“What are epidurals? And when is it too late for an epidural?” Pregnancy comes with many questions, and as a midwife and childbirth educator, I have answered these particular questions more times than I can count. Missing the golden window for solid pain relief is understandably a common concern for any mama-to-be approaching birth. The truth is, there is no hard and fast rule that dictates you’ve come too far, every situation is unique—but there are certainly some general rules of thumb your care team will use as a guide to determine whether it’s too late for an epidural. Let’s discuss.
Let’s rewind: What is an epidural?
An epidural is a commonly used form of pain relief for labour and birth. Recent data from Australia revealed the epidural is a very popular choice with 32 per cent of birthing women opting to use one.
If you’re questioning what is in an epidural—it’s a local anaesthetic, injected into the space around your spinal nerves, known as the ‘epidural space’ via a small tube that remains in your back and is attached to a pump.
The idea of having drugs continuously flowing into your body might have you wondering: does an epidural make you high? Rest assured it doesn’t quite work like that. The goal of an epidural is to reduce or remove pain from the belly button down (nifty right?!). For some people, sensation disappears completely, but more commonly people still feel pressure and touch, while the pain subsides. Typically, women are given a button to press that allows them to give themselves a top-up of pain medication as needed (don’t worry, it’s safe—it will lock you out so you can’t overdo it!).
You may have also heard of a combined spinal-epidural. This involves injecting a local anaesthetic or opiate which provides pain relief much more rapidly, as well as placing the small tube into your back to provide ongoing relief.
Each hospital and anaesthetic doctor will practice slightly differently in terms of what they offer but rest assured, if you ask for an epidural, the anaesthetist will know exactly what they need to do to make you as comfy as possible.
Does an epidural hurt?
Just like when you get a normal needle, epidural insertion does cause a stinging sensation on the skin where the local anaesthetic is injected. Once this is done, you will feel pressure and pushing while the doctor places the epidural in the correct position. This is typically described as strange and uncomfortable, but not painful. Most women find that it’s the contraction pain that is taking their focus and once the epidural is in, you won’t feel the thin flexible tube that is left in your back.
When should I ask for an epidural?
If you are reading this article thinking HELL YES to the epidural, you might be wondering when’s the best time to get an epidural during labour?
As always, everyone’s experience will differ but I would encourage you to wait until you are in established labour before giving the anaesthetist the call-up. That is to say, wait until your contractions are strong, regular and continuing to build in intensity and you are at least 4-5cm dilated. If you need more clarity on the whole early vs. established labour thing, this article has you covered.
How long does an epidural last?
The beauty of an epidural is that it lasts as long as you need it to! The thin tube that is left in your back delivers a continuous dose of medication to keep you comfy for as long as it takes for your little one to arrive. After the birth, your midwife will turn off the medication pump and gently remove the tube from your back. Most people find that within two hours of the epidural being turned off they have full movement of their legs back.
Now to the million-dollar question: when is it too late to get an epidural?
Well, to be honest, the only time it is 100 per cent too late for an epidural is when your baby’s head is literally exiting the vagina and by this point, YAY, birth is basically over and that pain you’re feeling? It’s about to stop. Ah-mazing.
Prior to this moment, it can be a little murky as to whether an epidural is going to be a good option. In my experience, different hospitals, midwives and doctors will practice differently so I encourage you to talk to your birthing hospital about their approach to epidurals in the later stages of labour. Epidurals might be one of the many things you want to think about in the lead up to your birth. If you’re feeling overwhelmed, take a breath because this guide can step you through.
Why does it make a difference how dilated I am?
There are a couple of key reasons why administering epidurals when you are close to full dilation can be more difficult (but I want to stress, still absolutely possible!)
Typically at this stage of labour, contractions are at peak intensity and you are rocketing towards the pushing stage. When an epidural is placed, it is imperative that you remain as still as possible. For women who are in the throes of labour, particularly in the later stage when your bub’s head is causing intense pressure to build in the vagina, it can be very hard to sit on your bottom and remain still. For some people, the knowledge that they are close to the finish line AND that they’d have to sit still for an epidural leads them to decide to press on without it. For others, they are highly motivated to get the epidural in and decide to work with the anaesthetist to make it happen. Secondly, sometimes when an epidural is administered in late labour, there isn’t enough time for it to take effect. Typically, the procedure of epidural insertion takes around 15-30 minutes with pain relief beginning around 10 minutes later.
None of this is to say that you can’t have an epidural at this stage of labour—as a midwife, I have seen many successful epidural insertions for mums who are close to fully dilated. It is simply to say that you, your midwife and the anaesthetist will need to work together to decide if YES this is a good option for you or NO it’s better that you continue without one.
OK…what else can I use for pain?
It’s also worth considering what other medications are available for working with pain because let’s be honest, the epidural is not the be-all and end-all.
At this point in labour we’ve missed the boat on morphine (dang) but when used properly, gas and air can be an incredible addition to labour, at any stage! Gas and air is nitrous and oxygen blended together that you inhale through a mouthpiece. When inhaled deeply (you really have to suck it back) just as the contraction begins, it takes the edge off the pain and can work wonders in making contractions more bearable. Your new BFF Gas and air can also come into the shower or bath with you! Meaning that not only is there another medication available to help you, but there are MANY tools to help you through labour, if you’ve assessed the pros and cons of an epidural and decided it isn’t for you.
Are epidurals available to everyone?
Almost! Most hospitals are able to offer epidurals—but it’s always worth checking to avoid an unwelcome surprise. Medically speaking, there are a small number of conditions that will prevent someone from being able to safely use an epidural for labour. The main condition, which we monitor for in pregnancy through routine blood tests, is low platelets. Platelets are a type of blood cell that assists blood in clotting, and adequate blood clotting is imperative if you are having a needle placed in your back. If you have any concerns about your eligibility for an epidural, or epidural risks, chat to your doctor or midwife at your next pregnancy appointment.
So there you have it friends! I hope this article has successfully busted the myth that there is a hard line in the sand in which an epidural is off the table. Yes, there are circumstances in which it’s more difficult and worth considering alternatives, but there are also ways to make it happen if it’s important to you. Something I always say to women who are feeling stressed about missing the epidural window is this:
One of two things are going to happen. Either you will get your epidural and the pain will stop. Or you will give birth to your baby, and the pain will stop.
When we consider this, the idea of going without an epidural is less daunting. Regardless of your pain management choices, don’t doubt for a second how incredibly strong, capable and resilient your body is—you’ve got this!
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Expert author: Beth Ryan
Beth Ryan is a registered midwife with a Master’s degree in Public Health. You can find out more about her by following her on Instagram here.