E127: Understanding Epidurals

Epidurals get talked about like a scoreboard, and that mindset can steal your peace before labor even starts. I want a calmer, clearer conversation one that treats pain relief as a tool, not a test of strength, and helps you build a labor pain management plan you can actually live with when things get real. 

From my lens as a doula with more than 20 years in a busy practice, we walk through what an epidural is (and how it differs from a spinal or a combined spinal epidural), why today’s epidurals are often lighter than they used to be, and why the “right” choice depends on your body, your baby, your goals, and your circumstances. We also dig into timing: the real pros and cons of getting an epidural early for rest, anxiety, high blood pressure concerns, or a long induction, versus waiting until labor is well established. Along the way, I call out common myths, including the idea that you must be a certain number of centimeters, or that an epidural automatically leads to a C-section. 

We also get practical about what happens after the epidural. “Walking epidural” doesn’t mean strolling the halls, but movement still matters. I share simple positioning strategies like side-lying with a peanut ball, supported hands and knees, and other bed-based options to help rotation, descent, comfort, and progress. And because epidurals don’t always work perfectly, we talk about why it’s smart to plan multiple coping tools so you’re not left scrambling if you feel a hot spot or uneven coverage. 

If you want a thoughtful, non-judgmental guide to epidurals, childbirth education, and empowered decision-making, hit subscribe, share this with a friend who’s pregnant, and leave a quick review wherever you listen.

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Show Credits

Host: Angie Rosier 
Music: Michael Hicks 
Photographer: Toni Walker
Episode Artwork: Nick Greenwood 
Producer: Gillian Rosier Frampton
Voiceover: Ryan Parker

Transcript

Welcome And What We Cover

SPEAKER_00 0:10

Welcome to the Ordinary Dool of Podcast with Angie Roger, hosted by Hatcheton Last. Here, we explore the many layers of pregnancy, labor, birth, breastfeeding, and postpartum life through the lens of more than 20 years in a busy Doula practice, supporting thousands of families. Whether you are preparing for birth, navigating feeding, or adjusting to life of a new baby, this podcast is designed to offer practical knowledge, thoughtful conversation, and empowering support for the real experiences.

SPEAKER_01 1:12

Go visit hatched and latched.com for um preparation for childbirth, um, dual services, lactation services, and postpartum.

Why Epidurals Feel So Polarizing

SPEAKER_01 1:20

So today I want to talk about um a topic that that kind of in the birth world is a little bit polarizing and doesn't have to be. Um, but I get it, I totally get it. Um and I want to talk about epidurals and what about epidurals is intriguing, what why do some people want them, bank on them? Why do some people not want them and want to avoid them? So when I first became a doula over 20 years ago, the epidural conversation was pretty simple. Like you wanted one or you didn't, you were against it or you were for it. But today the conversation is a lot more um nuanced actually. So we know a lot more about labor, we know a lot more about pain and how movement positioning um can impact labor. And also the medical community has come along, come a long way, especially in this realm of women's health and giving individualized care. So we can we're better at looking at the person, the whole person, and giving them the kind of birth that they want. We let the patient have input. That did not used to be the case not that long ago, believe it or not. So um we also know that there's no right way or wrong way to give birth, right? Um, and everybody's sitting in a different camp with that. Um, but ultimately, at the end of every single day that a baby's born, we want a healthy mom and a healthy baby. And there are really phenomenally perfect ideal ways to get there. Um and then sometimes we need to do something where we step outside of that ideal in order to get our ultimate goal, which is um, of course, incredibly important. So this conversation around epidoles has changed a little bit. And I want to talk about making decisions in your pain management um strategy. So a lot of people in this world, um, in the birth world is what I'm talking about. That's the world I live in. Um epidural can be kind of a hot topic. People are for them or against them, like we said, but it's this is not really like a moral decision, right? Um both birth culture often creates like team epidural and team unmedicated. And that's not usually as simple as that because if you're on one of those teams and you're solidly in your corner, but your birth goes a different way, like you have to get an epidural, or you couldn't get an epidural, um, that's conflicting, a lot of conflict going in inside of you. So so I like to have, I don't know, a little more fluidity there. Now I can say that, right, as a birth professional, but as a personal person, I I was totally on team unmedicated and never ever had it, wanted an epidural, never wanted, you know, never had one, never needed one, which is the miracle of all that, I guess. Um, so I I would have been devastated had I had to use that tool. But a lot of people aren't in that camp, and that's great. And some people don't even care, right? And some of us can't wrap our minds around why people don't care about that. But neither one is inherently better than the other. It just depends on what your goals are for your birth. And that's not a right or wrong thing, that's a very personal, individualized thing. Pain management comes in lots of different forms. Um, this is simply one of the forms, one of the tools among dozens, honestly, dozens of others. So remember this: needing pain medication or pain relief is not a failure. It's normal, right? Um, and that pain relief can come in lots of different ways. Maybe you were hoping it would be the tub, maybe you were hoping it would be massage and movement. Um, but sometimes an epidural is needed or wanted, even if all those other things are working. So choosing an unmedicated birth isn't necessarily a badge of honor. It's cool, right? I get it. Um, just like some people are vegan, some people are vegetarian, some people are carnivores. You know, I see a little bit of all of that, and then we and we can see that and then make our own choices. So this isn't really a badge of honor, it's just a personal choice that hopefully your birth aligns with. So the goal always is a healthy mother, healthy baby, and a woman who feels informed and respected at the end of her birth.

