An epidural is a type of pain relief delivered through a thin tube placed near your spine. It’s most commonly used during labor and childbirth, where an estimated 70 to 75% of women opt for one, making it the single most popular method of managing labor pain. Epidurals are also used during certain surgeries and for chronic pain management, but if you’re reading this, you’re most likely pregnant or planning ahead.
How an Epidural Works
Your spinal column has a narrow space between the bones of your vertebrae and the tough membrane (called the dura mater) that surrounds your spinal cord. This is the epidural space, and it contains the roots of nerve fibers that carry pain signals to your brain. When an anesthesiologist injects medication into this space, it blocks those nerve fibers from transmitting pain.
The blocking happens in a specific order. The smallest nerve fibers shut down first, which controls things like blood vessel tone. Next, the sensory fibers go quiet, so you lose the sensation of pain, temperature, and touch in the affected area. Motor fibers, the ones controlling muscle movement, are the last to be affected. This is why a well-dosed epidural can take away your pain while still letting you move your legs and push during delivery.
The result is a band of numbness roughly from your belly button to the tops of your legs. You stay fully awake and can still feel the pressure of contractions, but the sharp pain is gone.
What Happens During the Procedure
The whole process takes about 10 minutes, with pain relief kicking in roughly 15 minutes after that. You’ll either sit on the edge of the bed with your back curved outward (sometimes called the “mad cat” position) or lie on your side with your knees drawn toward your chest. Both positions open up the spaces between your vertebrae so the needle can be placed accurately.
First, your skin is numbed with a local anesthetic. You’ll feel a minor pinch during this step. Once the area is numb, the anesthesiologist inserts a larger needle to reach the epidural space, then threads a thin, flexible catheter through it. The needle is removed, and the catheter stays taped to your back so medication can be delivered continuously or in repeated doses.
During the placement, you may feel pressure, tingling, a brief burning sensation, or a momentary jolt of shooting pain. Some people feel nothing beyond the initial pinch. Any discomfort typically disappears as soon as the insertion is finished. A test dose of medication is given first to confirm the catheter is in the right spot. If it isn’t, the catheter is repositioned before the full dose begins.
Standard Epidural vs. Combined Spinal-Epidural
There are two main approaches. A standard epidural delivers medication only into the epidural space and takes a bit longer to reach full effect. A combined spinal-epidural (often called a CSE or “walking epidural”) adds a small dose of medication directly into the spinal fluid before the epidural catheter is placed. The spinal component kicks in almost immediately, bridging the gap while the epidural portion builds up. Both aim for the same result: good pain relief without taking away your ability to move your legs or push when the time comes.
Common Side Effects
The most frequent side effect is a drop in blood pressure, which happens in about 20% of patients. Your care team monitors your blood pressure closely after placement and can treat a drop quickly with fluids or medication. You might also experience itching, temporary difficulty urinating (which is why a bladder catheter is sometimes placed), or shivering.
Occasionally, the epidural provides uneven relief, numbing one side of your body more than the other. When this happens, repositioning or replacing the catheter usually fixes the problem. A more rare complication is a post-dural puncture headache, which occurs if the needle accidentally punctures the membrane surrounding the spinal fluid. This causes a distinctive headache that worsens when you sit up and improves when you lie flat.
Who Cannot Get an Epidural
Certain conditions make epidurals unsafe. If you’re on blood-thinning medications or have very low platelet counts (the blood cells responsible for clotting), the risk of bleeding near the spine is too high. A platelet count of 70,000 per microliter or above is generally considered safe for placement in people with pregnancy-related low platelets. An active infection at the insertion site, certain spinal abnormalities, or a severe allergy to local anesthetics would also rule out the procedure.
What It Feels Like as It Wears Off
Once the medication is stopped, either after delivery or after surgery, sensation returns gradually. The order reverses from how the block set in: motor function comes back first, then touch and temperature, and finally full normal sensation. Most people notice a tingling or “pins and needles” feeling as the numbness fades. The area where the needle was placed may be mildly sore for a day or two, similar to a bruise, but this resolves on its own.
You won’t be allowed to walk until you can move your legs reliably and your blood pressure is stable. Nurses will check your strength and sensation before clearing you to stand. For most people, this happens within a couple of hours after the infusion stops.
Epidurals Beyond Labor
While childbirth is the most well-known use, epidurals serve a broader role in medicine. They’re used during surgeries on the lower body, such as hip or knee replacements, either alone or alongside general anesthesia. Epidural steroid injections, a related but different procedure, deliver anti-inflammatory medication to treat chronic back pain or sciatica. These are typically one-time injections rather than continuous infusions, and the goal is reducing inflammation around irritated nerves rather than blocking sensation entirely.