What Is a Walking Epidural?

Pain relief is commonly used during childbirth, as the experience is extremely painful for most pregnant people. Epidurals are well-known as a very effective method for alleviating labor pain and are one of the most common forms of pain relief used in childbirth.

The walking epidural is a low-dose pain relief drug administered during labor that is a popular alternative to the stronger dose offered by classic epidurals. Walking epidurals provide effective, safe pain relief without fully blunting sensations for the pregnant person.

The medications used in a walking epidural allow greater feeling and movement in the lower half of the body during labor and delivery. In the procedure, anesthesia is administered directly into the epidural space (outermost section) of the spinal cord as needed during labor.

Note that despite its name, most pregnant people with a walking epidural will not actually be walking during labor. Learn more about using a walking epidural for labor pain, including benefits and possible risks.

Walking Epidural vs. Classic Epidural

The goal of an epidural is to provide targeted analgesia (pain relief) rather than full anesthesia (an all-body lack of feeling). A walking epidural allows the pregnant person to feel more sensation during the delivery of their baby while still relieving much of the pain.

Epidurals work by blocking the nerves to numb the lower half of the body below where the IV catheter is inserted into the spine.

As with anesthesia itself, there is more than one form of epidural. One type is considered the continuous classic epidural, while the other is called a walking epidural (also called a combined spinal epidural).

Classic continuous epidural

In a classic epidural, the catheter stays in place so that medication can be administered throughout labor. The medication blocks the nerves to the lower half of the body, resulting in a lack of feeling and ability to move.

Spinal injection

Spinal injections involve injecting a single dose of medication into the spine. They wear off quicker and can be used on their own or in conjunction with an epidural.

Walking epidural

This procedure is a combination of the classic epidural and spinal injection, using a lower dose of medication while also offering continuous relief. A walking epidural uses the same medications as a classic epidural but in smaller amounts.

The drug cocktail typically contains a narcotic (like morphine or fentanyl) and a drug like epinephrine to prolong the anesthetic effect and stabilize the person's blood pressure.

Various hospitals and birthing centers may offer different types of epidurals and pain management options. Aim to talk to your health care provider about your pain relief options and preferences.

As noted above, most pregnant people receiving a walking epidural will not walk around freely after the epidural has been placed. This can be due to any of the following reasons:

• Leg weakness
• Low blood pressure
• Medical equipment cords requiring connection to the bed
• Personal preference

Also, many hospitals discourage or prohibit walking while using a walking epidural for safety and insurance reasons.

How a Walking Epidural Works

An anesthesiologist administers the epidural. The procedure takes about 10 minutes, with pain relief in place in about another 10 to 15 minutes. The actual insertion of the needle and catheter (the tiny tube that delivers the medicine) is timed to be done between contractions so that the pregnant person can hold still.

Getting a walking epidural is very similar to getting a traditional epidural, except that the placement and the medication used are slightly different. Essentially, the pregnant person sits up and takes a curved-spine (or cat) pose with head to chin.

The health care provider cleans the pregnant person's back, numbs the area with a local anesthetic, and then injects the needle into the appropriate space along the lower spine. After the needle is placed, the health care provider feeds in the catheter and removes the needle. The catheter is then taped in place.

Typically, you will have the option to get your epidural once you are four to five centimeters dilated. Technically, you can be provided an epidural at any point—it's never too late, medically speaking. However, once you reach 10 centimeters, it's time to push, which will take precedence over putting in an epidural.

Also, note that the pelvic pain and pressure during the pushing stage will not be blunted to the same extent by an epidural as the pains of labor are. So, even if you get an epidural right before pushing, you may still feel some of the pain that goes along with delivering a baby.

Pros and Cons of a Walking Epidural

One of the advantages of a walking epidural is that the very ability to move promotes contractions, which may even shorten labor times. Plus, as mentioned above, with the walking epidural, pregnant people get to feel all the sensations of labor and delivery without the intense pain.

Mobility is especially useful in the second stage of labor (pushing) where the adoption of a more upright or squatting position can help with the birth. It also gives a pregnant person more control over their body which may improve their comfort and feelings of agency during delivery.

Walking epidural advantages

Advantages of a walking epidural include the following:

• Ability to get into more positions for delivery
• Decreased need for forceps or vacuum extraction
• Greater mobility during labor
• Lower C-section rates
• Lower dose of medication
• May help decrease pain
• Possibility of a shorter labor

Walking epidural disadvantages

On the flip side, having a lower dose of anesthesia may result in less relief in the event of extraordinary pain. As such, pregnant people will sometimes switch from a walking to classic epidural mid-labor. Fortunately, it's an easy switch to make, and relief is available as soon as the higher-dose drugs are delivered.

Drawbacks of a walking epidural may include the following:

• Doesn’t eliminate the risks of using an epidural
• May have to switch to classic epidural
• May provide less pain relief

Walking Epidural Risks and Possible Side Effects

While a walking epidural exposes you to lower doses of medication, it doesn't entirely erase the small risks associated with treatment. Possible complications may include:

• A severe headache caused by the leakage of spinal fluid
• A sudden drop in blood pressure
• Backache
• Difficulty urinating
• In very rare cases, nerve damage where the catheter was inserted
• Localized pain at the catheter insertion site
• Nausea
• Ringing in the ears
• Shivering

While some pregnant people are worried that indirect exposure to the anesthetic drugs may affect the baby's respiration and heartbeat at birth, there is no evidence that epidurals cause damage to the baby. Also, know that serious side effects from having an epidural for the pregnant person are rare.