Gone are the days when women had no choice but to endure labor and delivery without medication to ease the pain. Now, techniques like epidurals can make an otherwise painful experience more calm, controlled, and even comfortable.

Of course, many women hope to get through childbirth without having to ask for medications. But once labor starts, it's common — and completely understandable — for a woman to change her mind and request some sort of relief to make things easier or, at least, more bearable. No matter how prepared you are, physically and mentally, giving birth is hard.

Whether you've known from day one that you'd be asking for an epidural or have your heart set on a medicine-free birth, here's the lowdown on epidurals and how they can take some of the pain out of labor and delivery.

What's an Epidural?

An epidural (sometimes called an epidural block) is what most women think of when they consider pain medication during labor. Epidurals are a form of regional anesthesia that provide continuous pain relief to the entire body below the belly button (including the vaginal walls) throughout labor and delivery. With an epidural, a woman is comfortable and still fully awake.

How Is It Done?

An epidural involves medication given by an anesthesiologist through a thin, tube-like catheter that's inserted in the woman's lower back and then into the area just outside the membrane covering the spinal cord (called the epidural space). You'll need to sit or lie on your side with your back rounded while the doctor inserts the epidural.

The amount of medication can be regulated according to your needs. As your labor progresses and you start to deliver, the anesthesiologist can administer medication as needed through the catheter in your back without having to reinsert any needles.

What Will It Feel Like?

The thought of a big needle going into your back can be downright unnerving. But contrary to what many women may think, getting an epidural doesn't hurt that much at all. The skin is numbed first, so you'll probably feel just a stick or pinch and some pressure. Of course, you may be aware of the catheter in your back, which can be annoying for some women, but it isn't painful or uncomfortable.

Once the epidural is in place, you may still feel the pressure of contractions, although you shouldn't feel the pain. Actually, being aware of your contractions, if even a little, helps once you start to push.

As the doctor adjusts the dosage, your legs may feel a little weak, warm, tingly, numb, or heavy. Unlike some other labor and delivery medications, epidurals don't affect your mind. You'll still feel alert and aware of what's going on.

How Long Will It Take?

It only takes a couple of minutes to insert an epidural. You should start to feel the effects in about 10 to 20 minutes. The epidural catheter will stay in place throughout your labor and delivery.

What Are the Risks?

Epidurals do have some drawbacks. They may:

• make it harder for a woman to push the baby out (although the anesthesiologist can adjust the amount of medication being given if this happens)
• cause the mother's blood pressure to drop
• cause a headache
• cause temporary difficulty with urination, requiring a urinary catheter
• very rarely cause bleeding

Although some studies suggest that epidurals may increase the chances of cesarean deliveries (C-sections) or vaginal deliveries that require forceps or vacuum extractions, others show no correlation. It's not clear if the surgery or assisted delivery were needed because of the epidural or if the epidural and the surgery or assisted delivery were both needed because of some underlying problem.

How Will It Affect My Baby?

Some epidural medication does reach the baby, but it's much less than what the little one would get if the mother is given pain medications through an IV or if she is given general anesthesia. The risks of an epidural to the baby are minimal, but include possible distress (such as a slow heartbeat) caused by the mother's lowered blood pressure.

What Will I Feel Like After Delivery?

If you have an epidural, you may shiver a little after the baby is born (which is common with or without an epidural). You might feel some numbness in your legs and tingling as the medication starts to wear off, which may take a little while. That means you may not be able to walk around for at least a few hours after the birth. Even after that, ask someone to help you until your legs feel back to normal. If you had a C-section, the doctor may continue the epidural for a while after the delivery to control any pain.

You may also have some soreness in your back for a few days from where the epidural was inserted. Very rarely, women who get epidurals may have very bad headaches after the birth.

What Other Medications Can Help?

Epidurals aren't the only way medication can help you deal with the pain and stress of labor and delivery.

Also injected into the lower back through a catheter, a spinal block provides faster pain relief with smaller doses of medication. However, a spinal block only lasts for up to 2 hours, so it may be given during the actual delivery rather than during labor.

Some women may get a combined spinal-epidural (or CSE) block, which is, at its name implies, a combination of a spinal block and epidural that can offer faster pain relief that can then be continued throughout labor. This is often called a "walking epidural" because it allows some women to walk around once it's inserted since it has less of an effect on muscle strength. Walking can be possible with other techniques as well, depending on the medications used.

Another option for pain relief is a nerve block, which is given as an injection and deadens the sensation in specific, smaller areas of the body (such as the vagina and perineum — the area between the vagina and anus).

Analgesics are pain medications that can be administered through an IV or as a shot given as needed. Tranquilizers can be given through an IV to relax anxious women. Tranquilizers do not relieve pain, however, and can have significant side effects. If medications are given through an IV, the baby's going to get those medications, too.

Talk to your doctor about the various medications available and how they could affect you and your baby. If you're interested in getting an epidural, let your doctor know as soon as you decide, and check to see how early and how late in your labor it will be possible for you to get one.

Although many women want to give birth without any pain medications, it isn't a sign of weakness if you decide to ask for something to ease your pain or anxiety. Childbirth is often one of the hardest, most painful things the human body can go through. Getting a little relief makes you no less of a mother or woman. You know your body better than anyone — only you can be the judge of how much pain you can or can't take.

Reviewed by: Elana Pearl Ben-Joseph, MD
Date reviewed: May 2013