Pregnancy: Should I have an epidural during childbirth?

Get the facts
Compare your options
What matters most to you?
Where are you leaning now?
What else do you need to make your decision?

1. Get the Facts

Your options

Have an epidural to control pain during childbirth
Don't have an epidural. Instead, use other methods to control the pain.

Key points to remember

An epidural is medicine that numbs your lower body so that childbirth doesn't hurt as much. The dose can be changed to make you partly numb or completely numb, depending on how much pain you're feeling.
For most women, this is a personal decision that depends on two things: how worried you are about having pain and how important natural childbirth (labor without pain medicine) is to you.
An epidural is considered the most effective and easily adjustable type of pain relief for childbirth.¹
Epidurals are very common. But there are some risks and possible side effects you should know about.
Labor pain is unpredictable. You may have more pain than you expected. If you plan to have natural childbirth and then decide that you need pain medicine, you shouldn't feel that you have "failed."

FAQs

What is an epidural?

An epidural is pain medicine that you get through a very thin tube (catheter) inserted into your back. Your lower body becomes partly or totally numb, depending on how much medicine is used. But you stay awake and alert.

Some hospitals and birthing centers offer a "light epidural" or "walking epidural." This is a light dose of medicine that makes it possible for you to walk around and to push during contractions. Ask your doctor if your hospital or center offers a "light epidural."

Sometimes you can't get an epidural:

Your labor may happen so fast that there isn't time for an epidural.
You may be in a smaller hospital that doesn't offer them. If you think you may want an epidural, find out ahead of time if they are offered at the hospital or birthing center where you're planning to go.
You may have a health problem that means you can't have an epidural.

What are the benefits of having an epidural?

Epidurals are considered the most effective and easily adjustable type of pain relief for childbirth.¹
After an epidural is started, you can quickly get pain relief if and when you need it during labor and delivery.
The medicine in an epidural doesn't make you sleepy, so you are awake and alert for the delivery.
If you were to end up needing a C-section, the epidural could quickly numb the area below your waist for the surgery.

The epidural medicine doesn't go directly into your bloodstream, so your baby is unlikely to be affected. But there isn't enough research yet to say for sure that there are no effects.²

What are the risks of having an epidural?

Longer labor. On average, an epidural adds an extra hour to labor.² But some studies suggest that this doesn't happen if you wait until your cervix is at 4 cm before you have the epidural.³
Drop in blood pressure. This can lower your baby's heart rate. To help prevent this, you receive fluids through an IV beforehand and are encouraged to lie on your side, which improves blood flow to the baby.
Being unable to feel your contractions and to push.This increases your risk of needing an assisted delivery (forceps or vacuum) and possibly your chance of needing a C-section that you wouldn't otherwise have needed.²
Seizure. This is very rare.

What are the side effects?

After delivery with an epidural, you may have:

Back soreness at the catheter site. This isn't common. Some women fear that an epidural causes long-term back pain. But studies have not shown a connection between new back pain and epidural use.²
A severe, prolonged headache. This can happen when the spinal cord sheath has accidentally been punctured during the epidural. The puncture happens to about 3 out of every 100 women. That means the puncture does not happen to 97 out of every 100 women. After the puncture is fixed with a different medicine, the headache usually goes away.

What other methods are used to control labor pain?

Pain medicines . You can get a shot of pain medicine or get it through an IV. The most common medicines used are opioids, also known as narcotics. These medicines:
- Help you relax between contractions.
- Decrease the pain (but they don't take it away completely).
- Have side effects, including drowsiness, nausea, and vomiting.
- Are less likely than an epidural to cause you to have a forceps or vacuum delivery.⁴
Natural methods . There are also several ways to control pain without using medicine. They include:
- Distraction. Walk, play cards, watch TV, take a shower, or read to help take your mind off your contractions.
- Massage. Massage of the shoulders and low back during contractions may ease your pain.
- Imagery. For instance, think of contractions as waves rolling over you. Picture a peaceful place, such as a beach or mountain stream, to help you relax between contractions.
- Focused breathing. Breathing in a rhythm can distract you from pain. Childbirth education classes teach you different methods of focused breathing.
- Acupuncture. Small studies suggest that acupuncture works for some women.⁵
- Hypnosis. This way of managing labor pain and anxiety works for some women.⁵

Why might your doctor recommend an epidural?

This is usually a personal decision, but an epidural might be recommended in certain situations, such as when:

Your labor pain is so intense that you feel exhausted or out of control. An epidural can help you rest and get focused.
You have a higher than average chance of needing a C-section. If you do need surgery, the epidural would already be in place and you could be quickly numbed.

