Epidurals are not dangerous for most people, but they do carry real risks that range from common and mild to extremely rare and serious. About 80% of women who give birth in the U.S. with pain relief choose an epidural, making it one of the most frequently performed procedures in medicine. The vast majority of those go smoothly, with serious complications occurring in fewer than 1 in 100,000 cases for obstetric patients. That said, understanding the full picture of what can happen helps you weigh the decision clearly.
The Most Common Side Effects
The side effect you’re most likely to experience is a drop in blood pressure. This happens in 10% to 20% of women within the first hour after the epidural takes effect. Your blood vessels relax and widen, which can cause dizziness, nausea, or a general feeling of faintness. Medical teams monitor for this routinely and can treat it quickly, usually by having you lie on your side and giving medication through your IV to bring your pressure back up. In about 15% of those cases, the blood pressure drop is significant enough to temporarily affect the baby’s heart rate, which is why continuous fetal monitoring is standard during an epidural.
Itching, shivering, and difficulty urinating are also common. You’ll typically have a catheter placed for your bladder since the epidural numbs the nerves that tell you when it’s full. These effects resolve once the epidural wears off, usually within a few hours of delivery.
Spinal Headaches
During placement, the needle can accidentally puncture the membrane surrounding your spinal fluid. This is called a “wet tap,” and it can cause an intense headache that gets worse when you sit or stand up. The headache typically starts within a day or two of delivery and can last a week or more without treatment. If it’s severe, a procedure called a blood patch (where a small amount of your own blood is injected near the puncture site to seal it) resolves the headache in most cases. The risk of this complication varies, but it’s one of the more well-known downsides of epidural placement.
How Epidurals Affect Labor
Epidurals tend to slow things down. Research on labor duration found that epidural use added roughly 82 minutes to the pushing stage at the upper end, and it tripled the rate of what’s considered a prolonged second stage of labor. That longer labor isn’t inherently dangerous, but it does increase the chance that your medical team will intervene to help things along.
The connection between epidurals and cesarean sections is one of the most debated topics in obstetrics. One large departmental study found that physicians who used epidurals in more than 70% of their patients had a cesarean rate of 23.4% for first-time mothers, compared to 14.8% among physicians who used them 40% of the time or less. When epidurals are placed before active labor (before about 4 centimeters of dilation), some analyses suggest the probability of cesarean delivery more than doubles compared to other forms of pain relief.
Instrumental deliveries, where forceps or a vacuum device help guide the baby out, also increase with epidural use. One study comparing epidural to narcotic pain relief found instruments were used in 27% of epidural deliveries versus 16% without. That higher rate of instrumentation contributes to more significant perineal tearing. A meta-analysis found that perineal trauma doubled among patients who received epidurals, driven largely by the increased use of forceps and vacuum.
Effects on the Baby
Most babies born after epidural use are perfectly healthy, but there is a measurable statistical association with lower scores on the Apgar test, the quick assessment done at one and five minutes after birth. A large propensity-matched study found that epidural use was associated with 1.8 times the odds of a low five-minute Apgar score (below 7) and 1.7 times the odds of admission to the neonatal intensive care unit. The association was strongest in labors that started spontaneously rather than being induced.
It’s worth noting that these are observational findings. Women who choose epidurals often have longer, more difficult, or more painful labors to begin with, which makes it hard to separate the effect of the epidural itself from the effect of a complicated labor. Still, the association is consistent enough across studies to be part of an informed decision.
Rare but Serious Complications
The risks that worry people most, like permanent nerve damage or paralysis, are genuinely rare in obstetric patients. A Finnish study covering 1.4 million procedures found the rate of permanent injury from epidurals in obstetric patients was 1 in 144,000. A separate study of over 318,000 obstetric patients found an overall permanent injury rate of 1.2 per 100,000.
Spinal hematoma, a blood clot that forms in the spinal canal and can compress the spinal cord, occurred at a rate of 1 in 200,000 among young women receiving obstetric epidurals in a Swedish study of 1.7 million procedures. For context, that same study found the risk was dramatically higher (1 in 3,600) for older patients undergoing knee replacement surgery. Age, blood-clotting ability, and overall health make a significant difference in how risky the procedure is for any individual.
When Epidurals Aren’t an Option
Certain conditions make epidurals unsafe. An active infection at the site where the needle would be placed is an absolute reason not to proceed. Blood-clotting disorders or very low platelet counts are relative contraindications, meaning your anesthesiologist will weigh the bleeding risk carefully. If you’re on blood-thinning medications, the timing of your last dose matters. These are situations your medical team will screen for before placing the epidural.
Epidurals Don’t Always Work
One underappreciated risk is simply that the epidural might not provide the relief you’re counting on. A review of over 19,000 deliveries found an overall failure rate of 12%. Nearly half of those were fixed with simple adjustments like repositioning the catheter. About 7% of patients needed their catheter completely replaced, and roughly 2% needed it replaced more than once. By the end, 98.8% of patients reported adequate pain relief, but the path to getting there isn’t always smooth. Between 5% and 8% of epidurals provide incomplete or patchy relief even when placement appears correct, leaving numb spots on one side or gaps in coverage.
If complete pain control is your primary goal, knowing that you may need adjustments or a redo sets more realistic expectations than assuming it will work perfectly on the first try.