“Pain, Pain, Go Away: Epidurals” – with Dr. Zevi Hamburger

Epidurals are one of the most commonly requested forms of pain relief during labor and delivery, yet many expectant parents have questions about how they work, when they can be administered, and what to expect. On the Healthful Woman podcast, Dr. Zevi Hamburger, an anesthesiologist, joined the conversation to explain epidurals in straightforward terms, covering the mechanics of the procedure, the different types of labor analgesia available, and how patients can make informed decisions before their delivery day. If you are researching pain management options during labor, this podcast offers a factual, clinically grounded overview based on that recorded discussion. To learn more or speak with a provider, call for details.

How Epidurals Work: The Basics of Labor Analgesia

Placement and Mechanism

An epidural is a regional anesthesia technique in which medication is delivered into the epidural space of the spine, the area just outside the membrane surrounding the spinal cord. A small catheter is placed through a needle inserted in the lower back, allowing anesthesia providers to deliver continuous or intermittent doses of local anesthetic, often combined with a low-dose opioid, throughout the course of labor. Once in place, the catheter allows for dose adjustments as labor progresses.

Dr. Hamburger explains that the goal of an epidural is to block sensory nerve signals from the lower body while preserving enough motor function for the patient to participate actively in pushing during delivery. The medication used, typically a combination of bupivacaine and fentanyl, works by interrupting the transmission of pain signals along the nerve roots that exit the spinal cord at the lumbar level.

What Patients Typically Experience

Most patients report feeling pressure during contractions rather than sharp pain after the epidural takes effect, which generally occurs within 10 to 20 minutes of initial dosing. Individual results may vary based on anatomy, medication sensitivity, and labor progression. As Dr. Hamburger noted, modern epidural techniques aim for a “walking epidural” level of density, meaning the patient retains some lower body movement while achieving meaningful pain relief. The catheter remains in place until after delivery, at which point it is removed and the medication wears off relatively quickly. Patients curious about what the full labor and delivery experience may look like can explore our obstetrics care services for more context on what our providers offer throughout pregnancy.

Types of Epidurals and Labor Pain Relief Options

Standard Epidural vs. Combined Spinal-Epidural

Dr. Hamburger discussed several approaches to labor analgesia, each with its own characteristics. The standard epidural, described above, provides sustained pain relief through a continuous catheter infusion. A combined spinal-epidural (CSE) technique adds a single spinal injection before placing the epidural catheter, providing faster onset of relief, often within minutes, while still allowing for ongoing dosing through the catheter as labor continues.

Patient-Controlled Epidural Analgesia

Many hospitals, including those affiliated with academic medical centers, now offer patient-controlled epidural analgesia (PCEA). This approach allows the patient to self-administer small supplemental doses within preset safety limits, giving laboring patients more control over their comfort level. Dr. Hamburger noted that PCEA can help reduce total medication usage while improving patient satisfaction because the patient can respond to breakthrough discomfort promptly rather than waiting for a provider to adjust the infusion.

Non-Epidural Alternatives

Epidurals are not the only option. IV opioids, nitrous oxide, and non-pharmacologic techniques such as positioning and hydrotherapy may help manage labor discomfort for patients who prefer to avoid or delay an epidural, or for those in whom epidural placement is not appropriate. Every patient’s clinical situation is different, and the anesthesia team will review medical history, including factors such as certain clotting disorders or prior spinal surgeries, before proceeding. Patients with high-risk pregnancies should discuss pain management plans early in their prenatal care. You can read more about how our team approaches complex pregnancies through our high-risk obstetrics program.

Epidurals During the COVID-19 Pandemic: A Provider Perspective

Dr. Hamburger also shared updates from his experience at Mount Sinai Hospital during the COVID-19 crisis, offering a window into how labor and delivery care adapted under significant strain. Anesthesia teams had to modify standard protocols to account for the increased use of personal protective equipment, changes in staffing, and the need to perform epidural placements in patients who were potentially COVID-positive.

