#94: Epidural Expectations vs. Reality: What You Need to Know Before Birth

Have “get the epidural” circled on your birth plan? Or maybe you’re curious but not sure if it’s for you? In this episode, we’re pulling back the curtain on what epidurals really are, how they work, what they don’t do—and why preparation still matters deeply, even if you’re planning on pain meds.

We’ll explore:

• What epidurals actually do (and don’t do)

• How they’re administered, and what it feels like

• Common misconceptions that leave people unprepared

• Side effects and interventions that often come with them

• What to do if an epidural fails or doesn’t fully work

• Why birth prep is still crucial with or without meds

• The essential tools every birthing person needs—no matter the plan

Listen to the episode now:

If you're preparing for birth and have “get the epidural” solidly circled on your birth plan—or even just thinking about it—this post is for you. Today, we're diving deep into the world of epidurals, pulling back the curtain on what they really are, how they work, what they don’t do, and why you still need to prepare, even if you're certain it's the path for you.

Whether you’re all in on an epidural, undecided, or planning to go unmedicated but open to the possibility of changing course, there are crucial insights you need to know. Let’s get into it.

Epidurals 101: What They Are and How They Work

An epidural is a form of regional anesthesia administered via a catheter into the epidural space of your spine. It delivers a combination of local anesthetics (like bupivacaine or lidocaine) and opioids (like fentanyl or sufentanil), often alongside other agents like epinephrine or clonidine to prolong effectiveness or stabilize blood pressure.

The Procedure:

1. Pre-hydration: You’ll typically receive IV fluids for ~30 minutes before the epidural to counteract potential blood pressure drops.

2. Placement: The anesthesiologist numbs your lower back, inserts a needle to access the epidural space, places the catheter, and removes the needle.

3. Test Dose & Setup: A test dose is given to ensure proper placement. Once confirmed, the medication is administered continuously.

4. Onset: Effects start in 10–20 minutes. You’ll likely be asked to lie still on your back to allow the medication to distribute evenly.

What It Feels Like:

You should feel a reduction in or elimination of contraction pain—but not necessarily complete numbness. Many people still feel pressure, especially during pushing. In some cases, you might still experience pain, especially if the epidural is incomplete or “wears off” during the pushing stage.

What Epidurals Don’t Guarantee

One of the biggest misconceptions about epidurals is that they will completely remove all pain. In reality, they:

• May only work partially (you might feel relief on one side, or only dull the pain)

• May fail entirely (~1 in 8 fail to offer adequate relief)

• Take time to administer and may be delayed due to staff availability

• Don’t always eliminate pressure, warmth, or rectal sensations during the pushing stage

• May wear off late in labor

If you’re unprepared for these realities, it can result in panic, disappointment, and even a traumatic birth experience. Preparation is your buffer against those outcomes.

The Catch: Interventions That Often Come With Epidurals

An epidural isn't a standalone procedure—once it’s placed, there are various interventions that are required to or often accompany it, which include:

• Continuous monitoring (fetal heart rate, blood pressure, oxygen) is required

• Bladder catheterization (loss of sensation makes urination difficult) *I have had a client request a bedpan instead of a catheter, but most people opt to get a catheter. 

• IV fluids (which can lead to edema and cause challenges with chestfeeding when given over extended periods of time)

• Pitocin (to compensate for labor slowdowns)

• Restricted mobility (you’ll need support to change positions, if allowed)

• Increased likelihood of assisted delivery (forceps, vacuum, or cesarean, especially with heavy motor block)

These interventions aren’t inherently negative, but knowing about them empowers you to prepare mentally and advocate for yourself.

When Epidurals Fail (And What To Do About It)

While uncommon, complete epidural failure does happen—and partial failure is more frequent than many expect. You may:

• Feel pain in a "window" area the medication doesn't reach

• Get minimal relief that doesn’t allow relaxation or sleep

• Unable to move but still feel intense contractions

Preparation is protection. Emotional readiness helps prevent panic and helps you stay grounded if things go differently than planned. Be ready to:

• Ask for a repositioning or replacement of the catheter

• Request dose adjustments

• Advocate for reassessment if the epidural isn’t effective

Why Birth Prep Still Matters (Even If You Want the Epidural)

There’s a myth that preparing for birth is only for people planning a natural, unmedicated experience. That couldn’t be farther from the truth.

Here’s why:

1. You may not get the epidural in time

Labor might progress too quickly, or staff might be delayed (as in one case I witnessed where the anesthesiologist was called away to surgery mid-procedure).

2. You may still feel discomfort

Epidurals reduce pain, not all sensation. Pressure, movement, and fatigue still require coping techniques.

3. You still need to support labor progress

Without movement, gravity, or comfort, labor may stall. Knowing positioning strategies (even in bed!) and breathing techniques can make a huge difference.

Building Your Birth Toolkit

Here are key elements every birthing person should have—even if you're banking on an epidural:

• Breathing techniques (box breathing, rhythmic breathing)

• Mindset work (expectation management, reframing pain)

• Movement strategies (even in bed—side lying, peanut ball, semi-reclined)

• Emotional grounding (affirmations, partner support, visualization)

• Advocacy language (knowing when and how to speak up for yourself)

The Bottom Line

You can be all-in on an epidural and still prepare intentionally and holistically for your birth.

Here’s what I want you to remember:

 ✅ Epidurals are valid and often beautiful tools ✅ Epidurals are not a guarantee ✅ Pain coping skills, birth prep, and mindset work still matter deeply ✅ You are not failing if you choose or reject an epidural—you’re navigating birth your way

So whether you're still deciding or already planning for an epidural, don't skip your childbirth education, pain coping practice, or mindset work. You deserve to feel calm, informed, and confident—whatever path your birth takes.

Ready to Prepare?

If you want to dive deeper into pain relief options—both medical and non-medical—mindset work, movement, advocacy, and everything in between, check out my Path to a Powerful Birth course. We cover it all, including a full section on epidurals, preparation strategies, and actionable tools for every kind of birth experience.

Learn more at clearlightbirth.com

Research Citations:

• Anim-Somuah, M., Smyth, R. M. D., & Cyna, A. M. (2018). Epidural versus non-epidural or no analgesia in labour. Cochrane Database of Systematic Reviews, (5), CD000331. https://doi.org/10.1002/14651858.CD000331.pub4

• Sharma, S. K., & McGrady, E. (2014). Early versus late initiation of epidural analgesia for labour. Cochrane Database of Systematic Reviews, (10), CD007238. https://doi.org/10.1002/14651858.CD007238.pub3

• Pan, P. H., Bogard, T. D., & Owen, M. D. (2004). Incidence and characteristics of failed conversion of labor epidural analgesia to cesarean delivery anesthesia: A retrospective analysis of 19,259 deliveries. Anesthesiology, 100(4), 908–914. https://doi.org/10.1097/00000542-200404000-00014

• Torvaldsen, S., Roberts, C. L., Simpson, J. M., Thompson, J. F., & Ellwood, D. A. (2006). Intrapartum epidural analgesia and breastfeeding: A prospective cohort study. International Breastfeeding Journal, 1, 24. https://doi.org/10.1186/1746-4358-1-24

• Beilin, Y., Bodian, C. A., Weiser, J., Hossain, S., Arnold, I., Feierman, D. E., & Martin, G. (2005). Effect of labor analgesia with and without fentanyl on infant breastfeeding: A prospective, randomized, double-blind study. Anesthesiology, 103(6), 1211–1217. https://doi.org/10.1097/00000542-200512000-00018

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