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Your guide to the most common medical method of pain relief

By Paula Ford-Martin

Just over 60% of women in the United States get an epidural during labor. Though other drugs are available, epidurals (and their related anesthetics, spinal blocks and combined spinal-epidural blocks) are the most commonly used for labor pain relief. These medications work to lessen pain below the waist, where you feel it most, but allow you to be alert during delivery, which may be part of their draw — on top of that whole “feeling no pain” thing!

If you’re considering medical pain relief, here’s what you need to know. (And be aware that you can mix in non-medical comfort measures to deal with any discomfort, too.)

Epidurals

Once you decide you want an epidural, you’ll be given IV fluid to hydrate you and decrease your risk of low blood pressure. Next, a doctor who specializes in pain relief (called an anesthesiologist) will inject the epidural medication into your lower back. These are the steps:

First, the anesthesiologist cleans the skin with an antiseptic, then numbs it with a local anesthetic using a very small needle. This feels like a tiny pinch. Then the epidural needle is positioned in the correct spot, and a very thin, flexible tube, called a catheter, is placed through it. The epidural needle is then removed, leaving the catheter in place so it can be used to deliver the medication nonstop via a special pump (and to add more in the event a C-section and surgical anesthesia are needed). Your legs will begin to go numb and may tingle or feel warm. If you're already having contractions, you'll experience significant pain relief after this moment.

An epidural can take place at any point in labor. That’s right, there's pretty much no such thing as "too late," says Jeffrey Swisher, MD, chair of the department of anesthesiology at California Pacific Medical Center in San Francisco. He adds, with a little smile, “Unless the baby is actually waving at you, you can get an epidural.”  

Though there are still those who believe that an epidural will halt labor, Swisher says that advances in epidural drugs and dosages have eliminated this concern: “The way that we formulate and deliver the medication in the past 25 years has made it safer, and it’s also made it so you aren’t so numb you can’t feel anything or effectively push.” A 2014 review of research on labor epidurals shows that labor isn’t slowed by the administration of an epidural and that women don’t need to wait until they’re in active labor to request one.

Potential side effects of epidurals, although they're uncommon, include fever, headache and backache, in addition to the low blood pressure mentioned before. The pain relief may be uneven, providing more numbness on one side of your body than the other, but this is rare, and your anesthesiologist can adjust for it. Because the medication can also affect the nerves that control urination, you may need a catheter inserted into your bladder so you can pee. Once the epidural is placed, you’ll need to stay in bed because numb legs will make it difficult to walk and your blood pressure and the baby's heart rate will need to be continuously monitored.

Spinal Blocks

For a spinal block, the anesthesiologist injects medication using a special needle directly into the spinal fluid in the lower back. The advantage? This works very quickly and effectively to dull any pain. According to Swisher, “Literally within a minute or two, a woman is numb ... it’s efficient, it’s safe, it’s a minimal amount of medication so the baby isn’t affected, and it allows the mother to be awake and participating in the birth of their child, which is great.” 

The procedure for getting a spinal block is similar to that of an epidural, though once the needle is removed no tube is left in its place for adding more medication. As a result, spinal blocks wear off within a couple hours (in fact, they’re rarely used in vaginal deliveries because they last for such a short time). Anesthesiologists frequently add a small amount of a narcotic, such as fentanyl or preservative-free morphine, to a spinal block to boost pain relief post C-section.

If you have a spinal block for a C-section, you’ll be numb from mid-chest down and won’t be able to walk or move your legs on your own. However, you may feel sensations of pressure when the doctor pulls your baby out through the incision. Similar to epidurals, possible side effects include nausea due to a dip in blood pressure and heart rate, a sore back and, rarely, a headache — all of which can be easily treated. You’ll also need a catheter so you can pee after the C-section, when you'll still be numb for a bit of time.

Combined Spinal-Epidural (CSE) Blocks

A CSE block is sometimes used so moms-to-be can move early in labor. That's why it's often called a "walking epidural." A small amount of narcotic is injected into the spinal fluid and the epidural catheter is placed as with a regular epidural, but there's no local anesthetic used. This allows early, moderate pain relief without you being numb and confined to bed. The side effects of a CSE are similar to an epidural or spinal, with the exception of a slightly greater chance of a headache. 

Because the choice of pain medication is up to the anesthesiologist, you may want to talk to your provider in advance if a CSE (and the potential ability to move around for a little while longer) appeals to you and is offered. Many hospitals discourage movement when you’re under any anesthesia for safety reasons — meaning that even if it’s possible for you to walk to the bathroom, they’ll ask you not to.  

Considering a drug-free delivery? Learn about natural pain relief methods for childbirth.

Published on December 30, 2015.

Paula Ford-Martin has authored more than a dozen consumer health and parenting books, including the bestselling Everything Pregnancy Book, 4^th edition, and The Only Pregnancy Book You’ll Ever Need.