The epidural, the pain relief option of choice in the US, is a method by which medication is delivered in effort to lessen, or eliminate, the pain of childbirth. A local anesthesia is given after active labor has begun before a needle is placed into the "epidural" space in the back between the vertebrae of the birthing mother. Typically, the patient will be seated on the edge of a birthing bed or chair, leaning forward, so that her back is slightly rounded. Most often, a small catheter is threaded through the needle, after which the needle is withdrawn. The catheter, the medium through which more medication can be delivered, is left intact and taped to the skin to keep it in place.

Many women liken the placement of the epidural needle to a moderate to severe "sting" or "pinch" from the initial needle stick, lasting anywhere from a few seconds, to several minutes. Approximately three to five minutes after the initial medication dose, the uterine nerves will begin to numb and shortly thereafter, the complete "dull" effect is most often achieved. The medication is re-administered every two to three hours, depending on the type and amount of anesthetic drug used and the comfort level of the patient.

Immediately after a vaginal delivery of the baby, the catheter is typically withdrawn, and the medication usually wears off completely within two hours, although the duration of pain relief often depends on which medication is delivered via the catheter. With a C-Section, however, the epidural is often kept in place for administering pain relief over the 24 hours that follow surgery.

The primary advantage to an epidural is pain relief. Other advantages of the epidural vs. narcotic pain medications include the ability of the birthing mother to remain alert during childbirth, and the fact that less of the epidural medication reaches the baby. Many women who have opted for epidurals have had very positive experiences and have reported that they were able to relax and enjoy the births of their children without having to focus on the pain of childbirth. In fact, some find themselves wondering why any other woman would choose childbirth without it.

Women should be aware, however, that although the use of epidural anesthesia in childbirth has been shown to be a relatively safe method of pain relief for both mother and baby, it does carry some disadvantages as well as risks to some patients. These include the following:

• The epidural often yields complete numbness from the waist down, thereby inhibiting the birthing mother from moving and making use of gravity, which can, in turn, slow labor and present an increased risk of "Failure To Progress."  This diagnosis can also increase the risks for a chain reaction of other interventions, including the use of labor augmenting drugs such as Pitocin, delivery with the aid of forceps or vacuum extraction, episiotomy, and in some cases, Cesarean Section if progression does not improve. The risks of these interventions increase if an epidural is administered too early in labor (before 5 centimeters). 
  
• Catherterization of the birthing mother. 
  
• Nausea, vomiting and/or uncontrollable shivering. 
  
• Intense itching, particularly if narcotics are used as medication. 
  
• Constant intravenous fluids, as well as electronic fetal monitoring devices in place throughout labor. 
  
• Maternal fever. 
  
• Inability to feel the pushing urge and/or inability to push effectively.
  
• Back discomfort that can last anywhere from days to years. 
  
• Short-term bladder dysfunction (inability to urinate). 
  
• Moderate to severe headaches.

Additionally, although rare, serious complications can occur from the use of epidurals in some women. They include:

• Toxic allergic reaction and/or shock. 
  
• Spinal or Dural puncture (risk is increased in overweight women). 
  
• Respiratory paralysis. 
  
• Convulsions. 
  
• Hypotension (sudden drop in blood pressure). 
  
• Cardiac arrest. 
  
• Paresthesia (a "pins and needles" sensation). 
  
• Infection.

Possible risks to the baby include:

• Drowsiness, lethargy and poor sucking reflex immediately after birth.
  
• Hyperthermia (increased body temperature) if maternal fever was present during labor, which can lead to separation of mother and baby and inhibit bonding while the infant undergoes a neonatal workup. 
  
• Fetal distress and/or abnormal heart rate.
  
• Poor muscle tone. 
  
• Neonatal Jaundice.

Although many of the above complications are exceptional, it is wise to research any possible intervention during childbirth. If you have concerns or questions about pain relief options during labor, take the opportunity before labor begins to speak with a medical care provider, a certified childbirth instructor or anesthesiologist to discuss the risks, and benefits, of your options. For most women, an epidural can result in a positive and painless childbirth experience. For others, researching other pain managing techniques may be more appealing.

Whether pain relief is a mere consideration or a definite resolution for any pregnant mother, education and information is key to making the best possible decision for you and your baby.