Labor Lowdown: Everything To Know About A Walking Epidural

Giving birth with an epidural is such a weird sensation. There you lay, bits to the wind, with at least one nurse or midwife “cheering” you on and telling you to “push.” How can you push if you can’t even feel? If you’ve had an epidural, they might as well ask you to summon a unicorn. One seems as plausible as the other, no? Enter the “walking epidural.” While it’s not exactly a new concept, walking epidurals are starting to become a much more popular way to ease the pains of labor without entirely taking away the contraction and pushing sensations.

But what, exactly, is a walking epidural? What’s the difference between it and a regular epidural? And what are the pros and cons of trying a walking epidural? Let’s lay it all out.

What is a walking epidural?

Also referred to as a CSE, or combined spinal-epidural, it’s a form of pain relief administered during labor. Still fuzzy on the definition of a walking epidural? Think of it as an epidural with a lighter anesthetic that’s given less frequently. In essence, it dulls the pain of contractions without completely taking away all sensations.

A walking epidural is administered by an anesthesiologist and the entire process usually takes about 10 minutes. Before any needles are used, the back of the pregnant person is cleaned. Then the injection area is numbed with a local anesthetic. Afterward, the needle and catheter are inserted between contractions so that the pregnant person is able to sit still.

What’s the difference: walking epidural vs. traditional epidural?

The most significant difference between regular and walking epidurals is the dosage and frequency of anesthetic given to a laboring person. But, what else does that mean for the mom? What can you expect during delivery with a walking epidural versus the “real thing”?

To break it down, Scary Mommy spoke with Liesel Teen, BSN, RN — a labor and delivery nurse and the founder of the popular pregnancy, birth, and postpartum education resource Mommy Labor Nurse. “The process of receiving a traditional and walking epidural is the same for the patient,” Teen tells us. “The only difference is the placement of the needle and the medication used to numb the body.”

Here’s a closer look at each.

Traditional Epidural

Not a big fan of pain? It’s generally not a problem with a “regular” epidural since you won’t feel much of anything in your lower half. Anytime you want to shift, you need to rely on your partner or hospital staff. It’s a pretty weird feeling! But it also means you don’t feel the intense and overwhelming labor pains. You know, if you’re not into that sort of thing.

“In a traditional epidural, medication is placed in the epidural space, which is just outside of the space that contains spinal fluid and the spinal cord,” explains Teen. “A small catheter is left in the epidural space, which administers numbing and pain medication to you throughout labor. Traditional labor epidurals numb a woman’s body from her belly button down. Her legs will feel heavy, which limits the amount of moving she can do on her own.”

Walking Epidural

If the idea of not being able to tell when you need to push (or to feel the pushing, for that matter) freaks you out, you might consider a walking epidural.

“The medications used in walking epidurals are often given in lower doses, which allows women to have more flexibility when moving from one position to another,” says Teen, adding, “The medication used to numb the body is also placed into a different part of the spinal column. With a walking epidural, numbing and pain medication is placed into the spinal space of your spinal column. This allows for almost instant pain relief. Then, just like with a traditional epidural, a small catheter is left in the epidural space to deliver medication throughout labor. The needle is then removed.”

What are the benefits of walking epidurals?

Let’s face it: If you’ve ever had a regular epidural, you know that much of your laboring felt a bit like a guessing game. You had no idea what you were doing or when you were supposed to do it. That can not only make the laboring process seem a bit confusing (and maybe even terrifying), it can also slow things down.

Walking epidurals allow you to be more dialed into what’s going on with your body, leading to all kinds of benefits. According to Teen, they include:

• A walking epidural often boasts a quick onset.
• You have the greater ability to move more freely throughout labor.
• You can labor in an increased variety of positions (and frequent position changes in labor can help baby get into a more favorable birthing position).
• Labor may be shorter due to the ability to move around more easily.
• It may decrease the need for other interventions, like forceps and vacuum use.
• You may experience more effective pushing during the second stage of labor because you can feel the contractions.

What are the cons that come with walking epidurals?

Perhaps the biggest con of a walking epidural is that it’s simply a misnomer. In most instances, hospitals still won’t allow you to get up and walk around, even with a “walking” epidural. You’ll still be clumsy, and the medications will diminish much of your feeling in your lower half. As such, getting up and milling about can cause quite the safety risk. So, yup, you’ll still be mostly stuck in bed — but at least you’ll be able to move around better and experience the more “natural” parts of birth when you feel the contractions.

Teen says some of the other potential cons, depending on personal preference, include:

• The medication administered isn’t as strong, so you will continue to feel pain with contractions as your labor progresses.
• The same risks that apply for traditional epidurals apply for walking epidurals as well (decrease in blood pressure, the epidural may not work, itching and shivering, epidural fever, back pain, nausea).
• Because the walking epidural needle is placed into the spinal space, there is a greater chance of experiencing a spinal headache after delivery.
• Even though it is called a “walking epidural,” most women are not allowed to walk around after it is administered. Many hospitals prohibit women with walking epidurals from walking around for safety reasons.
• Getting an epidural, walking or traditional, can mean a slightly long labor. According to a recent study, there is sometimes a two-hour difference during the second stint of labor between the women who get an epidural and those who don't. The second stage of labor is usually when mamas have to push.
• Epidurals take a little time to wear off and sometimes last even after you give birth. So if you want to be active and mobile post birth, an epidural may not be for you because there might be some numbness.

Do you have to get a catheter with a walking epidural?

Even with a “walking” epidural, catheters are almost always required. As mentioned above, opting for a walking epidural doesn’t mean you get to get up and walk around. As such, you’ll need a catheter placed to help drain your urine and keep you clean(-ish) during labor. Catheters seem terrifying, right? If they can be placed after your epidural kicks in, though, you’ll be glad to have one less thing to worry about as you labor for the next 6, 12, or 24 hours.

How long does a walking epidural last?

A walking epidural can last a very long time. In fact, if the catheter is inserted properly and you're given a proper dosage of medication, it can last up to five days. Thankfully, labor doesn't usually take that long, so you can count on a walking epidural to last as long as you need it to.

Why haven’t I heard about this before?

Many hospitals and health care providers simply don’t offer them — although it’s unclear why hospitals don’t make walking epidurals more readily available. Teen believes it could be because many laboring moms “end up converting their walking epidural to a full epidural so they can have complete relief from the pain of labor.” In other words, most pregnant people choose to go the natural route, want total relief from the start, or wind up deciding along the way that contractions aren’t their jam.

Teen’s advice? Ask your doctor about all of your options upfront. “I always recommend talking to your provider during prenatal appointments to discuss what options are available for pain relief during labor. As mentioned, not all hospitals provide the same pain relief interventions, so it’s important to know what your options are so you can make an informed decision before you give birth,” she recommends.