Epidural During Labor: Powerful Pain Relief, Safety Tips, and Risks Explained

If you’re considering an epidural during labor, you’ve likely encountered strong opinions, both for and against it. As an anesthesiologist, I’m often asked whether epidurals are safe, how well they work, and what the real risks are. This post reviews the evidence, explains what to expect, and addresses common myths to help you make a confident, informed choice.

What Is an Epidural?

An epidural during labor is a procedure performed by an anesthesiologist in which medication is injected into the epidural space. This can be given as a single injection or more commonly through a catheter placed in the epidural space. A labor epidural works by numbing the nerves that supply the lower body, reducing pain felt in the abdomen and pelvis during labor and delivery.

While epidurals are commonly associated with childbirth, they are also widely used to manage post-surgical pain after many abdominal and chest surgeries.

What is the Epidural Space?

The epidural space can be thought of as a pool that needs to be filled with medication (a local anesthetic). The nerves that exit the spinal cord must “soak” in this medication in order to block pain transmission and achieve numbness. This space is filled with soft, fatty tissue and is located between the spinal ligaments and the spinal cord itself.

How is an epidural procedure performed? (Step-by-Step)

Epidural during labor is usually placed while you are sitting up. Occasionally, it may be done while lying on your side, although this position can sometimes make the procedure more challenging. An epidural can be performed by an anesthesiologist or a trained, certified registered nurse anesthetist (CRNA).

A sensation of pressure in the back is normal during placement. If you feel any sharp pain or unusual discomfort, it is important to communicate this to the provider performing the procedure, as this feedback can help guide needle placement.

For labor and delivery, the epidural is placed in the lower back. An epidural needle is carefully advanced into the epidural space, and a thin, flexible catheter is threaded through the needle and left in place. The needle is then removed, and once the catheter is secured, it is usually not felt. Local anesthetic is administered through the catheter and adjusted to achieve the desired effect; pain relief while still allowing some movement of the legs.

Because a labor epidural numbs the nerves that supply the legs, walking is not permitted in order to prevent falls. A urinary (Foley) catheter is also placed so that you do not need to get up to use the bathroom which is not uncofortable becuse epidural covers that as well.

How Effective Is an Epidural for Labor Pain?

Simply put, there is nothing that beats it. An epidural during labor is the most effective way to relieve labor and delivery pain.

That said, epidurals do not always work exactly as intended. In some cases, the pain relief may be incomplete, uneven, or stronger than desired. When this happens, it is important to troubleshoot effectively and know what steps can be taken next.

Why Do Women Report That an Epidural Is “Not Working”?

There are a few common reasons why an epidural during labor may not work as expected.

One-sided (Unilateral) Epidural

This is what happened to me with my first epidural. The most common reason for a unilateral epidural is that the catheter is inserted slightly too deep and shifts to one side. A simple fix is to pull the catheter back by 1–2 cm and give an additional bolus of local anesthetic, which usually resolves the issue, as it did for me.

However, after the additional bolus, my epidural became very dense, meaning I could not feel or move my legs when it was time to push. While this is not always the desired effect, it can be managed. I watched the contraction monitor and pushed when I saw a uterine contraction begin, and everything went smoothly.

Occasionally, a one-sided epidural develops later during labor. This is often related to lying predominantly on one side, which allows the medication to pool and work only on that side. This is why you need to frequently switch the side you are lying on.

Epidural not working at all

In this situation, the catheter may have ended up too superficially in the soft tissues and never reached the epidural space. As a result, the local anesthetic does not provide pain relief. Because epidural placement is a “blind” procedure, the provider relies on tissue resistance as the needle passes through different layers. A characteristic loss of resistance is felt when the needle enters the epidural space. If a “false loss of resistance” is encountered, the provider may believe the needle is in the correct space when it is not. The best course of action is to replace the epidural as soon as possible.

Benefits of Getting an Epidural

The benefits are obvious, and the main reason many women choose it. An epidural during labor provides significant pain relief, allowing women to go through labor and delivery without unnecessary suffering. It also ensures that any surgical repair of lacerations (vaginal tears) after delivery can be performed comfortably and without pain. In cases of an emergency C-section, anesthesia can be administered quickly through an epidural that is already in place, allowing the process to move rapidly while keeping the mother awake.

In 2024 British Medical Journal publication involving a sample of over half a million woman, epidural was found to be associated with 35% reduction in severe maternal morbidity, with a more pronounced effect in women with medical indications for epidural analgesia and with preterm births, in other words- higher risk pregnancies.