What An Epidural Actually Is

SPEAKER_01 5:31

So let's talk about what an epidural actually is. It is medication placed into the epidural space. So epide means near or around, right? So just outside of. So it's the dural space. There's the spinal cord, the dural space, dura mater, duramater, and then we have um the epidural space. So it's just a space. And um, of course, we know a little needle goes in there, it punctures that, and it threads a tiny catheter, and then it stays there and it kind of drips narcotics, a little bit of local um anesthetic companied with with sometimes bupivacaine and fentanyl. Um, and that just kind of numb the area, numbers pain while allowing you to still stay awake. Do you know how cool that is? Do you know how for how long to take pain away mean taking all consciousness away? So we have a way now to take some pain away with still helping you be mostly mobile, totally awake and alert, right? So it um it's kind of cool, it's versatile, it can be adjusted throughout labor as well. So there are differences in epidurals, or spinals. Spinal goes one layer deeper, one membrane deeper, into the spinal space, like um, so that's quicker. Um, that'll be a quicker relief, deeper relief. If uh a combined spinal epidural is a CSE, a little bit different than an epidural as well. Um, if we're having a planned cesarean, then we might be getting one of those other types of pain relief. Um the spinal, if nothing stays in your back. Actually, that it's just a dose is given and it's pulled out. It's a pretty heavy dose and lasts for a couple of hours. So that's pertinent to some situations. Um, some hospitals use different types of medications than others, and all epidurals are different than they were 20 and 30 years ago. It used to be the goal was like absolute knock them out, right? So no awareness, complete numbness, and that was kind of weird too. And I have had clients, many, many clients over the years who like they regretted getting the epidural because of the weird feeling that is to not feel anything. Um, but the goal now is to be able to feel, right? So that's how kind of how epidurals are designed now. They've come a long way, they've got a little more finesse to them now. And one thing to remember about this too is that timing matters, right? The timing of an epidural. I would say, and I'm looking, I'm pulling all my stats right now again for the last several years, and I'm curious to pull this piece out of it, um, what the the epidural percentage of people that I work with that use epidurals and don't. And for the last 20-ish years, well, the 20 years that I um pulled data, it was about 39% epidural rate. So like a 61% um unmedicated rate. I my gut says that's changed where we have a little higher epidural rate now in my practice, anyway, with the people that I've worked with over the years. I'm pulling that data right now. Um, and so I th what I'm sensing is a lot more people are saying, I do want to get an epidural, but not yet, and I'm not for a while. And that's a really healthy space to be in, actually. It leaves you the option of saying, you know what, I'm good, I wouldn't keep going, um, but not being disappointed if you have to get it because you're kind of planning on it. And it helps us understand that um, you know, some people like think as soon as contractions start, they don't want to feel anything. And that's not the case, right? Contractions warm up, it's kind of slow in the beginning. Um, it doesn't get difficult generally speaking until later on. So a lot of people want to just delay that. Um, some people think they have to wait till four or six centimeters. That's not the case, that's kind of a myth. Some people get epidurals at one centimeter, some get them at ten. Um now hospitals will place an epidural kind of whenever, right? Um, after labor is established, of course, or if the woman requests it. Um, and of course, if an anesthesiologist is available. So we need all those things to kind of be in place. And I have had, of course, clients be very comfortable and fine and say, all right, I'm ready for the epidural. Um, actually, one just not long ago, she was coping beautifully. There wasn't actually a lot to cope with. Um labor was super slow, and I think we were going to either break her water or start pitocin, something to kind of augment things along. And although she was doing really well, she insisted on having an epidural before that happened. Great, totally fine. Other people would say, let's do that, and then I'll see and see if I want one. Um, but the timing of things can be pretty flexible, which is awesome. Um, so here's some some pros and cons of timing things.