2. Compare Options

	Have an epidural	Do not have an epidural
What is usually involved?	A large needle is used to place a small tube, called a catheter, in your lower back. The needle is removed, and the catheter is taped to your skin. The medicine leaves you partly or completely numb below the waist, depending on how much is used. You will probably have to stay in bed and have your bladder emptied with a urinary catheter. You can probably move your legs and feel when it's time to push. But pushing may be harder and take longer.	You use other ways to control pain, such as pain medicines or natural methods like breathing techniques, massage, and distraction.
What are the benefits?	An epidural works very well to relieve pain. The medicine doesn't go into your bloodstream, so you remain awake and alert throughout labor and delivery.	You avoid the risks and side effects of an epidural. Without pain medicine, you have a natural childbirth.
What are the risks and side effects?	The risks of an epidural include: Longer labor. A drop in blood pressure. Being too numb to push and needing an assisted delivery. Having the baby move into the wrong position. The possible side effects include: A sore back. A severe headache.	Labor may be more painful. Too much pain can tire you out so much that you may need other methods to help you deliver.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

For more information, see:

Personal stories about epidural use during childbirth

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"When I had my first child, I didn't use pain medication at all. I was very firm about not using any, and luckily I didn't have terrible pain. For this pregnancy, I had an OB who encouraged me to plan ahead "just in case." It's a good thing I did, because I had such unbearable back labor that I had to have some kind of pain relief. I'm glad I'd already gone over my options and decided that a light epidural would be acceptable if needed. Having that relief, but still being able to feel enough to push, made all the difference in the world! "

— Carmen, 29

"I am so nervous about the idea of having a needle in my back that I just couldn't consider an epidural. Actually, I couldn't come up with any type of pain medication that I was comfortable with taking. Women have had babies for centuries without pain medication, and I managed to, too. "

— Theresa, 34

"Pain shuts me down, but I really want to feel good about having my baby. I've talked to my nurse-midwife about the risks and benefits of having an epidural, and it seems like the perfect fit for me. "

— Anne, 37

"I didn't really think too much about how I was going to handle labor pain. When I was in the middle of labor, they told me I could have an epidural, and I just said yes. I didn't like it at all. I couldn't feel enough to push. Then, I had a bad headache for days afterwards. Of course, it only matters that my baby is healthy, but I won't have an epidural again. "

— Courtney, 22

3. Your Feelings

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have an epidural

Reasons not to have an epidural

I have a low tolerance for pain. I'm worried that I won't be able to control it without medicine.

I have a high tolerance for pain, so I think I can control it without medicine.

More important

Equally important

More important

I think it's fine to use pain medicine during labor.

I'm against using medicine during labor.

More important

Equally important

More important

I'm not worried about the risks involved with an epidural.

I'm worried about the risks involved with an epidural.

More important

Equally important

More important

I'm not worried about needing an assisted delivery because of an epidural.

I'm very worried that an epidural might require an assisted delivery.

More important

Equally important

More important

My other important reasons:

More important

Equally important

More important

4. Your Decision

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having an epidural

NOT having an epidural

Leaning toward

Undecided

Leaning toward

5. Quiz Yourself

Check the facts

1. If you decide to have an epidural to control pain, are you doing the wrong thing?

Yes
No
I'm not sure

You're right. No one can criticize you for wanting to have the best experience possible. If you decide you need pain medicine, you haven't "failed."

2. Is an epidural the best type of pain relief for childbirth?

Yes
No
I'm not sure

You're right. An epidural is considered the most effective and easily adjustable type of pain relief for childbirth.

3. Is an epidural completely safe, with no risks or side effects?

Yes
No
I'm not sure

You're right. Although epidurals are very common, they do have risks and possible side effects.

Decide what's next

1. Do you understand the options available to you?

2. Are you clear about which benefits and side effects matter most to you?

3. Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

Not sure at all

Somewhat sure

Very sure

2. Check what you need to do before you make this decision.

I'm ready to take action.
I want to discuss the options with others.
I want to learn more about my options.

3. Use the following space to list questions, concerns, and next steps.

References

Citations

American College of Obstetricians and Gynecologists (2004). Pain relief during labor. ACOG Committee Opinion No. 295. Obstetrics and Gynecology, 104(1): 213.
Eltzchig HK, et al. (2003). Regional anesthesia and analgesia for labor and delivery. New England Journal of Medicine, 348(4): 319–332.
Poole JH (2003). Analgesia and anesthesia during labor and birth: Implications for mother and fetus. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 32(6): 780–793.
Cunningham FG, et al. (2005). Forceps delivery and vacuum extraction. In Williams Obstetrics, 22nd ed., pp. 547–563. New York: McGraw-Hill.
Smith CA, et al. (2007). Complementary and alternative therapies for pain management in labour. Cochrane Database of Systematic Reviews (1).