If you've not gone through labor yourself, then you've likely heard someone else's delivery story, chocked-full of advice and warning: do get the epidural, don't get the epidural. Swayed by a multitude of variables, each woman's experience with labor anesthetics and analgesics can be as different as night and day, feeling like the best thing since over-the-counter emergency contraception to one lady and like pure hell to another. So what's to distinguish these differing experiences? Should you opt for the epidural, or against it?
The answer is, opting for neuraxial anesthesia (epidurals and/or spinals) depends on the individual. Not every woman is comfortable with the sensations of numbness and heaviness that go along with bathing your spinal nerve roots in a cocktail of local anesthetic and opioid drugs (often bupivicaine and a special type of morphine called duramorph). Receiving an epidural also means that for the next several hours of labor until the baby is born, mom cannot get up from bed, walk, or eat food or dark liquids (all safety or precautionary measures). For women who have very low blood pressure, skin infections on the lower back, or who have had back surgeries and/or conditions like scoliosis, epidural placement may be contraindicated.
The good news is, however, for the majority of laboring women, epidural and spinal placement is extremely safe, for mom and baby. That said, it's worth listing the several risks you might hear when you request an epidural. The first and most common is that the epidural won't work. In one out of 10 women, the epidural will be "patchy," covering half, part, or most but not all of the area that is meant to be numb. In this case, the anesthesiologist administering the epidural might take out the original sterile catheter and try to place a second into a better location within the epidural space.
Other risks include infection (just as with anything entering from the outside environment: IVs, catheters, needles), headache, and damage to nerves. All of these are extremely rare however, occurring in only one in 100 women for headache and one in several thousand women for temporary nerve damage. It's also worth pointing out that natural, vaginal delivery also runs the risk of causing nerve damage to the pudendal and femoral nerves and that this risk is probably much higher than the risk of nerve damage from an epidural.
Now that safety is addressed, what is the difference between an epidural and a spinal? Location, location, location! The only differences are where the medicine is being injected (in terms of the depth into your back) and how fast will be the onset of numbness and pain relief. In a spinal (often used for planned c-sections and other procedures where rapid anesthesia/analgesia is needed), medicine is delivered a little deeper into your lower back through a much smaller needle, into the cerebrospinal fluid (CSF). There is also no catheter left in place, so it's a one-time shot of anesthetic that cannot be continuously bolused, and therefore wears off in about an hour and a half.
If after considering the safety and efficacy of neuraxial anesthetics you are still not a fan, other options for intrapartum pain relief also exit. Nitrous (like the laughing gas you used to receive at the dentist) and IV pain medications are two other options, as are non-pharmacological interventions like using the services of a doula or water birth bath. An important thing to remember is that no matter where you are in labor, or what you've already communicated to the obstetrician or anesthesiologist regarding your wishes for pain control, you can always change your mind and opt for an epidural, with the only caveat being that epidurals placed at the final stages of labor may take longer to get in and are slightly more difficult to place.
For more information, talk with your health care provider about which pain control plan(s) may be best for you.