Epidurals and Baby’s Experience of Birth: What You Should Know
Epidurals are one of the most common pain relief options in labor - 70% of births in the US! (That’s way higher than the 20-30% in the UK) and for many parents, they provide much-needed relief and a sense of control over the birth experience. But there's a conversation that sometimes gets left out—how epidurals affect not just the birthing parent, but the baby.
This can be hard to hear, and I want to approach it with warmth, understanding, and a deep respect for the choices each family makes. (Can you feel me giving you a hug?)
If you had an epidural, this isn't about guilt or blame. It's about understanding the whole picture so that parents can make informed decisions that feel right for them. (And maybe, if you had difficulty with feeding or fussiness after birth, this will help to give you some answers!)
What We Know About Epidurals and Baby
When we think about labor pain, we often focus on what the birthing parent is feeling. But babies are active participants in the birth process. The uterus contracts, helping to push baby down and stimulating their nervous system as they prepare for life outside the womb. Hormones—like oxytocin and endorphins—play a significant role in regulating this experience.
Epidurals work by blocking pain signals, and when they do, they also affect the hormonal environment of birth. Here's what the research actually shows:
Hormonal changes: Epidurals reduce maternal production of beta-endorphins (stress-coping hormones) and can lower levels of catecholamines (adrenaline-like hormones). This means less stress hormone exposure during labor—for both parent and baby. Whether this is ultimately "good" or "bad" is more complex than it might seem. While less maternal stress can seem beneficial, the research is less clear about whether babies directly experience increased pain without these hormones.
What's more certain: Studies show that babies born after epidural use have slightly lower Apgar scores on average and higher rates of needing NICU admission—though these effects are generally mild. Babies may be sleepier in the first hours after birth, or in some cases, more reactive to stimulation. Some babies do have more difficulty initiating breastfeeding in the immediate postpartum period.
The Breastfeeding Question
This is where things get really complicated, and I want to be honest: the research is mixed.
Some studies show epidurals are associated with breastfeeding challenges—particularly with early latch, more frequent supplementation with formula, and earlier cessation of breastfeeding. Other studies show no significant difference. What we do know is that the dose of medication matters. Higher doses of fentanyl (the opioid often added to epidurals) correlate with more reported feeding difficulties and fussiness in the first days of life.
Other factors also complicate the picture: epidurals can prolong pushing, lead to instrumental deliveries (vacuum or forceps), increase instrumental trauma, affect maternal fever, and alter the timing of skin-to-skin contact—all of which influence breastfeeding success. It's hard to separate out the epidural's effect from these other factors.
Why This Matters: The Real Trade-offs
Here's what I think is important to acknowledge: epidurals do create trade-offs. They're not neutral interventions, even though they're generally safe.
Potential downsides:
Altered hormonal experience during and after birth
Variable effects on early infant alertness and feeding behavior
Increased reliance on other interventions (Pitocin, instrumental delivery)
Extended recovery for some parents
Real benefits:
Meaningful pain relief for parents experiencing severe suffering
Lower maternal stress, which can allow some labors to progress
Ability to rest during long labors
Access to emergency C-section anesthesia if needed
For some people, reduced anxiety and improved mental health around birth
The question isn't "Are epidurals good or bad?" It's "What matters most in YOUR labor, and what are you willing to trade?"
Does This Mean Epidurals Are Bad? Absolutely Not.
Epidurals are a valid and important tool for many births. They can be life-changing for those experiencing long or difficult labors, those who need to rest before pushing, or those managing high levels of fear or trauma around birth. Sometimes they're exactly what allows a pelvic floor to relax and a baby to pass through.
This is not about saying "never get an epidural." It's about understanding the trade-offs so that parents can prepare and make choices that align with their needs and values.
What Can You Do?
If you're planning an epidural, having had one in a past birth, or making a decision about this:
Before birth:
Get clear on what matters most to you (pain relief? alertness? early bonding? breastfeeding ease?)
Discuss medication doses with your care team—lower doses may preserve more sensation and alertness
Have a plan for what to do if breastfeeding doesn't start easily
After birth:
Prioritize immediate and frequent skin-to-skin contact—this helps regulate baby's nervous system and supports bonding
Have lactation support available early, especially if your baby seems sleepy or uninterested
Give yourself and your baby grace as you figure out feeding—this often resolves with patience and support
Know that oxytocin-boosting practices (eye contact, scent, snuggling) all help support the natural hormonal flow after birth
The Bottom Line
Epidurals are neither all good nor all bad—they are a tool with genuine benefits and real trade-offs. When we talk about birth options, we deserve the full story: the research that's solid, the research that's messy, and the choices that matter.
The most important thing to know is this: no single decision in labor defines your birth or your relationship with your baby. The love, care, and connection you offer your baby will always matter infinitely more than any intervention or choice you make during labor.
You deserve support. You deserve information. And you deserve to make the choice that feels right for you.
With love and respect, Emily
