An epidural is a form of regional anesthesia commonly used for pain management during labor. It involves inserting a fine catheter into the epidural space of the lower spine to deliver a continuous flow of local anesthetic, which blocks pain signals from the uterus and birth canal. Because this procedure places medication near the spinal cord and requires specialized training, its administration is highly regulated. This article clarifies which healthcare professionals perform the procedure and how a midwife integrates this option into maternity care.
Who Administers Epidurals in Labor and Delivery
Midwives do not administer epidurals, as this procedure is outside their scope of practice globally. The administration of neuraxial anesthesia, including epidurals, is reserved for highly trained anesthesia specialists. These professionals possess the medical education and clinical experience necessary to safely perform the procedure and manage potential complications.
The two main types of providers who perform labor epidurals are Anesthesiologists and Certified Registered Nurse Anesthetists (CRNAs). Anesthesiologists are medical doctors (MD or DO) who have completed a minimum of four years of medical school followed by a four-year residency program focused on anesthesiology. Their training encompasses all aspects of general and regional anesthesia, pain management, and critical care.
CRNAs are advanced practice registered nurses who hold a graduate degree and have experience in critical care before completing a rigorous nurse anesthesia program. Both Anesthesiologists and CRNAs are skilled in the precise technique required to locate the epidural space and insert the catheter. Their continuous availability is why epidurals are only offered in hospital settings where a full-service anesthesia department is present.
The Midwife’s Role in Pain Management and Epidural Coordination
While a midwife does not perform the epidural procedure, they play a central role in coordinating care and supporting the patient throughout the process. When a patient decides to pursue an epidural, the midwife acts as the primary liaison between the patient, the labor and delivery nurses, and the anesthesia team. They are responsible for ensuring all prerequisite steps are completed efficiently to minimize the time a laboring person must wait for pain relief.
Before the anesthesia provider arrives, the midwife prepares the patient by obtaining informed consent and initiating a rapid infusion of IV fluids. This fluid bolus is a standard measure used to stabilize the patient’s blood pressure, as a common side effect of epidural placement is a sudden drop. The midwife also assists the patient into the correct position, such as a curled, side-lying or seated position, which is necessary for optimal access to the spinal column.
During and immediately after epidural placement, the midwife maintains a continuous presence, closely monitoring the mother’s vital signs and the fetal heart rate. They monitor for changes in blood pressure, which could impact the baby’s oxygen supply, and assess the effectiveness of pain relief. This constant attention continues for the duration of the epidural’s effect, including watching for potential side effects such as fever, itching, or an inadequate block.
The midwife’s comprehensive approach begins long before the decision for an epidural, focusing on non-pharmacological pain relief methods. These include hydrotherapy, movement and positioning techniques, breathing exercises, and continuous emotional support. These comfort measures may help a patient delay or avoid the need for an epidural, supporting natural physiological labor.
Distinguishing Between Midwife Certifications and Practice Settings
The availability of an epidural depends entirely on the midwife’s certification and the location of the birth. In the United States, there are primarily two categories of professional midwives: Certified Nurse-Midwives (CNMs) and Certified Professional Midwives (CPMs). Licensed Midwives (LMs) often overlap with the CPM credential, and these different credentials dictate where the midwife is legally permitted to practice.
Certified Nurse-Midwives are registered nurses who have completed a graduate program in midwifery and passed a national certification exam. Because their training includes a strong foundation in nursing and they work within the medical system, CNMs primarily attend births in hospitals and accredited birth centers, where they have immediate access to anesthesia services. A person choosing a CNM in a hospital setting can readily obtain an epidural, even though the CNM does not administer it.
Certified Professional Midwives and Licensed Midwives (direct-entry midwives) are typically trained outside the conventional nursing model and focus on out-of-hospital birth. They attend births in freestanding birth centers or at home. Since these settings do not have an in-house anesthesia team, epidurals are not an available option for pain relief. The choice of midwife and practice setting thus determines whether a patient will have access to neuraxial anesthesia during labor.