What Exactly Is an Epidural? (Hint: It's Not Just a Shot)
Childbirth is complicated, and it's understandable to have questions about the process if you've never gone through it before, including details about pain medication options like an epidural. The epidural, in particular, is a commonly misunderstood aspect of childbirth. Many people think it's just a shot, but the truth is a little more complex.
TikTok user @z00mie recently went viral for a post in which she expresses her shock at learning what's actually involved in an epidural. "Finding out that the epidural isn't a shot, it's a tube that stays in your back for your entire labor," she wrote over video of her mouth hanging open. "I have no words," she wrote in the caption. Shocked to learn the truth, too? Well, so were many people in the comments section.
"They really don't tell us anything on purpose," one person wrote. "Wait, I thought it was a pill," someone else said, while another person chimed in with, "I never knew this! This is really confirming my desire to NEVER get pregnant."
Of course, you're not born knowing how epidurals work, and this generally isn't covered in school unless you're a med student. So what is an epidural, again? How exactly is an epidural given? And how long does an epidural last? Here's the deal.
What Is an Epidural?
An epidural — also known as an epidural block — is the most common type of pain relief used in childbirth in the US, according to the American College of Obstetricians and Gynecologists (ACOG). With an epidural, medication is given through a tube placed in your lower back, per ACOG.
"A labor epidural is a very thin plastic tube — about the size of a guitar string — that is placed in a patient's lower back during labor," says Caitlin Sutton, MD, assistant professor of anesthesiology at Baylor College of Medicine. "Medicine is given through the epidural to bathe the nerves that carry pain signals during labor and delivery."
Not everyone chooses to have an epidural. But they are often a popular choice during labor because of the way they work, says Laurie Chalifoux, MD, an obstetric anesthesiologist at Corewell Health and Anesthesia Practice Consultants. "The beauty of this method is that the medication works at the level of the spine instead of going into your bloodstream, so it does not make you or the baby sleepy," she says.
What Does an Epidural Do?
At a basic level, an epidural is designed to provide pain relief while you're in labor. "This can allow patients to really enjoy the birth process instead of being overwhelmed by pain," Dr. Chalifoux says.
An epidural "numbs the person's pain fibers from about the belly button down so they don't feel the pain of uterine contractions," says G. Thomas Ruiz, MD, lead ob-gyn at MemorialCare Orange Coast Medical Center in Fountain Valley, California. But, he points out, "everyone is a bit different" and some people may feel and be able to do more than others when they have an epidural.
"If someone were to have an ideal epidural, it would be what we refer to as a 'walking epidural' where you have just the right amount of local anesthetic to dull your pain fibers but not take out your musculoskeletal fibers, so you could still move your legs," Dr. Ruiz says.
Still, an epidural "can often make the legs feel a bit heavy," Dr. Sutton says. "This pain relief helps lower stress hormone levels and often allows patients to rest comfortably during labor before their babies are born," she continues. "The pain relief can also be helpful after the baby is delivered if you need any stitches for tearing."
In general, you should be able to feel the urge to push when you have an epidural, Dr. Ruiz says. "But most patients with an epidural are not very mobile," he says, noting that you'll usually have a catheter in your bladder as well to help you use the bathroom.
While Dr. Chalifoux stresses that it's the patient's choice whether they would prefer to have an epidural or not, she also points this out: "Doctors would never expect a person to have dental work or an appendectomy without anesthesia. So, we believe that birthing persons should have a right to safe pain control as well."
How Is an Epidural Given?
Getting an epidural is a bit of a process. It may be given soon after you start contractions or as your labor progresses, Dr. Ruiz says.
Before you're actually given the epidural, your skin will be cleaned and you'll be given local anesthesia to numb an area of your lower back, ACOG says. You then sit or lie on your side with your back curved out in a C shape.
An anesthesiologist will insert a needle into a small area of your lower back and a thin tube will be inserted through it, ACOG explains. "Some people may feel a 'funny bone' sensation momentarily down one leg or the other during placement," Dr. Sutton says.
The needle will be removed and the tube remains, typically secured with tape. Medication is given through the tube, and you may be able to control how much medication you're given with the help of a button. Pain relief usually starts within 10 to 20 minutes after the medication is started, ACOG says.
Potential Epidural Side Effects
An epidural is a medical procedure, and it comes with the risk of potential side effects. According to ACOG, those can include:
- Breathing problems
- Drop in your blood pressure
- Trouble emptying your bladder
- Reactivation of cold sores
"Generally, they're safe and most people do like them," Ruiz says. "It's a good option to have if the pain of labor is overwhelming someone."
How Long Does an Epidural Last?
Actually placing the epidural takes about 10 minutes, according to the UNC School of Medicine. Fortunately, there is no set time limit on how long the pain relief from your epidural will last. "You can continue to receive pain relief through an epidural for as long as you need it," according to the American Society of Anesthesiologists. "The amount of medication you receive through the epidural can be increased or decreased as necessary."
In general, the epidural will remain in until you've delivered your baby and any tears are repaired, Dr. Chalifoux says.
How Is an Epidural Removed?
Luckily, the epidural removal process is simple. "The tape is removed and the epidural catheter is pulled out," Dr. Chalifoux says. "This part does not hurt." The numbness will usually wear off in a few hours, he explains.
If you're interested in having an epidural or you're unsure of whether you want one or not, Dr. Ruiz recommends talking to your doctor. "We're pretty well versed in epidurals," he says. "And, if you're really nervous, the anesthesiologist from labor and delivery will usually be more than willing to talk to you about the process."