Contrary to common misconceptions:

• • An epidural does not increase the risk of a C-section

• • It does not significantly prolong labor

• • It does not directly affect the baby

While an epidural may lower blood pressure and cause relaxation, which can temporarily reduce blood flow to the placenta, this is well understood, closely monitored, and easily prevented or treated. I’ll discuss this in more detail later when addressing whether an epidural is safe for the baby.

Epidural analgesia had no impact on the risk of caesarean section or long-term backache, and did not appear to have an immediate effect on neonatal status as determined by Apgar scores or in admissions to neonatal intensive care. 

Anim-Somuah M et al. Epidural versus non-epidural or no analgesia for pain management in labour. Cochrane Database Syst Rev. 2018 May 21

Epidural Side Effects: What to Expect

When discussing epidural side effects, it is helpful to divide them into two categories:

Common Epidural Side Effects

1. Low blood pressure (Hypotension)

Blood pressure may drop after an epidural during labor because the medication blocks not only sensory nerve fibers but also sympathetic nerve fibers that help maintain blood vessel tone. When blood vessels relax, they hold more blood (think of this as a larger “pool”), causing blood pressure to fall. This can lead to dizziness or nausea. Because this effect is common and expected, experienced anesthesiologists routinely prevent harm by giving intravenous fluid boluses and medications as needed, while closely monitoring blood pressure after epidural placement.

2. Epidural-related fever

A fever may occur after epidural placement that is not related to infection. Although the exact mechanism is not fully understood, it is thought to involve an inflammatory response. Importantly, this type of fever does not appear to worsen maternal outcomes.

3. Motor blockade (difficulty moving the legs)

This occurs when the epidural is very dense. Ideally, a labor epidural should relieve pain while preserving the ability to move the legs and feel pelvic pressure, allowing you to recognize when it is time to push.

4. Urinary retention (difficulty peeing)

Temporary difficulty urinating can occur due to nerve blockade. This is usually not an issue because a urinary (Foley) catheter is routinely placed during labor with an epidural.

5. Itching (pruritus)

Itching is a common side effect because opioids are often mixed with local anesthetics in epidurals, and opioids are known to cause itching.

6. Post–dural puncture headache (PDPH)

This can occur if the needle inadvertently passes one layer too far and punctures the dura (one of the outer layers protecting the spinal cord). This allows cerebrospinal fluid to leak, which can lead to a characteristic headache. The most effective treatment is an epidural blood patch.

Uncommon and Serious Epidural Complications

The Society for Obstetric Anesthesia and Perinatology (SOAP) established the Serious Complication Repository Project to monitor severe adverse outcomes related to obstetric anesthesia. Over five years, data from more than 300,000 deliveries across 30 U.S. institutions identified 157 prespecified complications. Here are the statistics on most severe complications:

• • Epidural abscess or meningitis:
    4 cases → less than 1 in 60,000

• • Epidural hematoma:
    1 case → 1 in 250,000

• • High neuraxial block:
    58 cases → 1 in 4,000

• • Serious neurologic injury (anesthesia-related):
    7 cases → 1 in 36,000

• • Respiratory arrest (anesthesia-related):
    16 cases → 1 in 10,000

• • Cardiac and mortality outcomes:
    • • Maternal deaths related to anesthesia: 0
    • • Cardiac arrests related to anesthesia: 2 cases
    • • Myocardial infarctions related to anesthesia: 2 cases

Epidural for labor has to be performed by an experienced anesthesia provider so that serious side effects do not happen.

Frequently Asked Questions

1. When Is It Too Late to Get an Epidural During Labor

The short answer: there is no true “too early” or “too late” time to get an epidural during labor.

Historically, there were concerns that placing an epidural early (before 3 cm of cervical dilation) could slow labor. However, this has been disproven. A landmark 2005 New England Journal of Medicine study showed that early epidural placement does not prolong labor and, in some cases, may actually help labor progress by allowing the mother to relax once pain is controlled.

As for being “too late,” unless the baby is already crowning, it is generally not too late to receive an epidural. That said, because it typically takes about 15 minutes for a labor epidural to take effect, your provider may recommend a combined spinal-epidural (CSE) in advanced labor to provide faster pain relief.

2. Does Epidural Prolong Labor?

According to the American Journal of Obstetrics and Gynecology 2023 review, contemporary epidurals extend first-stage labor by approximately 30 minutes and second-stage by 15 minutes, with no increased cesarean risk or assisted vaginal delivery when modern techniques are used. However, it’s important to remember that measuring labor duration in research is complex. Variables such as the definition of labor onset, hospital practices, and provider preferences can all influence results. From both my professional and personal experience, epidurals do not significantly prolong labor.

