change positions, feel pressure to push, and move their legs (though walking isn't usually recommended for safety).

Myth

"Epidurals cause permanent back problems."

Fact

You might have soreness at the insertion site for a few days. But long-term back pain after pregnancy is usually related to pregnancy and birth itself (carrying extra weight, pushing, posture changes) — not the epidural. Studies don't support a connection between epidurals and chronic back pain.

The Real Pros and Cons

Now that we've cleared up the myths, let's talk about the actual benefits and drawbacks — honestly.

✓ Potential Benefits

  • Significant pain relief — often complete
  • Allows you to rest during a long labor
  • Can help you relax if tension is stalling labor
  • If cesarean becomes necessary, epidural can be dosed up (avoiding general anesthesia)
  • You're awake and present for delivery
  • Reduces stress hormones that can affect baby
  • Can be a positive, empowering choice

✗ Potential Drawbacks

  • Limits mobility — you'll be in bed
  • Requires continuous monitoring
  • May cause blood pressure drop (managed with fluids/medication)
  • Can cause itching (from opioids in the mix)
  • Pushing phase may be longer
  • Small chance of spinal headache if dura is punctured
  • Rarely, incomplete or one-sided relief
  • You'll need a catheter (can't walk to the bathroom)

When You CAN'T Get an Epidural

Epidurals aren't available to everyone in every situation. Here are some reasons you might not be able to get one:

Epidural May Not Be an Option If...

You have certain bleeding disorders or are on blood thinners

You have an infection at the insertion site or a systemic infection with fever

You have certain spinal abnormalities or previous spinal surgery (depends on the situation)

Labor is moving too fast — if you're about to push, there may not be time

Anesthesia isn't available — small hospitals may not have 24/7 anesthesia coverage

You have very low blood pressure or certain heart conditions (case by case)

If any of these apply to you, talk to your provider during pregnancy so you can plan alternatives.

What About Other Pain Relief Options?

Epidural isn't your only choice. Here's the full menu:

Medication Options

IV opioids (Stadol, Nubain, Fentanyl): Take the edge off but don't eliminate pain. Can make you drowsy. Wear off relatively quickly. Usually used in early labor.

Nitrous oxide (laughing gas): You breathe it through a mask during contractions. Takes the edge off and reduces anxiety. Doesn't eliminate pain but helps you cope. Wears off within breaths. Not available at all hospitals.

Spinal block: One-time injection (no catheter) that provides complete numbness for 1-2 hours. Usually used for cesareans, not labor, because it wears off.

Non-Medication Options

Hydrotherapy: Shower, tub, birth pool — water is powerful pain relief

Movement and position changes: Walking, swaying, hands and knees, birth ball

Counter-pressure and massage: Especially on the lower back during contractions

Breathing techniques: Slow breathing, vocalization, visualization

TENS unit: Electrical stimulation that can reduce pain perception

Continuous support: Having a doula reduces the need for pain medication — not because doulas are magic, but because support and encouragement genuinely help you cope

Questions to Ask Yourself

There's no right or wrong answer here. But these questions might help you think through what's right for YOU:

Reflection Questions

What does my gut say when I imagine laboring with an epidural? Without one?

How do I typically cope with pain? Do I want to feel everything, or would I rather not?

Is being mobile during labor important to me?

Am I comfortable being flexible, or do I need a firm plan to feel prepared?

What support will I have? (Doulas, partners, nurses — all affect your coping ability)

What would help me feel most empowered and present during birth?

Still figuring out what you want?
Our free Birth Vision Builder helps you think through your pain management preferences and more.

Build Your Birth Vision — Free

You Can Change Your Mind

Here's something important: you don't have to decide right now. And whatever you decide, you can change your mind.

You can plan for an unmedicated birth and get an epidural at 6 centimeters. That's not failure — that's responding to your experience in real time.

You can plan for an epidural and then labor so fast there's no time. That's not a disaster — your body did what it needed to do.

You can say "I want to wait and see." That's a valid birth plan.

The goal isn't to have a "natural" birth or a "medicated" birth. The goal is to have YOUR birth — one where you feel informed, supported, and respected in your choices.

What I Tell My Clients

After years of attending births, here's my honest take:

I've seen beautiful, empowering births with epidurals. I've seen beautiful, empowering births without them. The epidural isn't what makes a birth good or bad — it's whether you felt heard, whether you had support, whether your choices were respected.

Some of the most peaceful births I've attended were moms who got epidurals early, rested, and pushed their babies out calmly. Some of the most powerful births I've attended were moms who roared through transition and caught their own babies.

Both are valid. Both are birth. Both are bringing life into the world.

What I want for you is information and support — so whatever you choose, you choose it because it's right for YOU. Not because someone scared you. Not because someone shamed you. Because you knew your options and you made your call.

The Bottom Line

An epidural is a tool — not a trophy, not a failure, just a tool. Learn about it. Think about what you want. Stay flexible. And know that whatever you decide, you're still a badass for bringing a human into the world.

Love,
Maddy the Doula Lady 💙

✿ ✿ ✿

Want support no matter what you choose?
A doula is in your corner whether you go unmedicated or get an epidural at 2cm.

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Mary's Hands Network provides free doula support across Louisiana

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