Choosing to have an epidural is a very personal decision. Many women would like to have the option of an epidural during labour but are concerned about when they are allowed to have one, or when is the right time to have one. So when can you get an epidural during labour?
When Can You Get An Epidural During Labour?
Typically, an epidural is placed when you are considered to be in active labour, around 5 centimetres dilated. This is because epidurals interfere with the release of oxytocin, the hormone that causes uterine contractions.
Less oxytocin means contractions can slow down, often resulting in the need for augmentation with artificial oxytocin (Pitocin or Syntocinon). This can increase the chance of fetal distress and possibly lead to c-section. Research has shown women who have epidurals have a much longer second stage than those who don’t.
A recent review of 9 studies looked at trials involving women giving birth to their first baby, and found no differences in the risk of c-section and instrumental birth between early versus late epidurals. However it’s important to note the studies varied in their definition of ‘early' and ‘late' placement of epidural, and the dose, concentration and technique of epidural also varied.
The authors of the review concluded that for first time mothers in labour who request epidurals for pain relief, the best time to initiate epidural analgesia is when the woman requests it.
It’s not uncommon for women to reach almost full dilation and then request an epidural. This stage of active labour is intense, contractions are coming in waves, and it is often a stage of great emotional upheaval. Yet dilation can be complete in minutes, which means an epidural given at that point might not have time to start working.
If you have a long first stage of labour, you can become very exhausted and this can influence your choice to have what midwives refer to as a ‘compassionate epidural’. An epidural can allow you to rest and recover energy for second stage pushing and birth.
If possible, allow time for the epidural to wear off by the time you are fully dilated. This gives you the chance to push your baby out without interventions such as forceps or vacuum.
When you decide to have an epidural is really up to you. But it’s worth checking whether your hospital has anaesthetists available around the clock, or if they are called in on a needs basis.
It's also important to be aware of what kinds of epidural anaesthesia are routinely offered at your hospital, so you can make an informed decision about what is right for you.
Some women are concerned they will not be able to cope with contraction pain, and feel they will want an epidural very early in labour. Other women will choose to wait and see how they are coping before deciding to have an epidural. It’s important to think about all your options so you can make an informed decision about when to get an epidural.
Recommended Reading: Labour Pain – 8 Things That Can Make Labour Pain Worse.
Take a look at the clip, below, from the documentary, The Business of Being Born. It talks about how early epidurals can lead to problems during labour, as well as how closely linked inductions of labour and epidurals are.