3. Does It Hurt to get Epidural for Labor?

Most women feel only a brief pinch and burning sensation at the start, when a small needle is used to numb the skin. After that, the procedure itself is usually pain-free, with only mild pressure in the back during catheter placement.

4. Who Should or Shouldn’t Get an Epidural?

An epidural during labor is safe and appropriate for most women, but there are certain situations in which it may not be recommended. Epidurals are contraindicated in women who are at a high risk of bleeding complications, including those taking certain blood thinners—this is why routine laboratory tests are often checked before placement.

5. Is an Epidural Safe for the Baby?

A large body of evidence supports the safety of an epidural during labor for babies. A 2018 Cochrane review that included more than 11,000 women found no difference between epidural and non-epidural groups in Apgar scores below 7 at five minutes (Apgar score is a measure used to assess whether a newborn may need additional medical support after birth). The review also found no difference in neonatal intensive care unit (NICU) admissions between the two groups.

More recently, concerns have circulated suggesting a possible association between epidural use and autism. These claims are not supported by scientific evidence. In fact, a 2021 study published in JAMA Network Open found that receiving an epidural during labor was associated with a reduced risk of developmental concerns at two years of age. Specifically, the study noted fewer concerns related to communication and fine motor skills in children whose mothers received an epidural.

6. What is CSE (Combined Spinal-Epidural)?

A combined spinal-epidural (CSE) is a technique that combines both a spinal and an epidural during labor. In this approach, the next tissue layer (dura) is intentionally punctured so that a small amount of local anesthetic can be injected directly into the fluid surrounding the spinal cord. This provides rapid and effective pain relief.

After the spinal portion is completed, an epidural catheter is placed into the epidural space. This allows medication to be administered continuously over time, maintaining pain control throughout labor and delivery.

This technique is particularly attractive in more advanced stages of labor because of its immediate effect. However, because the dura is punctured, there is an increased risk of post–dural puncture headache (PDPH) compared with a standard labor epidural.

7. What Are the Alternatives to an Epidural During Labor?

While epidurals are a popular pain relief choice, there are other options depending on personal preference, medical factors, and labor progression:

• • Natural (Unmedicated) Labor
    Involves no medications, relying on breathing exercises, movement, positioning, hydrotherapy, and support.

• • Systemic Opioids
    Medications like morphine and fentanyl are administered intravenously, but they come with side effects like nausea, sedation, and potential impacts on the baby.

• • Local Anesthesia (Pudendal Nerve Block)
    Offers localized pain relief during the second stage of labor, but is less effective and not always performed by all providers.

• • Nitrous Oxide (Laughing Gas)
    Provides mild pain relief and anxiety reduction, though it’s becoming less common due to environmental concerns.

Personal Perspective on Epidural During Labor

As an anesthesiologist, it is probably inevitable that I am somewhat biased in favor of an epidural during labor. However, even setting my professional background aside, I chose to receive an epidural relatively early with all three of my children—simply because it made sense to me.

The most serious epidural side effects are extremely rare, and even when they do occur, they are typically manageable. For me, the pain relief was excellent, and the overall labor and delivery experience was positive and empowering. I also knew I was in capable hands, and trusting the person performing the procedure made a significant difference.

Choosing whether to have an epidural during labor is a deeply personal decision, and there is no single “right” choice for everyone. Understanding how epidurals work, their pros and cons, possible side effects, and alternatives allows you to make an informed decision that aligns with your values, comfort level, and birth goals. Whether you plan to labor without medication, request a labor epidural early, or change your mind in the moment, all of these choices are valid. What matters most is that you feel supported, safe, and empowered throughout your labor and delivery experience.

Key Takeaways

• • An epidural during labor is the most effective form of pain relief for labor and delivery and is widely used and well studied.

• • A labor epidural works by numbing nerves in the epidural space, significantly reducing pain while often preserving the ability to move and push.

• • Epidurals do not increase the risk of C-section, do not significantly prolong labor, and are safe for the baby, based on large, high-quality studies.

• • Common epidural side effects—such as low blood pressure, itching, or temporary leg weakness—are expected, manageable, and closely monitored.

• • Serious complications from epidurals are extremely rare, especially when performed by experienced anesthesia providers.

• • If an epidural is not working well, it can often be troubleshot or replaced to improve pain control.

• • Alternatives to epidural during labor exist, but none provide the same level of pain relief.