Let's Have a Great Epidural!

Satisfaction with childbirth does not always mean an absence of pain, rather a feeling of being in control, respectfully consulted in decision-making, and being well supported and cared for by both care provider and birth attendants. 


Actively participating in your labor can help you maintain a sense of control and increase your satisfaction. The following 11 steps can give you something to do that will potentially stop or slow down the "cascade of interventions" that so commonly accompany epidural anesthesia.



1.    Choose a doctor or midwife with a low cesarean rate (under 15%).  (1) 

Whether you have a cesarean as a result of receiving epidural anesthesia depends mainly on your care provider’s philosophy of obstetrical management. 


2.    Delay an epidural until 5 centimeters’ dilation or later.  (2)

The earlier an epidural is given, the more likely a first-time mother will have a cesarean section for “failure to progress”. 


3.    Stay off your back after having an epidural.  (3) 

Lie on your side, sit up all the way, use hands and knees or kneel on the bed with a birth ball.  Women are simply not made to lie on their backs during labor.  Use gravity to keep your baby’s head well applied to your cervix and keep your labor on track.  Staying on your back for long periods of time during labor is linked to the following:  malpresentation of the baby’s head, inhibiting cervical dilation and fetal descent, fetal distress, slow first and second stages of labor.


4.    Keep cool by having someone fan or sponge you or by lowering the temperature in the room.  (4)

 This may help prevent or slow the onset of an epidural-caused maternal fever and consequent newborn diagnostic testing.


5.    Avoid awkward positions and change positions from time to time.  (5) 


6.    Refuse an instrumental delivery or cesarean section based solely on arbitrary time limits.  (6) 


7.    Delay pushing until the head begins to show or you feel an urge to push.  (7) 

Also called “laboring down”, many care providers believe this practice increases the number of spontaneous births, decreases the use of forceps and allows more posterior babies to rotate to anterior positions. 


8.    Refuse an induction of labor.

Unless the risks of continuing the pregnancy are demonstrably higher than those of the induction, there is no benefit to the mother or baby of inducing labor.  Often the pain of an induced labor is far more intense than that of your own, spontaneous labor and can necessitate an epidural before 5 centimeters dilation. 


9.    Eat and drink to thirst and hunger in labor. 

You can’t run a marathon on ice chips. Current research suggests that the tradition of starving women who have had an epidural for fear of aspiration during a cesarean section using general anesthesia is no longer part of evidence-based care.


10.    Keep your head in your labor. 

Being numb to the pain of labor, some women will watch TV, complain of being bored, or may worry about how the baby is faring.  Being pain-free does not necessarily mean being stress-free.  Practice relaxation, visualization, massage, or anything that helps to keep you engaged in your labor.


11.   Consider a CSE, or intrathecal instead of a traditional, all-anesthetic epidural. 

Using a small amount of narcotic, these newer epidurals numb the pain, but allow some feeling and mobility in the lower body.  While it's likely you won't be able to leave the labor bed or walk (hospital policy), you should be able to change positions freely.   




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