Planning on getting an epidural during labor, mama? There is a lot of conflicting information out there about epidurals, epidural side effects, and their safety – for both mom and baby.
So here, I want to set the record straight!
Like most things in life, epidurals certainly don’t come without risks. The benefits of an epidural are a bit more obvious, so today I want to cover epidural side effects with you.
How you choose to manage your pain during labor is totally up to you! I’m all about providing mamas with the knowledge to make the best and the safest decisions for themselves and their babies throughout pregnancy, labor, and birth.
So, without further ado, let’s jump in!
- Epidural side effects
- 1. Epidurals and low blood pressure
- 2. Nausea and vomiting with epidural
- 3. One-sided epidurals
- 4. Epidural hot spots
- 5. Epidurals can make you itchy
- 6. Shivering and shaking after an epidural
- 7. Fever with epidural
- 8. Headache after epidural: Spinal headaches
- 9. Back pain after an epidural
- 10. Epidurals might slow down your labor
- 11. Epidurals might speed your labor up!
- Let’s look at some other epidural facts
- 1. You might need to have a catheter placed in your bladder
- 2. You won’t be able to get out of bed
- 3. Some women can’t get epidurals
- The big question: Are epidurals safe?
- So, is an epidural right for your birth?
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Epidural side effects
The main purpose of this article is to help you decide if an epidural is right for you! How are we going to do that? Through education of course.
Here at Mommy Labor Nurse we know that education = power, and that’s especially true when it comes to having a more positive birth experience!
There is one thing I want to say before we get started with these epidural side effects.
And that is: epidurals are totally safe for most mamas!! But there are some potential side effects that I want you to know about ahead of time.
1. Epidurals and low blood pressure
Have you heard about how epidurals can affect your blood pressure? If you’re in my Birth It Up: Epidural Birth Class, then I bet you have!
One of the most common side effects of an epidural is something we call hypotension. Hypotension is basically just a fancy word for low blood pressure.
Why does low blood pressure happen with epidurals?
Epidurals can cause your blood vessels to dilate, and can actually decrease the amount of blood flowing back to your heart, resulting in a drop in blood pressure
One of the first things your body does when your blood pressure drops is to move blood away from your placenta. It does this to redirect blood towards your vital organs (heart, brain, lungs, etc.) to keep you alive!
What happens if I get low blood pressure during labor?
As you can imagine, your baby doesn’t love it when the placenta is deprived of blood (aka oxygen!). It’s not uncommon to see some changes in baby’s heart rate on the fetal monitor when this happens.
Most of the time the drop in blood pressure is mild, requires minimal intervention, and picks right back up.
However, a severe drop in blood pressure can result in some scary side effects for you and baby. But rest assured, there are some easy ways we can get it back up quickly!
How is low blood pressure with an epidural managed?
The most common interventions to quickly increase your blood pressure are:
- Giving you extra fluid through your IV
- Changing your position
- Administering medication through your IV
While it’s rare that we can’t get your blood pressure back up – it does happen. If this is the case and baby isn’t tolerating things well, a C-section might be the safest option.
This is one reason someone might have an “emergent” C-section.
2. Nausea and vomiting with epidural
One common epidural side effect is nausea. I see it happen all the time when a mama’s blood pressure drops after an epidural.
Typically, you will actually feel symptomatic before we can detect the decrease in blood pressure on the monitor. Nausea is usually our first clue!
All of this to say, speak up if something doesn’t feel right. Remember, there are interventions we can do to quickly bring your blood pressure back up.
Getting your blood pressure back to your baseline almost always resolves nausea, so definitely use that voice of yours!
3. One-sided epidurals
When you get an epidural in labor, you expect it to work on both sides, right? Doesn’t seem like too much to ask for!
Usually, epidurals work great, but sometimes they don’t. You guys know that I’m all about setting realistic expectations when it comes to birth!
There are a handful of things that can make the placement easier or more challenging for the anesthesia provider. And sometimes poor placement can cause the dreaded one-sided epidural.
What can you do about a one-sided epidural?
So, what can you (and your nurse) do if you find yourself with a one-sided epidural? First off, I strongly encourage you to speak up! It will be difficult for your nurse to help you get relief if she doesn’t know that you are hurting.
Here are a few other things we can do to remedy this situation:
The first intervention I always try for one-sided epidurals is to reposition mom to the painful side. You see, epidurals work by gravity.
If your left side isn’t as numb as your right, we can turn you on your left side and let more of the epidural medication flow to that side.
If the position change alone doesn’t work, we can usually give you an extra little “bonus” dose of pain medication from your epidural pump.