Early Versus Late Epidural Timing

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When you get an early epidural, like quite early epidural, the benefits are that you get a rest. So it depends on what time of day you're going into labor and how long have you slept and rested going into labor. Um, so you might be less exhausted, right? Um, if we're gonna have a long induction, it's uh and it's hard to know how long inductions are gonna be, but some of them are pretty long. I had one, I've been to like four births in the last, I don't know, less than a week. And one of them was a super long, like she went to labor early, early on a Tuesday morning, um like 1 a.m. early, and then had her baby about 4 a.m. on a Friday morning. So it all of Tuesday, Wednesday, Thursday, and part of Friday. Um, that's long, right? So when labor's long like that, you can be totally exhausted. So um she did get an epidural at some point, but waited quite a while, which was impressive. Um, some people, another benefit of earlier epidurals would be people with hypertension, like if you're having any um proclamic symptoms sometimes or um severe anxiety, some people are incredibly anxious about everything and they are not gonna have any kind of a good or positive experience through a labor process. So an epidural could, in a case like that, be a great tool earlier on. Some drawbacks to an early epidural is that it does limit our movement. And so limiting our movement help, you know, that doesn't do much to help baby rotate and descend. Um, it doesn't stop movement, but it does limit it to some extent. It does require continuous monitoring. So when we get an epidural, we do get a few tethers, I call them. Um, we're getting a blood pressure cuff that's gonna be on for quite a while and be used pretty frequently in the beginning. Um, you're gonna get a bladder catheter, you're gonna get continuous fetal monitoring, you're gonna get IV fluids. Um, so you have the epidural catheter, of course, in your back. So um it's a little more intervention-y that way. And if we get it early, we've got those interventions for quite a while. Um, also, some you know, causes may cause other interventions, can you know, cause other risks too, um, as we have them for a long time. So there's some drawbacks to getting an early epidural. Now let's talk about like later epidurals. When the labor is well established, we're really into it, we're into that um active or getting to a near transition phase. What I see so commonly is people want to labor through, like move through labor on their own with their other coping skills until it gets really hard, right? And um, and it's hard to judge before it happens how what really hard means. Some people want to do it even if it's really hard, and then they change their mind. Other people want to do it even if it's really hard, and other people want nothing to do with really hard, and all of those are fine. Um, so getting an epidural later, um, we have the freedom to move. Position changes are great. We could be pretty organic with that. Um, I did a birth a couple days ago with a mom who was totally unmedicated. She moved all over the room. She hated laying down. Like she lay down like a hot second and popped right back up off the bed again because she didn't like it. But she was walking, she was leaning, she was standing, she was on the ball, she was in the tub, she was on the toilet, she was on a with a step stool, um, and she was marching around the room. Like movement was really key for her. She ended up not needing an epidural. I think with her previous baby, she did get one. Um, but it is a a bummer part, a drawback to getting a later epidural is that it's hard to sit still during those more intense contractions um deeper into labor. So some people get an earlier epidural just because they know they can sit still while it's being placed, which is a short period of time. And honestly, we can work with it, right? Like um, we can manage for a few minutes, and most anesthesiologists are gonna work with you on the timing of that so that they, you know, you can do what you got to do during a contraction and they can get do the actual placement um between contractions, we hope. Um, another part about waiting, a drawback about waiting a little bit longer for an epidural is sometimes the anesthesia team might not be available immediately. So I was at a birth, oh, I don't know, a couple maybe a month ago, and um this mom was doing great. Her plan was always to get an epidural. It was her third baby, she was definitely gonna get an epidural, but she's doing fine and she was proud of herself, she was impressed with herself. Um, and she wasn't quite sure when to get it. And she put it off for an hour and put it off for another hour, and finally she says, okay, I'm ready. But the anesthesiologist was not there. It was a smaller hospital and says a CRNA who is doing other things in the hospital. So we had to wait about an hour. She hadn't anticipated that. Um, she might have not waited that long if she knew she had to wait a little longer. And then sometimes um another drawback is that the baby is emerging or being born before it takes effect. That's kind of a bummer. Not the end of the world, but um, and I always advise people before you get an epidural to see where labor's at, right? Like, see, are you are you wanting to get an epidural because you're nine centimeters, or you want to get an epidural, and it turns out you're still three centimeters, and it becomes a really good decision, easy decision to make. Um, I have had a couple cases where um the mom gets an epidural, didn't want to get checked, too intense. She goes, Nope, I'm not changing my mind, no matter what the check is, so they get an epidural. And then as they're laying down, so after get an epidural, usually you sit for that, and she's as they're laying down, here comes the baby. So didn't get a chance to work, but that's okay. So there isn't usually a best time to get an epidural. There's unique times to get epidurals, and that all depends on your labor, your goals, and your particular circumstances, your fatigue levels, the time of day, um, the support you're getting or not getting, um, how labor feels to you, the position of the baby. There's a lot of things that go into that. I think some what I sense from a lot of my clients is hospital staff will kind of um push you into getting an epidural before you're ready, maybe, because they'll tell you there's a window of time, or the anesthesiologist is ready right now, and they're trying to save you from some frustration, perhaps, but um you can wait. You can wait a little if you want to.

