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Between contractions, dilation of the cervix, and pushing the baby out, there are many reasons women experience pain during childbirth.

If you’re pregnant and worried about the pain of giving birth, you may wonder if an epidural is right for you. Here are some answers to common questions about epidurals for labor and delivery.

Why Does Labor and Delivery Hurt?

To understand why labor and delivery can be painful, it helps to understand what’s happening at every stage of the process.

Labor begins when uterine muscles start to contract. These contractions help dilate the cervix, the part of the uterus that connects to the vagina, thereby opening the birth canal. But these powerful contractions also cause waves of tightening, discomfort, and pain in your pelvis.

As the baby’s head pushes against the cervix, tissues in the cervix begin to stretch (efface) and open (dilate). This causes pain in the pelvis — and often in the lower back too.

When you’re fully dilated (about 10 cm), the opening of the cervix is large enough for the baby’s head to squeeze through. As you push along with uterine contractions, the baby moves through the birth canal and out the vaginal opening.

Pain typically increases as the baby’s head decends through the birth canal. Contractions become more frequent, and you’ll soon feel the urge to push. The combination of uterine contractions plus your pushing moves the baby through the birth canal (vagina) and out of your body.

If the pain becomes too intense, your obstetrician or provider can help manage your pain with intravenous medications or regional anesthesia through an epidural or spinal block.

Epidurals for Labor

An epidural, or epidural block, is a way of delivering medication to numb the entire area between your bellybutton and thighs. Typically, anesthetists give epidurals when your cervix is at least 4 centimeters dilated.

If your pain is growing or is more intense than you expected, you don’t have to wait. The best time to get an epidural is after labor begins, but before your pain feels unbearable.

Epidurals take about 20 minutes to take effect, so it might be too late if the baby’s head is visible (crowning). Talk to your doctor or nurse midwife at any point during labor if you decide you want an epidural.

What Happens During an Epidural?

An anesthesiologist or nurse anesthetist will administer the epidural. Here is what they will do:

• Numb an area of your lower back with an injection.
• Insert a needle with a thin, flexible tube (catheter) into your lower back. The doctor places the catheter in the space between the spinal bones (vertebrae) and the sac containing spinal fluid (dural sac).
• Administer pain medication (anesthetic) through the catheter.
• Monitor the amount of medication you receive and adjust it to keep you comfortable.

The catheter stays in place throughout labor and delivery. You remain awake and alert the entire time. Your upper legs, vagina, and pelvis will be numb, but you’ll still be able to move your legs.

Although you won’t feel pain, you’ll still feel pressure in your uterus and vagina. You should still be able to push your baby out.

Some women receive a spinal block in addition to an epidural (combined spinal-epidural block). In a spinal block, the doctor injects medication directly into the dural sac.

Your doctor may recommend a spinal block if labor becomes very difficult or if you need to have a C-section. A spinal block provides immediate pain relief but wears off after an hour or so while the epidural keeps working.

Epidurals continue to work while the catheter is in place. The effects usually wear off a couple of hours after doctor removes the catheter.

Pros and Cons of Epidurals

Epidurals are safe for most women during labor and delivery. Talk with your doctor about whether an epidural is right for you.

Pros of epidurals

Epidurals can help make labor and delivery more tolerable. Medication can keep you from becoming exhausted, so you have enough energy to push the baby out when your cervix is completely dilated. Epidurals also make it easier for doctors to numb you quickly if they need to perform a C-section.

Cons of epidurals

You’ll have to stay in bed once you receive the epidural. Because you’ll be numb, you won’t be able to move around and use different labor positions.

What Else Should I Know About Epidurals?

Some women might worry that an epidural can harm their baby. But epidurals are safe for most women and their babies. In fact, little medication reaches the baby.

Talk to your doctor about how an epidural might affect your labor and delivery — and your health.

Ask your doctor about side effects after an epidural. It’s normal to have:

• Changes in the pace of contractions (slower or faster).
• Low blood pressure for a short time.
• Shivering.
• Soreness at the injection site.

After you deliver your baby, you’ll need to stay in bed until the effects of the epidural wear off. Be sure to follow your doctor’s instructions about when it’s safe to get up and move.