If I'm getting an epidural, how long should I wait before going to the hospital?

You asked a really good question. You want to know how long you should wait before going to the hospital if you're planning in getting an epidural. Generally speaking, we advise women who are over 37 weeks to wait until contractions are about 3-5 minutes apart and that's been going on for at least 2 hours. This increases the chances that your cervix is actually dilating or changing from the contractions. Now you've probably heard a lot of women say "I was in labor for 5 days!" because they were contracting for 5 days, but the true definition of labor is cervical change, meaning your cervix is dilating from hour to hour. So a woman may have been contracting for 5 days leading up to the delivery of her baby, but she was probably only in labor for the hours leading up to the delivery.

What that means is that even though you are planning on an epidural, you are going to experience pain during labor. There's going to be a time at home where you're trying to decide if it's time to go in while you're waiting for the contractions to get regular. Then once you're at the hospital, there has to be a waiting period where we have to see what your body is doing. For example, let's say that you came into the hospital because you were contracting every 4 minutes. I would check your cervix and find out what you were dilated to, and if you were 2cm, all we can really do at that point is cross our fingers, tell you to work hard, shut the door, come back in an hour. In the meantime of course, we are monitoring you and the baby, and making sure things are okay. And then I'd come back in an hour and re-check your cervix, and if you were still 2cm, in spite of having regular and intense contractions, it means you're not in labor yet. And so you would get to go home, and continue to work hard, and come back later when they were more frequent or more intense. But let's say your cervix changed from 2cm to 3 cm in an hour's time. That means you're in labor, and you get to stay, and your doctor is probably going to let you get an epidural at that point.

A lot of studies have been done to try to find out if epidurals speed up the progress of labor or slow it down. And in real practice, what I've seen is that as long as epidurals are given at an appropriate time when you're contracting regularly, they won't slow you down. In most cases in fact, epidurals can speed you up, because you're having a hard time coping, and once your body relaxes after you get the epidural, you start to dilate.

When my patients ask me when they should get an epidural when they're contracting, I tell them that they should think about their pain on a scale from 0-10. 10 is like surgery with no anesthesia, and think about your pain when you're having a headache and want to take a tylenol for it to make sure it doesn't get out of control - that's about the same point you would want to get an epidural. So let's say you're going to take tylenol for a headache at a 4 or a 5, that's about the time you would get an epidural, and it should be just fine and not affect your labor length.

So back to your original question about when to go to the hospital if you're planning on getting an epidural. Of course we don't want you to be in torture and to hurt longer than you need to, but you are increasing your chances of being able to stay and actually be in labor if you wait till they're 3-5 minutes apart (the contractions), and it's been going on for at least 2 hours. Now also be sure to watch a few other things. If you start having any vaginal bleeding, if you feel like your water is broken, or you're not feeling your baby move at least 6 times each hour, then it's time to come to the hospital no matter what your contractions are doing. If you're contracting or not, those are reasons in and of themselves to get checked out on Labor & Delivery. Good luck with everything, and if you have any other questions for me in the future, feel free to ask them on our Facebook page at Facebook.com/IntermountainMoms, and recommend us to your friends and family too.