An epidural is placed in your lower back, and depending on why you need one, it happens in a hospital labor and delivery unit, a surgical suite, or an outpatient pain clinic. The term covers two related but distinct procedures: continuous epidural anesthesia (most commonly used during labor or surgery) and epidural steroid injections (used to treat chronic back or neck pain). Where you go and what happens during the procedure differ depending on which type you need.
Where on Your Body the Needle Goes
The needle enters the middle or slightly off-center of your lower back, between two vertebrae. For labor epidurals, the target is typically the space between the L3 and L4 vertebrae, or nearby levels in the lumbar spine. This region is chosen because the spinal cord itself ends higher up, around the L1 or L2 vertebra in most adults, which reduces the risk of the needle contacting the cord.
The needle passes through several layers of tissue on its way in: skin, a layer of fat beneath the skin, and then two tough ligaments that connect the bony spinous processes of your vertebrae. The final layer is a dense, elastic ligament called the ligamentum flavum. Once the needle pushes through that last barrier, it enters the epidural space, a narrow gap that surrounds the protective membrane of your spinal cord. This is where the medication is delivered. The practitioner confirms they’ve reached the right spot by feeling a sudden loss of resistance on the syringe as the needle clears that final ligament.
How You’re Positioned for Placement
You’ll either sit upright on the edge of a bed or operating table, or lie on your side in a curled position. Both approaches aim to do the same thing: round out your lower back and open up the spaces between your vertebrae so the needle can pass through more easily.
If you’re sitting, you’ll be asked to place your feet on a stool, hunch your shoulders forward, and flex your back as much as you comfortably can. Some facilities use a modified version where your legs stay on the table with your knees pulled toward your chest. If you’re lying on your side, you’ll curl into a similar rounded position. Either way, the goal is to reduce the natural inward curve of your lower back and widen the gaps the needle needs to pass through.
Labor Epidurals: Hospital Labor and Delivery
The most common reason people search for epidural information is childbirth. Labor epidurals are placed on the labor and delivery floor of a hospital by an anesthesiologist or a certified registered nurse anesthetist (CRNA). You won’t need to go to a separate department or operating room for this.
The procedure itself takes roughly 10 to 20 minutes from start to finish. After the needle reaches the epidural space, a thin, flexible catheter is threaded through it, and the needle is removed. That catheter stays taped to your back for the rest of your labor, delivering a continuous flow of numbing medication. Pain relief typically begins within 10 to 15 minutes of the first dose.
Once the catheter is in place, your labor and delivery nurse and the anesthesiologist monitor your blood pressure, heart rate, and the baby’s heart rate. You’ll stay in your labor room throughout. The catheter is removed after delivery, usually before you’re transferred to a postpartum recovery room.
Surgical Epidurals: Operating Rooms
Epidurals are also used as anesthesia for certain surgeries, particularly procedures on the lower body such as hip or knee replacements, hernia repairs, and some abdominal operations. In these cases, the epidural is placed in a preoperative area or the operating room itself, again by an anesthesiologist or CRNA.
A surgical epidural works the same way mechanically. The key difference is the medication and dosing, which are adjusted to provide deeper numbness appropriate for surgery rather than the partial relief used in labor. You may receive the epidural alone or in combination with lighter general anesthesia, depending on the procedure. The catheter is typically removed in the recovery room once the surgical team is satisfied with your pain control plan for the hours ahead.
Epidural Steroid Injections: Pain Clinics
If you’re dealing with chronic back pain, sciatica, or a herniated disc, your doctor may recommend an epidural steroid injection. This is a different procedure from a labor or surgical epidural, though it targets the same anatomical space. Instead of continuous numbing medication, a single dose of anti-inflammatory steroid is injected into the epidural space to reduce swelling around irritated nerves.
These injections happen in outpatient settings: interventional pain clinics, ambulatory care centers, or hospital-based pain management departments. You don’t need to be admitted. The specialists who perform them include pain management physicians (physiatrists), anesthesiologists, radiologists, neurologists, and some surgeons. Many large hospital systems run dedicated pain clinics at satellite locations outside the main hospital campus, so you may find yourself at a smaller medical office building rather than a full hospital.
The procedure takes about 15 to 30 minutes. Unlike labor epidurals, no catheter is left in place. The needle delivers the medication, then it’s removed. You’ll typically rest in a recovery area for 30 to 60 minutes while staff check your blood pressure and make sure you’re feeling stable, then you go home the same day. Relief from the steroid can take a few days to fully set in and may last weeks to months, depending on your condition.
Who Can and Can’t Get One
Most people are candidates for epidural placement, but a few conditions can make the procedure riskier or require the provider to adjust their approach. Active infection at the insertion site, certain blood-clotting disorders, and use of specific blood-thinning medications can rule out an epidural or delay it until conditions change. Prior spinal surgery, severe scoliosis, or spinal hardware like rods or fusion implants can make placement more difficult, though not always impossible. In those cases, the provider may use a slightly different needle angle, entering about 1 centimeter to the side of the midline rather than dead center, to navigate around anatomical obstacles.
If you have concerns about whether your spine anatomy or medical history could complicate an epidural, the anesthesiologist or pain specialist will review your situation beforehand. For labor epidurals, this conversation ideally happens during a prenatal appointment rather than in the middle of active labor.