You might hear your nurse or anesthesia provider refer to this as a bolus. The combo of position change plus a bolus from your epidural pump usually does the trick!
Replace the catheter
Sometimes, the epidural catheter does need to be replaced by an anesthesia team member. But don’t fret – this is rare, so please don’t lost any sleep over this one, okay?
4. Epidural hot spots
Remember earlier how I said epidurals weren’t always perfect? Well, that holds true for this one too. Another unfortunate side effect of an epidural is the potential for developing an epidural hot spot after the placement.
What the heck is an epidural hot spot?
A hot spot is when a bit of your contraction pain comes back in one, concentrated spot on your body. Everyone’s anatomy is different, and sometimes the medication that was originally given doesn’t go everywhere it needs to.
This is usually something we can resolve with position changes and extra medication through your epidural catheter. Similar to the things we do for one-sided epidurals.
Keep in mind…there is a small chance that if we can’t resolve the hot spot you would need the catheter replaced.
5. Epidurals can make you itchy
Yep, you read it right. It’s not uncommon to experience itching after an epidural. Itching, along with decreased blood pressure, are the most common epidural side effects.
Itching is actually a common side effect of opiate-based drugs, which is a part of what an epidural is!
My hospital uses a combination of Fentanyl and Bupivacaine in our epidurals, but yours might be a different combo – there are a number of variations.
Some moms have generalized itching all over their bodies. Others have it concentrated to one area – usually the face and nose.
It’s a pretty odd phenomenon and there actually isn’t clear data on why it happens!
Do keep in mind that while it’s annoying, the itching is temporary and should resolve once your epidural is turned off after delivery.
6. Shivering and shaking after an epidural
Have you ever heard of the epidural shakes? I’m guessing not, unless you learned it from my Birth It Up: Epidural Class 😉
I have a lot of patients tell me that they wish someone would have warned them about this one, so considered yourself warned!
Shaking after an epidural is common, but it’s not typically a response to feeling cold. Usually, shaking after an epidural is a side effect of the opiate-based medications used in an epidural.
It can also be related to normal hormonal changes that naturally occur as labor progresses. If the latter of the two is the culprit you can expect shaking to occur. The problem is that we can’t always pinpoint it!
While annoying, the shivering will settle down after delivery and does not pose a risk to you or your baby.
Managing epidural shakes
Funny enough, I have actually learned a little trick over my years working as an L&D nurse, to help with the shivering and shaking.
Now, I know you are going to think I’m making this up but hear me out: stick out your tongue!
Is this theory scientifically backed? Not to my knowledge! And honestly, I’ve searched, and have NO IDEA why it actually works, but it does for some mamas.
7. Fever with epidural
Getting an epidural can disrupt the thermoregulation center of your brain. The thermo-what? Thermoregulation refers to how the body maintains its internal temperature.
If this becomes disrupted, which can occur as a result of an epidural, it can decrease your body’s’ ability to regulate its temperature – wild, huh?
If this happens, it usually doesn’t cause any issues for mama or baby. If the fever gets high enough, we can use some Tylenol to treat it.
This is not an epidural side effect that I commonly see, but one I wanted you to be aware of, nonetheless.
8. Headache after epidural: Spinal headaches
Repeat after me, headaches resulting from the placement of an epidural, also known as a spinal headache, are rare.
When I say rare, I mean that you have about a 1% chance of this happening to you. I want to emphasize how rare they are mainly because you will feel pretty dang crappy if you’re unfortunate enough to experience one of these.
A spinal headache is a type of headache that can develop after the placement of an epidural or spinal anesthesia.
So why do spinal headaches happen?
Occasionally, as the epidural is being placed, the needle nicks the dura membrane. This is the thick outer layer of tissue that surrounds your spinal cord. When this happens, spinal fluid can leak into your epidural space.
This can cause a pressure change in your brain and give you, quite possibly, the worst headache of your life. I promise I’m not trying to scare you! Again, this is rare, but it’s good to be aware of the possibility.
What to expect if you get a spinal headache?
If you experience a spinal headache as a result of an epidural, you can expect symptoms to appear within about 48 hours.
In addition to the severe headache, you might also experience:
- Ringing in your ears or hearing loss
- Blurry vision
- Stiff neck
There’s a chance that the headache resolves on its own within a couple of days to weeks, but sometimes treatment is needed.
Treatment options for spinal headaches include:
- Bedrest for 12-24 hours
- IV hydration to help raise the pressure of your cerebral spinal fluid
- Certain medications
- Administration of a blood patch to help seal the leak and restore the pressure around your spinal cord
9. Back pain after an epidural
I saved this one for the end because it’s also a pretty rare epidural side effect. But some women do experience chronic back pain after receiving an epidural.