Walking Epidural And Smart Movement

SPEAKER_01 15:49

So let's talk about a lot of people have this term in their head called a walking epidural. So um, I actually had a client a couple years ago, and her dad um uh was the anesthesiologist who kind of did the studies around this and coined the phrase walking epidural. And I'd say, you know, it's a lot, a lot of people think they can walk with this epidural, and that's not really the case. Um that just means kind of a lighter dose epidural. So epidurals have gotten a lot lighter than they were, and they can be even lighter, they can be titrated. So you can discuss with your anesthesiologist what your goals are, what you're feeling. Um, if you have the standard dose or regular infusion, or if you want something a little bit lighter than that, and that can be changed throughout labor. Um, so walking might not be, it is definitely not getting out of the bed, but still movement is is possible, right? So moving in the bed is is very encouraged after um an epidural is given, even if it's if it's light or not. And leg movement oftentimes remains. A lot of women can still turn over in bed or move their own legs, some can't, um, or some can move one leg but not the other. Um, but we still have some pretty good sensations. So some things to use with movement, like after my clients get an epidural, for those who choose to, it's my job to help them move, right? And so I keep an eye on the clock and I keep an eye on like where the baby's at and how can we rotate and turn this baby. So using peanut balls, that's a really great friend after you get an epidural. Um, being on your side, using the stirrups. I don't like stirrups for very much, but sometimes putting the stirrup up on one side and and putting your your um leg up on a stirrup can be helpful. Hands and knees, we can still do hands and knees in bed nine times out of ten. I've helped 400-pound women get on hands and knees with an epidural. Um, and your femurs are pretty strong, they can still kind of support. There is a mom I was with, um, gosh, I'm trying to think, maybe three weeks ago, and she had an epidural and she got on her hands and knees for a long time. She loved it. And it was in what some people might call consider a pretty uncomfortable position, but she was there for like an hour and absolutely loved it. And it helped um, it helped the baby move. It helped cover some pain that she wasn't getting covered with the epidural. The throne position. So you're sitting in the bed, make the bed like a throne, it's like a squatty potty, a toilet with a squatty potty, but you're on the bed. So your feet are kind of high up, higher up than they would be like in a chair. Um, and you can sit straight up. So doing that, that's a great um position for epidurals. Not you don't want to do it for a long time. You don't want to do any positions for a really long time, right? Because epidural is a gravity-based drug, and it's wherever, whatever on the downside is going to get a little bit more numb. Um, flying cowgirl is a great one. Welcher's position is a great one with some assistance with that. So movement does not stop, should not stop because you have an epidural. So be if you're getting an epidural, be more cognizant of your movement and make sure that you're moving pretty frequently. Because these position changes still matter, right? Um, many people think once you get an epidural, you just lay flat. You're like a beach dwell, you don't move. No, not true. Um, so some things that you actually have to move more because it's not gonna be as organic. Um, so you kind of got to facilitate it. So, some some things that some positions that are gonna be helpful is just understanding you want to rotate something every 30 to 60 minutes or more. You can do open knee chests like my client did uh not long ago. Should love that position, was there for an hour. So you are on your knees, maybe a peanut ball, you're like sitting on a peanut ball or leaning on a peanut ball. Um, you might be sidelining, you might be doing some lunges or runners pose in the bed. Um, you can do supported hands and knees, you can do the Levant circuit. I did a lot of that last week with this posterior baby, kind of modified with an epidural, of course. But use gravity whenever possible. There's still lots of opportunities to use gravity after epidurals are used. Um and these these positions and the changes in position increase pelvic diameters in different planes of the pelvis. So we've got the inlet, the middle pelvis, and the outlet. And as you change and move position, you're gonna shift all of those at different times depending on where the baby is. That will encourage best feet rotation. Um, it reduces the risks of c-section, it improves comfort. Um, so there's a lot of perks to moving after epidurals.

