Epidurals: The Good, the Bad, and the Things You’re Probably Not Told

You’ve probably heard a pregnant mama say that her plan for birth is to get an epidural as soon as labour starts so she doesn’t have to feel any pain. While this may sound like the ideal plan for many women, it often overlooks how labour actually unfolds and what an epidural changes inside the body.

Labour is driven by a carefully coordinated flow of hormones, particularly oxytocin and endorphins. Oxytocin fuels effective contractions and helps labour progress, while endorphins act as the body’s built-in pain relief. As labour intensifies, endorphin levels naturally rise, helping many women cope with contractions and even enter a focused, altered state often described as “labour land.”

Epidurals interrupt this hormonal feedback loop. By blocking sensation, the body receives less feedback to release oxytocin and endorphins, which can slow contractions and reduce the body’s natural pain-coping mechanisms. This is especially true when an epidural is placed early in labour. When labour slows, additional interventions are more likely to be introduced to keep things moving.

Once an epidural is placed, many women find it difficult to move freely and often remain in bed. Epidurals also require IV fluids and continuous fetal monitoring, which can further limit movement. Since upright positions and movement help labour progress and support comfort and optimal fetal positioning, this restriction can affect how labour unfolds.

The part no one talks about: waiting for the epidural

Another piece that’s rarely talked about is the waiting period. In many hospitals, once you request an epidural, it can take time for an anesthesiologist to become available. Labour doesn’t pause while you wait. Contractions continue, and sometimes intensify, making this period especially challenging if no coping strategies have been practiced. Even the placement itself requires you to stay very still, including during contractions, which can be surprisingly difficult.

There are many stories of women who planned on getting an epidural, only to find that labour progressed faster than expected and there was no time for one. Preparing only for an epidural can leave someone feeling shocked and unprepared if labour unfolds differently than expected.

When an epidural is placed well and works effectively, it is the most powerful form of pain relief available in labour. It can significantly reduce or eliminate contraction pain and even allow a labouring mother to rest or sleep. This can be incredibly helpful during long or exhausting labours.

Supporting Physiology Even With an Epidural

Getting an epidural doesn’t mean physiology no longer matters. Even with reduced sensation, there are still many ways to support labour progress and reduce the risk of additional interventions.

Position changes remain important. With assistance from a partner, nurse, or support person like a doula, many women can still shift positions in bed. Side-lying, semi-upright, or hands-and-knees variations can work well, depending on mobility. Changing positions helps encourage effective contractions and can assist the baby in moving into an optimal position for birth.

A peanut ball is another powerful tool when an epidural is in place. Positioned between the legs while lying on your side, it helps keep the pelvis open, promotes fetal descent, and can support steady labour progress. Research suggests that peanut balls can reduce labour length and lower the likelihood of cesarean birth in people with epidurals.

Even with an epidural, maintaining a calm, low-stimulation environment matters. Dim lighting, quiet voices, and a sense of safety continue to support oxytocin release. Labour is still hormonally driven, and feeling rushed, observed, or stressed can interfere with progress, epidural or not.

Breathing, relaxation, and focused support are also still valuable. While pain may be reduced, intentional breathing and mental grounding can help the body stay relaxed, prevent unnecessary tension, and support effective pushing later on.

When it comes time to push, waiting for the body to show signs of readiness, often called laboring down, can be especially helpful with an epidural. Allowing the baby to descend naturally before coached pushing begins can reduce exhaustion and may lower the risk of severe tearing.

An epidural doesn’t have to mean passive birth. With the right support and intentional care, it’s still possible to work with your body and support physiology as much as possible.

At the same time, epidurals do come with potential side effects.

One of the most common side effects is a sudden drop in blood pressure. For the mother, this can cause light-headedness, nausea, vomiting, or even loss of consciousness. For the baby, lowered maternal blood pressure can affect blood flow and sometimes lead to concerning heart rate changes, which may result in further interventions, including a cesarean birth. It’s estimated that at least 1 in 7 women experience low blood pressure after an epidural.

Up to 10% of women who receive an epidural develop a spinal headache. These headaches can range from mild to severe. While most resolve within two weeks, some require an additional procedure known as an epidural blood patch.

Epidurals also don’t always work as expected. More than 10% fail partially or completely, sometimes numbing only one side of the body. For a labouring woman who was relying on the epidural to manage pain, this can feel overwhelming and frightening.

Back soreness after an epidural is common and usually resolves within a few weeks. In rare cases, improper placement can lead to nerve damage, which may be permanent.

Another consideration is pushing. With an epidural, many women cannot feel contractions or the natural urge to push. This often leads to coached pushing. Think holding the breath, counting to ten, and pushing on command, as commonly portrayed in movies. Coached pushing is associated with a higher risk of third- and fourth-degree tearing. When pushing is instinctive, the body naturally paces the birth, allowing tissues time to stretch and reducing the risk of severe injury.

None of this is meant to scare you.

There is a time and place for epidurals. Some labours are long, and rest becomes essential. Sometimes inductions make contractions more intense and harder to cope with. And sometimes, an epidural is simply the choice a woman makes - and that choice deserves respect.

What matters most is that the decision is truly informed.

Informed consent can only exist when you understand the benefits, the risks, and the alternatives, and when you feel free to decide what feels right for you. A 10% or 15% chance of a side effect may feel acceptable to one mother and far too high to another. Both responses are valid.

This isn’t about avoiding epidurals at all costs. It’s about understanding how they work, what they change, and preparing for all possibilities.

There are many ways to cope with labour, many tools to support pain, and many paths to a positive birth experience. Epidurals are one option, not the default, and not the only plan worth preparing for.

If you are looking for more on birth prep, check out my FREE Workshop