Sometimes it lasts for weeks, sometimes for years. Fortunately, the pain is not typically a debilitating kind of pain for most.
The large majority of women that experience back pain after an epidural describe it more as discomfort in the spot where the epidural was placed rather than true pain.
10. Epidurals might slow down your labor
If you are looking for the short answer then it’s yes, an epidural can slow down labor.
Now before you move on, I encourage you to finish reading this section because it’s somewhat of a loaded question.
Epidurals often get a bad rap for slowing down labor. And, like I told you, that can be true…but only some of the time.
The situation where I most commonly see this is when she gets the epidural too early in the labor process.
So, when should you get your epidural then?
In all honesty, you should get your epidural when you ask for it. But as a labor and delivery nurse with almost nine years of experience, I would recommend waiting until these three things are happening before you request an epidural:
- You are having painful and consistent contractions
- Your cervix is changing
- You are not actively pushing your baby out or feeling an intense urge to push
If all three of the above factors apply, there is a good chance you are around 4-6 cm dilated. This is a great time to get your epidural.
It’s totally okay for you to get your epidural early, and a lot of women do, I just want you to be aware of the potential for it slowing down your labor.
Why is it bad if my labor slows down?
Now, you might be asking, “What’s the big deal with my labor slowing down?”, and that’s a very fair question!
It can start a domino effect of medical interventions, something that is sometimes referred to as “the cascade of intervention”.
For instance, stalled labor can lead to the need for augmentation to get labor progressing again. If we are unsuccessful at jumpstarting your labor or your baby isn’t tolerating it, you may end up needing a C-section.
Again, this is definitely not something that happens to everyone that gets an epidural “early” in the labor process. But it is something that can happen and something I want you to be aware of.
11. Epidurals might speed your labor up!
To really throw you off, I have also seen the complete opposite situation happen! Some mamas dilate much faster after receiving their epidural because their body, and in turn, their pelvis, can finally relax and open.
This is usually the case for women that have been in labor and in pain for a looong time. Sometimes, the epidural is just the thing your body needs to relax enough to let baby descend lower into your pelvis and finish dilating.
Let’s look at some other epidural facts
1. You might need to have a catheter placed in your bladder
This is something that makes a lot of women anxious, but also something that’s not entirely true. While it used to be more common to put a urinary catheter in all women after an epidural placement, many hospitals have gotten away from this a bit.
Whether or not you “need” a urinary catheter after your epidural is pretty dependent on how quickly we anticipate your labor progressing. There are policies and protocols that help guide our decision but ultimately it’s up to you and your delivery team.
Let’s look at some examples
Let’s say you are having your first baby; you are 4 cm dilated and just got your epidural. There’s a pretty good chance you will be in labor for many more hours, so we might recommend placing a catheter to keep your bladder empty for the remainder of your labor.
On the other hand, you come in, you are 8 cm dilated, and this is your second baby. We know second labors tend to progress much quicker than the first, plus you are already dilated 8 cm.
In this scenario, labor likely will progress quickly enough that a urinary catheter isn’t necessary.
Why does it matter if your bladder is full or empty during labor anyways?
Excellent question! Think about your anatomy. Your bladder is in the same space where your baby is. A full bladder can get in the way and prevent baby from coming down and out. Makes sense, right?
Unless you have a walking epidural, which is a different story, your legs should be super numb after your epidural and therefore you won’t be able to get out of bed and walk to the bathroom.
So, if you can’t walk to the bathroom but it’s also very important for labor progression to keep your bladder empty, how do we address this?
Urinary catheter for the win!
This is when the urinary catheter comes into play. Don’t worry though, your nurse should wait until your epidural is working and your body, well your lower half at least, is nice and numb, before they place the catheter.
If for some reason your nurse wants to place your catheter before you’ve had time to get fully numb, make sure you speak up!
The other potential option, and it can be pretty tricky for a lot of women, is to use a bedpan or female urinal to keep your bladder empty after an epidural placement.
This can feel quite unnatural to some women, but it definitely is an option if you are anti-catheter. And if your nurse doesn’t present this to you, don’t be afraid to ask!
2. You won’t be able to get out of bed
Yep, with a traditional epidural, you can expect to be bed bound after the placement. Numb legs don’t really make for good walking legs.
I want you to hear me loud and clear on this one: bed bound does not mean you lie on your back for the rest of your labor and don’t move. This is a BIG misconception and unfortunately, something I hear about a lot from epidural mamas.
Position changes in the bed are not only possible with an epidural in place but they are highly recommended to prevent your labor from stalling. This is something your nurse can and should be assisting you with.
