First, what is an epidural? An epidural is regional anesthetic. This means, as opposed to IV pain relief, it isn’t expected to go into the blood stream, make you loopy or cross the placenta to the baby and sedate him/her. A simple way to think of the difference between an epidural and a spinal is that typically an epidural procedure involves placement of a small catheter attached to a pump for continuous, but usually lighter, anesthesia than a one-time injection in a spinal. If you think about it, that makes sense. Pushing and movement are required during labor whereas we don’t want you moving anywhere during a cesarean section. Some techniques involve a combination of the two, but that’s probably best explained by an anesthesiologist.
So, does an epidural slow down labor and increase risk of cesarean section? The answer to the first question is yes…sort of. The first stage of labor (dilation of the cervix) actually has no significant difference in duration regardless of when an epidural is placed. The second stage of labor (pushing and delivery of the baby) takes about 15 minutes longer on average with an epidural vs without. That, too, makes sense as walking with feet that have fallen asleep is going to be a little slower going than on feet that aren’t a little numb. As for increasing the risk of cesarean section, there is no apparent increased risk of cesarean section with epidural, although we do see slightly higher incidence of operative vaginal delivery, i.e. vacuum or forceps.
Can an epidural harm mom or baby? More common side effects for mom can be nausea/vomiting, low blood pressure, itching and difficulty with urination. While more severe effects such as infection and nerve damage are possible, they are fortunately very rare. Backache or headache can also occur, but these are not expected to persist if they do. Generally, sensation and ability to walk returns with a few hours after stopping an epidural. As for effects on the baby, because the anesthesia is regional, we don’t expect it to cross the placenta into the baby’s blood supply. Occasionally, we can see a decrease in blood flow to baby from mom if blood pressure gets to be very low, but if present, this is usually quickly corrected by treatment of mom’s blood pressure. Otherwise, much like numbing a tooth for extraction doesn’t affect your toes, the effect on baby from epidural is expected to be rather minimal.
For some women, epidural anesthesia can be a very effective option for pain control during labor, delivery and any laceration repair (hopefully, you don’t have any vaginal tearing during labor, but if you do, numb is good!). Other women either don’t need it or don’t want it. I’ve had some moms say that better pain relief allowed them to be more in the moment and really enjoy their baby more, but others felt that abstaining from pain relief allowed them to be more present during labor. Fortunately, unless there are medical reasons you can’t have an epidural, it’s a decision that you can make in conjunction with your OB and anesthesia providers. Be sure to discuss with them any concerns that you may have, and also pay close attention to your anesthesia provider to clarify all of the risks, benefits, alternatives and indications prior to proceeding with any medical procedure. Good luck with whatever decision is the right fit for you, and as always, we wish you your healthiest pregnancy, delivery and baby 😊