Getting an epidural during labor is a common pain relief choice for many women. An epidural is a regional anesthesia that blocks pain in a particular region of the body, usually the lower half of the body. It involves injecting anesthesia into the space around the spinal cord to numb the spinal nerves. This results in decreased feeling and sensation from the waist down.
Epidurals provide very effective pain relief during labor and allow women to remain awake and alert during the birthing process. However, there is a limited window of time during labor when an epidural can be administered. If left too late, it may be challenging or impossible for the anesthesiologist to place the epidural. So how many centimeters dilated is too late for an epidural?
When is the optimal time for an epidural?
Generally, the best time to get an epidural is when the cervix is dilated between 4-6 centimeters. This is usually during active labor when contractions are strong and regular, typically 3-5 minutes apart. At this point, most women request pain relief, and an epidural can be safely and effectively administered. The epidural medicine has enough time to take effect before the most intense part of labor begins.
Some key reasons why 4-6 cm is the optimal timing for an epidural include:
- The cervix is dilated enough that accidentally touching it with the epidural needle is unlikely.
- Active labor is established, but the most painful transition stage has not yet begun.
- There is still adequate time for the epidural to infuse and take effect before the pushing stage.
- The risk of requiring an emergency C-section after epidural placement is reduced.
Many anesthesiologists and obstetricians will recommend getting an epidural when you are 4-6 cm dilated if you desire one during your labor. This timing provides you with effective pain relief when labor typically intensifies while reducing complications.
Is 10 cm too late for an epidural?
Yes, 10 cm cervical dilation is generally considered too late for placement of an epidural. At 10 cm, the cervix is fully dilated, and the active pushing stage of labor has either begun or is about to begin. There are several reasons why an epidural is seldom placed when a woman is fully dilated:
- The most painful part of labor is over once a woman is complete, so pain relief is no longer needed for dilating the cervix.
- It can be very challenging for the anesthesiologist to place an epidural in an ideal position when the woman is complete and ready to push due to her position.
- There may not be adequate time for an epidural to provide pain relief before the baby delivers once a woman is complete.
- The risk of needing an emergency C-section after epidural placement increases significantly at full dilation.
For these reasons, most providers do not recommend attempting epidural placement when a woman has reached complete, 10 cm dilation. At this point, alternative options for pain relief during pushing such as local anesthesia may be considered instead.
What if I’m between 6-10 cm dilated?
The timeframe between 6-10 cm dilation is considered a gray area when it comes to epidurals. During this window, whether an epidural is possible depends on several factors:
- Rate of labor progress – If labor is progressing very quickly from 6 cm onwards, there may not be enough time to place an epidural before complete dilation is reached.
- Anesthesiologist availability – The anesthesiologist may be occupied with another patient and unable to come immediately to place the epidural.
- Epidural replacement – If the epidural medicine needs to be replaced or reinforced, it is usually still possible between 6-10 cm.
- Risk factors – Issues like high BMI or spinal surgery scars can make epidural placement more difficult and time consuming.
- Baby’s position – Position of the baby in the pelvis can affect ability to place an epidural.
The timing between 6-10 cm is considered a “gray zone” where the anesthesiologist will assess the specific situation before deciding if an epidural is still a feasible option. Often, they will recommend holding off until the cervix reaches 10 cm before attempting an epidural at this point when delivery is imminent.
When is it too early for an epidural?
Getting an epidural before the cervix reaches active labor (4 cm dilation) is also not recommended. Reasons that less than 4 cm is too early include:
- The cervix is not dilated enough, increasing the risk of accidentally puncturing it with the epidural needle.
- Early labor can stall or slow down after getting an epidural, resulting in a longer labor overall.
- The epidural may wear off before the most painful transition and pushing stages of labor.
- Increased risk of needing further interventions like Pitocin augmentation or vacuum/forceps assistance.
Ideally, an epidural should be placed once active labor is in progress and the cervix is dilated at least 4 cm. Early in the labor process, an epidural is more likely to lead to complications and stalled labor. Patience until active labor ensures the epidural is maximally effective.
