Doctors have to wait until the cervix is at least 4 centimeters dilated before doing an epidural. Otherwise, the epidural will slow the process down too much. However, once the cervix becomes fully dilated it is too late for an epidural to be given.
Other potential issues with having an epidural can include: It may not be possible – If you have certain medical conditions, your labor progresses too quickly, or an anesthesiologist isn't available, you simply may not be able to get an epidural – though other options like nitrous oxide may still be available.
There is no definite time. You can have it when you want it — at the beginning of labor, in the middle, or toward the end. The anesthesiologist will want to be sure that you are actually in labor and that you can stay still for the few minutes they need to precisely place the epidural catheter.
Recent research has suggested that 6 cm of cervical dilation should be the threshold for the active labor phase, and it has confirmed that epidural analgesia (EA) is a safe method of pain relief during labor.
But most women want an epidural when their contractions are getting strong, often when their cervix has dilated to about 5cm (2in) or 6cm (2.4in). Your midwife may advise against an epidural late in your labour, once you've reached the pushing stage, but it will depend on how your labour is progressing.
When can you get an epidural? Typically, you can receive an epidural as early as when you are 4 to 5 centimeters dilated and in active labor. Normally, it takes about 15 minutes to place the epidural catheter and for the pain to start subsiding and another 20 minutes to go into full effect.
For most women, this is a personal decision that depends on two things: how worried you are about having pain and how important natural childbirth (labour without pain medicine) is to you. An epidural is considered the most effective and easily adjustable type of pain relief for childbirth. Epidurals are very common.
The most common reason for women to be denied an epidural is because of a lack in midwife numbers.
There's a shortage of epidurals in Australia
“ANZCA has now been made aware of advice from Victorian and NSW health departments recommending temporary conservation of epidural kits for obstetric epidural use only.”
Faster Recovery Time
While every labor unfolds uniquely, some women find they feel significantly better after an unmedicated birth compared to a medicated one. One reason for this is the impact of natural hormones.
Most of the time, you can walk within a half hour or so of your epidural injection. However, you will not necessarily be walking normally at this point. Most clinics and hospitals monitor you for 15 minutes to an hour after an epidural injection. During this time, they will likely ask how you feel.
“There isn't a minimum cervical dilation. I have done epidurals at one centimeter and when a woman is fully dilated at 10 centimeters,” Dr. McGuire says. A common concern is that having an epidural early in labor slows down labor and delivery.
Ultimately, a natural birth may be more painful than a cesarean section. However, the pain after your cesarean section combined with the heightened risks to you and your baby may outweigh the initial pain of childbirth. Make sure you consult with your doctors to get the best possible advice for you.
Some people describe the feeling as being like intense period cramps, others say it feels like a tightening or pounding feeling in your uterus or across your belly, others describe the feeling as being like very intense muscle cramps, while still other people describe contractions as being like the sort of wrenching ...
Complications from epidurals are extremely rare, and pushing with an epidural is generally not a problem because you will still be able to feel pressure (rectal pressure, that is!) despite not feeling any pain or contractions.
The numbness and muscle weakness in your legs will probably wear off within 2 hours after the epidural medicine is stopped. You may find that it's hard to urinate until all the medicine has worn off. Your back may be sore.
You can have an epidural at any time from the beginning of labour, but most women who choose one have it when they're around 5cm dilated, when contractions get more intense and painful.
Transition typically lasts 30 minutes to 2 hours as your cervix fully dilates from 8 cm to 10 cm. Contractions will last roughly 60-90 seconds with only 30 seconds to 2 minutes between.
While a doctor cannot legally force you into any procedure, and you do have the right to refuse, it gets tricky to not have a catheter with an epidural and it is risky to not have a catheter during a c-section.
Occasionally there are circumstances where women can't get an epidural. Occasionally we see this in women who have a low platelet count. Additionally, women who are taking blood thinners (such as heparin) to prevent a blood clot during pregnancy should not receive an epidural within 12 hours of taking that medication.
While a handful of things might hurt worse than labor, the significance of the pain caused by giving birth should not be minimized. And though labor can be a painful process, certain things can contribute to or increase the discomfort felt.
Epidural Injection
The anaesthetist injects the epidural anaesthetic into a catheter which has been placed into the epidural space. This method usually provides pain relief for 1-2 hours, and once it starts to wear off, you can have a top up.
If you have an epidural, you will usually develop some temporary weakness in your legs. This means that you will need to stay in bed to avoid falls. Since epidurals can cause low blood pressure, you will need to have your blood pressure monitored.
The epidural is administered on an out-patient basis, so there is no reason for you to stay in hospital overnight. Epidurals are administered under a local anaesthetic. This means that you will be awake, but you may also be offered some kind of sedation.