C-Section Myths Pushing And Numbness

SPEAKER_01 20:09

So a lot of people think that an epidural might lead to a c-section. That's not true. Uh, I mean, sometimes it is, like being pregnant leads to a c-section, really, you know. Um, but very rarely is that the one and only factor. Um, the birth I was at last week, gosh, I thought for a really long time we had zero cervical change um after 16 hours, and pitocin was very, very high and had been on for a long time. And in my mind, you know, and we were doing all the things, all the position changes, all the movement, and I was thinking, gosh, there's gonna be a c-section. And she got an epidural at some point, she wanted one that was kind of her plan, so it worked out. Um, and sometimes a c-section is just gonna happen regardless of an epidural or not, if it if it's needed, right? Um, so that is kind of a myth that that epidurals lead to c-sections. Now, if we get an epidural and don't move, that could increase risk of a cesarean. Um, but that's why you want to keep moving. Some people are worried they won't be able to push, and I would say your pushing is less intuitive with an epidural, um, but we we figure it out. It takes, it might take a few pushes to get to where you're doing it effectively and efficiently. Um but sometimes in some cases pushing can be shorter with an epidural. So if you don't have an epidural, and many people don't, and you push perfectly because you just have to, um, the pushing might be one, two, three hours, four, it could be, you know, just the regular pushing times. But sometimes with an epidural, um, we might delay the start of pushing because we don't feel that urge to push or that sensation because of the epidural that's in place. So we might shorten the time of pushing because while we're just doing what's called rest and descend or labor down, the body's still contracting, the body doesn't feel like pushing, although it's 10 centimeters, and the baby just comes down a little bit, a little bit, a little bit. And then by the time we get to active pushing, and we may have much less pushing time. So delayed pushing can sometimes be appropriate in some cases of exhaustion or fatigue. Another myth with epidurals is that I'll be completely numb. I won't be able to feel anything. And epidurals have become a lot lighter than they used to be. And many women still can move their own legs. They can still feel pressure. They're still aware in some fashion of that there's a contraction happening. But the majority of it of course is masked by the epidural. And they can still participate pretty actively in their labor. So the team I also don't like to see the birth team checkout when an epidural is given where they people start jumping on their phones. Like we're given really awesome present support and then the epidural is given and the team kind of taps out. That's not cool either. We still need to keep it focused of course on the laboring person and and help it be a great birth. So some people think after they get an epidural their birth won't be empowering. And for some people getting an epidural is empowering right because you've made that decision. It's what you wanted. And when you feel informed when you feel respected when your choices are um honored and when you feel support in your choices your educated decisions it isn't about the pain that you experience that's you know not what makes for a good birth but it's how you are empowered through your birth and for so to some people that's not getting an epidural to others it absolutely is getting an epidural.