What are the risks if an epidural is given too late?
Attempting epidural placement when the cervix is fully dilated or close to complete dilation can increase the chance of the following risks and complications:
- Difficulty placing the epidural – It can be challenging to get proper needle position at 10 cm which delays pain relief.
- A failed epidural – The medicine may not spread effectively or only numb one side of the body.
- Increased risk of emergency C-section – If the baby needs to be delivered urgently, an epidural can slow the process.
- Nicked dural sac – The epidural needle could accidentally puncture the membrane around the spinal cord.
- Inadequate pain relief – There may not be enough time for the epidural to take effect before delivery.
For these reasons, anesthesiologists will often advise women against receiving an epidural after 10 cm dilation due to safety concerns, difficulty getting adequate pain relief before delivery, and increased risk of needing an emergency C-section.
Special circumstances when a late epidural may be possible
In some unique cases, an epidural may still be an option between complete cervical dilation and delivery of the baby. This is most common in these situations:
- Prolonged pushing stage – If the active pushing stage lasts over 1-2 hours, an epidural may be offered for pain relief.
- Labor stalls at 10 cm – If complete dilation is reached but lack of descent prevents pushing, an epidural can help the mother rest until pushing resumes.
- Reinforcing a current epidural – Additional epidural medicine is often given to improve pain relief if needed.
- Emergency C-section prep – If a cesarean becomes necessary at 10 cm, a stronger epidural can help in surgery.
However, in most normal labor situations, attempting an epidural for the first time after complete 10 cm dilation is avoided due to the higher chance of complications.
Key takeaways on epidural timing
Here are some of the key points to understand about epidural timing during labor:
- The ideal window for epidural placement is when the cervix is dilated 4-6 cm during active labor.
- 10 cm dilation is usually too late for initial epidural placement before delivery.
- Between 6-10 cm is a gray zone where epidural administration depends on specific circumstances.
- Earlier than 4 cm dilation increases risks of a stalled labor and epidural wearing off too soon.
- An epidural given too late raises risks of difficulty with placement, inadequate pain relief, and needing emergency C-section.
Being proactive and requesting the epidural during active labor around 4-6 cm dilation provides the best chance of having optimal pain relief during the most intense parts of labor while reducing risks of complications.
Frequently asked questions
Why can’t you get an epidural when fully dilated?
At full, 10 cm dilation, it is usually too late for an epidural because there is inadequate time for placement and the medicine to take effect before delivery. The challenging positioning can also make it difficult to administer the epidural properly.
How long does it take for an epidural to work?
It usually takes 10-20 minutes for epidural anesthesia to take effect. The medicine needs time to be infused and spread around the spinal nerves. If given too close to delivery, the epidural may not provide sufficient pain relief.
Can you get an epidural at 9 cm dilated?
It is challenging but possible in some cases to have an epidural placed at 9 cm dilation. Factors like the speed of labor progression and availability of the anesthesiologist will determine if 9 cm is too late. Many providers advise holding off until 10 cm at this point.
What if I’m at 10cm with intense pain?
If you are fully dilated with intense pain, most doctors will recommend trying positions, breathing, and other alternative pain relief techniques rather than attempting a late epidural. Local anesthesia or numbing medication can sometimes be used to help manage final pushing stage discomfort.
Why are epidurals no longer recommended in advanced labor?
Epidurals are avoided in advanced labor primarily due to risks like difficulty with placement, inadequate pain relief due to rushed timing, and increased chances of needing emergency C-section after administration.
The takeaway
Timing is everything when it comes to getting optimal pain relief from an epidural during labor. The best window is between 4-6 cm dilation during active labor, when contractions are strong and regular. Before 4 cm risks stall labor while after 6 cm, and especially after complete 10 cm dilation, attempted epidural placement can be challenging and ineffective. While each labor is unique, following the typical timing recommendations provides the highest chances of gaining adequate pain control when you need it most in a safer manner.