One key insight from his experience was that early epidural placement became even more valuable during the pandemic. Having an epidural catheter in place early in labor meant that if an emergency cesarean delivery became necessary, the anesthesia team could rapidly convert the epidural to surgical anesthesia without needing to perform general anesthesia, which carries a higher risk profile and was considered particularly risky during a respiratory illness outbreak. As Dr. Hamburger noted, this highlighted a practical advantage of epidurals that exists regardless of a pandemic context: a functioning epidural catheter provides flexibility for the entire care team.

Patients who are managing complicated pregnancies or have concerns about delivery planning may benefit from speaking with a maternal-fetal medicine specialist early. Learn more about high-risk pregnancy care and how coordinated planning between obstetric and anesthesia providers may help prepare patients for a range of delivery scenarios.

Why Choose Our Practice for Your Obstetric Care?

Our practice brings together the strengths of academic medicine and private practice in a model designed to deliver expert, research-informed care with the accessibility and personalized attention of a private setting. Our providers have been recognized as “Best Doctors,” “New York Best Doctors,” Castle Connolly Top Doctors, and Super Doctors, and our affiliated hospital has been recognized by U.S. News and World Report as a High Performing Hospital for Maternity Care. We are a member of the U.S. Women’s Health Alliance and a Rainbow Practice committed to inclusive, affirming care. Whether you are navigating a straightforward pregnancy or require high-risk obstetric care, our team is here to help you prepare for a safe and informed delivery experience. Call for details to schedule a consultation.

Frequently Asked Questions About Epidurals

When during labor can an epidural be placed?

Epidurals can generally be placed at any point during active labor, and current evidence does not support the idea that early placement meaningfully slows labor progress. The decision is typically made based on the patient’s pain level, cervical dilation, and clinical circumstances. Your obstetric provider and the anesthesia team will discuss timing with you. Individual results and experiences may vary based on how labor progresses.

Are there risks associated with epidurals?

Like any medical procedure, epidurals carry potential risks, including a temporary drop in blood pressure, headache if the spinal membrane is inadvertently punctured, itching from opioid medications, and in rare cases, inadequate pain relief requiring catheter repositioning. Serious complications are uncommon. Your anesthesia provider will review your specific medical history and discuss risks and benefits before the procedure. Consult with your provider for guidance specific to your situation.

Can I get an epidural if I have a high-risk pregnancy?

Many patients with high-risk pregnancies receive epidurals safely, though certain conditions may affect eligibility or require modified techniques. Clotting disorders, certain spinal abnormalities, and specific medication regimens may influence the anesthesia team’s approach. Early communication between your maternal-fetal medicine provider and the anesthesia team can help ensure that a pain management plan is in place well before your due date. Individual circumstances vary significantly.

Will an epidural slow down my labor?

Research suggests that modern low-dose epidural techniques do not significantly prolong the active phase of labor or increase the likelihood of cesarean delivery. Older studies using higher-dose formulations raised this concern, but current protocols are designed to minimize motor blockade while maintaining comfort. That said, individual responses vary, and your care team will monitor labor progress and adjust your plan as needed throughout delivery.

How does the epidural catheter get removed after delivery?

Once delivery is complete and the anesthesia team determines it is appropriate, the epidural catheter is removed by gently pulling it out. The process is brief and most patients describe minimal discomfort. The effects of the medication typically wear off within one to two hours after the infusion is stopped. You will be monitored by nursing staff during this period. Consult with your provider for specific guidance on postpartum recovery in your case.

If you are planning your delivery and want to learn more about epidurals and labor pain management options, our team of nationally recognized obstetric providers is here to help. Call us today to schedule a consultation and discuss how we can support you through every stage of your pregnancy and delivery.

Maternal Fetal Medicine blogs are intended for educational purposes only and do not replace certified professional care. Medical conditions vary and change frequently. Please ask your doctor any questions you may have regarding your condition to receive a proper diagnosis or risk analysis. Thank you!