When Plans Change And That Is Fine

SPEAKER_01 23:30

So it's how how do you know uh what is right for you? And sometimes you don't until the moment. But I always like people to consider an appointment just today with a couple it's kind of cool they're having their um their sixth baby. So they're having their sixth baby and this is the first time that they've they want to go and medicate it. So it was pretty cool um to to um educate them and to watch that kind of see that happen which was which was fun. And so kind of to see lights go on in there and for them and she's planning for the first time not to and we gave her a lot of neat tools so she knows what she's done and now we're doing something totally different which is kind of cool as well. So choosing what is right for you and a lot of times you don't know until you're in the moment and I've seen this shift and change for people at all different times. For some people it changes during prenatal education. They take a class they talk to a friend they they've never really thought much about it. They just thought they'd get an epidural because everybody gets an epidural and then they really get into where they're in that space in life and they want to learn about it and they're like you know what actually I don't want one. So I've seen people change their mind through education. Some people change their mind in the moment I it doesn't happen a ton but I love it when it does when somebody's planning on getting an epidural like that's their goal. But during labor they change their mind to like you know what actually I'm okay and they keep going and they keep going and they keep going and they have a baby. That's kind of cool. I've also seen other people really dead set against it and then something happens in labor like it's hard or it's long or it hits really fast and they decide to get an epidural so they changed their their goals and their tune at that point. That's okay too. But I love the ones where like I'm going to get an epidural and they just keep going and they just keep going and they just keep going and then all of a sudden they're pushing and they have a baby and I think that's a cool little bonus perk when that does happen. So as you are considering your choices you do have some right you have options you have choices um and we are living in a time where it's pretty awesome that we have those available to us. So if you're planning an epidural plan some other things too plan a lot of other coping mechanisms leading up to that um plan position changes after that and make sure that you still have um in mind some just in case stuff because one of the bummer things about epidurals is they don't work perfectly and a lot of people are banking on that as their only tool and when there's a glitch and it doesn't quite work perfectly or um it needs to be replaced or it's heavier on one side or the other and you still have to cope with something you want to have some tools to cope with that. So hopefully this today's conversation has helped a little bit about uh understanding in um epidurals and the appropriate use of them they're incredibly common of course in our world um but they are I'm seeing them so much more be delayed and then be we work with them after that there's still a lot of movement going on. So depending on which camp you're in or you're not I totally get it I've done home births myself um my favorite birth and I think I can speak for a lot of I do less is just a perfectly awesome physiologic empowering unmedicated birth. Now that's cool to us birth junkies um but I've I have friends and family who think that's terrible it's the worst thing ever and we don't need to do that anymore. It's true we don't so decide where you are and what you want to do and what's important to you because there's lots of neat options out there. And they're available to us so that you have a positive and empowering birth experience whatever that means for you. So that wraps up our conversation about epidurals and how they have um changed a bit over the years and we use them a little more judiciously and a little bit more um I don't know just we work with them a little

Final Takeaways And Next Steps

SPEAKER_01 27:20

bit better which is great. I wish the very best of luck to you wherever you lie on the epidural spectrum of things. Hopefully have a great birth and thanks for being with me here today. Again this is Angie Rosier signing off from the Ordinary Little podcast. Visit us over at hatchdenlatch.com and see if we can help you there. We've got some classes for sale or if there's any services we could help you with we'd love to do so. And as always please reach out to someone and make a human connection. We are important to each other and we need each other.

SPEAKER_00 27:49

I'll see you next time to the Ordinary Doolo Podcast with Angie Roger hosted by HatchonLatched you can find episode credits in the show notes and more information by visiting hatchdenlatch.com if this podcast has been helpful to you please leave a rating wherever you listen to your podcast. Your support helps us to continue having thoughtful conversations about birth, breastfeeding and postpartum life. Be sure to tune in next time as we continue exploring the many experiences, questions and realities surrounding the journey into parenthood