Despite rumours, doulas- at least these ones- are NOT just for people planning to give birth without an epidural! We totally support getting an epidural during labour if it feels right for you, and we want to help you feel prepared in case you decide to get one. Many of our clients tell us that they want to leave their options open and to make a call about pain management in the moment, and this flexible approach is a great way to make decisions during labour. If an epidural is on the table for you, read on to know exactly what to expect from the whole thing.


What, exactly, is an epidural?
There are a lot of different kinds of epidurals, but the ones given to people in labour are called lumbar epidurals. An epidural involves a carefully placed catheter (a very thin tube) in the epidural space, which is an area that surrounds the spinal cord- but is not the spinal cord itself. Once the catheter is in place, an infusion of medication is started. The medication may vary depending on you pregnancy, your health, and the anesthesiologist. The medication will be continuous (meaning that it won’t “run out” or “wear off”).

The goal of an epidural during labour is analgesia, not anesthesia. This means that you shouldn’t feel any pain from your contractions or from your cervical changes, but you are not completely numb (the way you would be when undergoing surgery). Most people have some degree of mobility in their legs, though they may not feel sensations. It’s a lot like the feeling when your foot falls asleep!

How do you get an epidural?
Once you’ve decided you want an epidural, your care provider will call the anesthesiologist. Your nurse will start an IV if you don’t have one already, hook you up to a fetal monitor, and take your blood pressure. You’ll also be asked to sign consent form for your epidural. The lab may arrive to draw blood.

When the anesthesiologist arrives, the activity in the room usually picks up and it might feel a bit overwhelming or confusing. You’ll sit on the edge of your bed, with your legs dangling over the side and your back exposed to the doctor. The doctor will clean your lower back before giving you a light injection to numb the area. After that’s done, they’ll feed the epidural catheter into the “epidural space” in your back. During this procedure, it’s important to stay still- but your doula, nurse, or partner can help you manage contractions while getting your epidural placed. The whole process takes about ten minutes.
Once the doctor is done, your epidural will be securely taped to your back (no, it won’t fall out!). You’ll lay back flat to allow the epidural to spread evenly throughout your body. Generally, you’ll start feeling relief within about 10 minutes, and within half an hour or so, you won’t feel any more contractions! Your epidural is a continuous dose of medication, so you don’t have to worry about it running out or wearing off.

Does it hurt?
Not usually. For most people, the worst part is usually the injection to numb your lower back. However, it’s no worse than getting freezing at the dentist! You may feel mild burning or warmth as the anesthetic spreads. After the freezing is in place, you won’t feel much of the procedure. Some people feel a dull pressure or ache as the epidural is placed, but not a sharp pain.

What else happens when I get an epidural?
There are a few “accessories” that come along with an epidural. You’ll have your IV in your arm or hand, and your epidural catheter in your back. Your care team will carefully monitor your blood pressure with a blood pressure cuff. You’ll need to be hooked up to continuous fetal monitoring, and you’ll also eventually require a bladder catheter. After you get your epidural, you won’t be able to get out of bed, though you’ll be able to roll over and change positions in bed. You also won’t be allowed to eat or drink anything (other than clear fluids).

Will it slow my labour down?
Nope! This used to be commonly believed, but now we know that epidurals don’t slow labour. In fact, sometimes an epidural can help labour progress more quickly, especially if it allows you to rest when you’re exhausted.

Can it be “too late” to get an epidural?
When you get your epidural has nothing to do with how dilated your cervix is, and there’s no specific time you need to get your epidural by. If your labour is moving quickly, there may not be enough time for the anesthesiologist to arrive, set up their equipment, and safely place your epidural before your baby is born- in which case, it may be “too late”. But most people have plenty of time to get an epidural if they want one.

What are the risks?
The most common side effects are intense itching (a side effect of the medicine), nausea and vomiting, fever, and low blood pressure. Uncommon side effects include a severe headache (known as an “epidural headache”), infection, seizures, and nerve damage (though these are all super, super rare). Studies indicate that there are no major side effects from epidurals on babies.

What should I do? Should I get an epidural?!
This one, we can’t answer for you- because only you know what is right for you. We recommend that you have a conversation with your doctor or midwife about the pros and cons, talk to your support team about your options and your questions, and check in with what your gut is telling you. There’s honestly no right or wrong way to have a baby, and having an epidural is a great option for many families! So long as you’re making your decisions feeling supported, empowered, and informed, you’re doing it right.