When’s the Best Time to Get an Epidural During Labor?

Written by Matt Murphy, DNP, RN, CEN, TCRN

Published on January 10, 2023

• An epidural is a safe and effective way to manage pain during labor.
• Epidurals are the most common choice in managing labor pain.
• Knowing when to get an epidural is a personal decision.
• You can get an epidural at the beginning, middle, or end of your labor.

Getting an epidural to help with labor pain is a personal decision. For some people, the idea of a needle and medicine being put into their back can create a lot of questions and anxiety—that’s totally OK!

Other people head into their final days of pregnancy knowing an epidural is a must. Maybe it’s based on stories from their friends or family. Perhaps they talked with their physician. Either way, they’ve decided an epidural is something they are comfortable with using for pain relief. 

Everyone should be empowered to ask questions about the labor and delivery process. You should feel comfortable asking for whatever information you need to make your decisions.

Headed into each of our three children’s births, we were on board the epidural train. However, we are both nurses and were comfortable with the facts surrounding our situation.

After deciding if an epidural is right for you, your next question might be, when should I get it? This also comes down, in part, to a personal decision. Knowing the best time to get an epidural during labor can be decided by working with the team treating you and understanding some basic facts.

What Is an Epidural? 

There are a couple of ways to treat the labor pain you feel while you’re in active labor. According to the American Society of Anesthesiologists, an epidural is very commonly used. It is a very safe and reliable option for pain relief.

To place an epidural, an anesthesiologist will first numb an area on your back. Although this will burn a little, the feeling is only temporary. Once numb, the doctor will insert an epidural needle that has a special tiny tube called a catheter over it.

Think of it like a needle sitting inside a tiny straw. The needle is inserted between the bones of your spine into a precise location called the epidural space.

Once in the right place, the needle is pulled out. What stays behind is the catheter that can be taped in place using special dressings. The purpose of the needle is to help get the soft catheter into the right place. Once the needle is taken out, medicine can flow through the catheter.

Since there is only a soft epidural catheter in your back, you can move around. You can get comfortable without worrying about messing anything up.

What Is the Purpose of an Epidural?

The epidural pain medication will numb you so that you can feel pressure but not painful contractions. An epidural is in a specific location in your spine, and the medication will affect a particular area. An epidural will affect your belly button down to the top part of your legs.

The fact that an epidural is placed only in the epidural space and only affects the lower half of your body offers some great benefits. One big advantage is that you can stay awake and alert during the entire birthing process with good pain relief.

The amount of epidural medication that reaches your baby is minimal. As per the American Society of Anesthesiologists, there is no current evidence that an epidural will cause any distress or harm to your child.

An epidural catheter can offer you excellent pain relief while allowing you to be an alert and active participant in the safe birth of your child. 

How Long Does an Epidural Last?

Relief with epidural anesthesia takes a little time to get going. But the beauty of an epidural as an option for pain management is that it can last as long as you need. The medication in an epidural flows to the spinal cord over time. It’s not like a one-and-done type of medicine when they place the catheter.

Once your active labor is over, the epidural is no longer needed. After the medication is stopped, the feeling will begin to return over the next few hours.

During this time, you will need to be careful when moving around. Only try to walk once you safely have returned to your normal level of sensation.

Is a Spinal Block the Same Thing?

One of the pain management methods sometimes used alongside an epidural is called a spinal block. A spinal block is similar but not the same thing as an epidural. A spinal block is also injected into the spine but goes a little deeper.

A spinal block also has a quick onset of pain relief, unlike an epidural which takes a little time to get working. Although it’s quick to start working, a spinal block is a single dose that lasts only about an hour. An epidural can give you continuous pain relief throughout labor. 

A spinal block is useful for quick pain relief but lasts a short time. An epidural takes longer to start working but offers continuous relief.

When Is the Best Time to Get an Epidural During Labor?

There is no definite answer for knowing the best time to get an epidural. Epidurals can be placed towards the beginning, middle, or even the end of the active labor process. This again comes down to a personal decision that you would likely want to discuss with the medical providers treating you.

Instead, maybe we should think more about when it’s not a good time to get an epidural. When might it be too late?

You Need to Be Able to Sit Still

Epidural placement takes expert skill and precision to make sure the needle and catheter end up in the right place. As a patient, you need to be able to sit as still as possible for as long as the doctor needs to get everything squared away.

It can take the doctor about 15 minutes to set up, and another 15 minutes to place the catheter. You need to be able to sit still long enough for the doctor to be able to do what they need to do.

Don’t Run Out of Time

Don’t wait too long into your labor to ask for your epidural because you might run out of time. As we said, it takes about 30 minutes from start to finish to place an epidural. Epidurals’ slow onset means it takes even more time for it to start working. If your labor progresses quickly, you might ask too late.

It’s not a competition, and nobody gets an award for tolerating the pain the longest. Once the labor and delivery team decide you’re truly in labor, you can start thinking about that epidural at any time. 

Risks and Side Effects of Epidural Use During Labor

No medical intervention is without some risk or concern over potential side effects. The good thing is, the risks and side effects for choosing epidural anesthesia are minimal and pretty uncommon.

Low Blood Pressure

Sometimes the medication used in an epidural for labor pain can lower your blood pressure. If your blood pressure goes too low it could be bad for you and the baby. Be aware but don’t be stressed about it.

The medical team can give you things like IV fluids and medicine to help keep your blood pressure where it should be. They can treat the side effect and still help you manage your pain using an epidural.

Headache

Sometimes the needle used to place the epidural catheter can go a little too deep and enter the space where the spinal fluid is. If this happens, sometimes spinal fluid can leak out which for some people gives them a headache.

There are simple ways to manage this which can be discussed with your anesthesiologist. 

Sore Injection Site

For some people, the spot where the doctor put the needle can be a little sore for a couple of days. This is more of an inconvenience than anything and does not mean this is something you would have to deal with permanently.

Infection

Anytime you break one of the body’s natural defense layers like the skin, you’re at risk for infection. When inserting an epidural catheter, physicians go to great lengths to limit the risk of infection. This includes cleaning the area thoroughly and using a sterile technique.

The risk of infection can’t be completely eliminated. Seek medical attention if you notice redness at the insertion site or increased pain.

Nerve Injury

The American Society of Regional Anesthesia and Pain Medicine tells us that the risk of permanent nerve injury from an epidural is low. The risk has been shown to be as low as 1 in 200,000 cases for the type of procedure such as an epidural catheter.

Should You Get an Epidural When You Give Birth?

Excluding a few unique circumstances, most people can get an epidural. Knowing information like what is described here is important. This information can help you decide if an epidural is right for you.

Who Can’t Get an Epidural?

There are a few scenarios where your doctor might tell you an epidural is not right for you because of increased risk.

• If you have a bleeding disorder.
• If you have an infection on your skin.
• If you have a brain or spinal disorder.
• If you’ve had spinal surgery.

The information WonderBaby provides is not intended to be, and does not constitute, medical or other health advice or diagnosis and should not be used as such. Always consult with a qualified medical professional about your specific circumstances.