The most common labor and pushing positions with an epidural are left or right side lying, chair position, and hands and knees.
Hands and knees might be a little tricky if you have super numb legs, but with assistance, might be an option for a brief period of time.
Related Reading: How to Push During Labor with an Epidural
What about walking epidurals?
When it comes to pain control and birth, most of us are familiar with epidurals, at least in the traditional sense. But have you ever heard of a walking epidural?
They are very similar to a traditional epidural, but they allow for greater feeling and movement in the lower half of the body and might even keep you from being bedridden.
Sounds like a win-win in my book! So, what’s the catch? Well, walking epidurals aren’t offered at a lot of hospitals.
There’s a good chance a walking epidural isn’t available where you plan on delivering. They just aren’t that common. So definitely talk to your provider ahead of time, so you don’t get your hopes up for nothing.
I just scratched the surface here on walking epidurals. If you want to learn more, I have a whole article on walking epidurals for you!
Related Reading: Everything You Need to Know about Walking Epidurals
3. Some women can’t get epidurals
As with any procedure, there are contraindications to getting an epidural. Let’s talk through these a bit!
You can’t sit still
Not to scare you but there’s a big needle in your back during the epidural placement. To avoid damage to your spinal cord or any other complications, you will need to sit still during the placement.
Of course, this is to the discretion of the anesthesia team member but typically the part that you need to be super-duper still for is pretty brief and not the entirety of the procedure.
It takes the provider a bit of time to get everything ready and then to get it all secured and taped once it’s placed and it’s usually okay if you need to move a little bit during these parts.
Your platelet count is low
When you arrive at the hospital you will have some bloodwork done. One of the things we are looking at is your platelet count. Platelets have a pretty important job. They form clots in our blood to prevent or stop bleeding.
Someone with a low platelet count, as is sometimes the case with gestational thrombocytopenia and preeclampsia, doesn’t have the ability to clot as well.
I don’t know about you, but if someone was sticking a big needle in my back, I would want to make sure my blood was clotting as it should.
There are policies in place to guide the anesthesia team with this. Typically, if your platelet count is below 90,000 – 100,000, it is not safe for you to receive an epidural.
Baby is unstable
If your baby is unstable and an emergent or urgent C-section is on the table then you probably won’t be able to get an epidural.
Epidurals typically take anywhere from 10-20 minutes to place and when baby’s heart rate is unstable, we don’t have time to spare. If it is truly an emergency, you will go under general anesthesia to deliver your baby.
Previous spinal surgery
This one isn’t a 100% contraindication, but you will want to have a consult with the anesthesia team sometime during your pregnancy (before you go into labor) to determine what the best and safest options are for you.
They usually request you bring x-rays, scans of your back, operative reports, and any other pertinent medical information to allow them to make the safest decision.
This is pretty rare. In fact, I’m not sure that I’ve ever seen it but it would be a contraindication so wanted to make sure I addressed it.
For obvious reasons, if you have an active infection at or near the site where the epidural will be placed, you should not receive an epidural.
Contrary to popular belief, in most cases, you can still get an epidural if you have a tattoo on your back.
As long as your tattoo isn’t brand new, still in the healing process (raised with peeling skin), or showing signs of infection (redness, swelling, drainage, foul odor), your tattoo should not prevent you from getting an epidural.
The big question: Are epidurals safe?
Now that we have covered all the possible side effects of an epidural, you might be wondering, “Are epidurals safe?”
The answer is, yes! From a medical standpoint, receiving an epidural is considered to be a very safe option for pain control during labor.
According to The American College of Obstetricians and Gynecologists (ACOG), the really serious maternal complications associated with epidurals are very rare.
ACOG goes on to say “The overall risks for your baby are low” and points out potential complications associated with unrelieved labor pain. (source)
Women receive epidurals every single day and have been receiving them for decades. I can promise you that epidurals would not be nearly as popular as they are if they were deemed unsafe for mama or baby.
I know I have covered some pretty scary side effects and complications but hopefully have also reassured you regarding their safety. Definitely don’t want to leave a bad taste in your mouth, just want to keep it real!
So, is an epidural right for your birth?
Whew, I know that’s a lot to digest. Ultimately, the decision is yours when it comes to labor and how you plan on managing your pain. Epidurals are wonderful and the perfect choice for some women.
Not so crazy about epidurals? I hear you, I went the all-natural route, and opted out of getting one myself.
The thing is, birthing without an epidural is tough. No matter how dead set you are on it, wanting it isn’t really enough.
Getting super educated is how you’ll succeed. This is exactly why I created affordable birth courses that have helped thousands of mamas, just like you!
Happy laboring, mama!