If you want to have a VBAC, do you need to have an epidural? Does a VBAC with epidural raise your risk of a repeat C-section?

Many of our doula clients and VBAC community members have told us their provider said they could only TOLAC/VBAC if they have a “just in case” epidural. 

If you have ever been told this, you have come to the right place. This article brings together all the research on VBAC and epidural, including whether it’s safe and how it affects VBAC success rates. 

You’ll also find lots of information on what it’s like to have a VBAC with and without an epidural, so you can make an informed decision with your provider.

Is it safe to have an epidural for VBAC?

Safety is a significant concern with all things in life, and when it comes to making birth decisions, it’s often the first thing on parents’ minds. 

So is it safe to have an epidural and VBAC? The simple answer is yes. 

It is safe to receive epidural anesthetic during labor to help decrease labor sensations during a contraction. The Royal College of Midwives explains that epidurals have been used since 1853; however, it wasn’t until 1942 that they started being used for parents in labor. 

Epidurals are placed and given in the lower epidural space of the mom’s back. Once the epidural is in place, they have a pump to manage what dose goes into the area at a time. 

Epidurals during labor have come a very long way over the years. When I had my first child, my epidural was so incredibly strong that I could not feel anything or even move. I received an epidural at 3 cm dilation, and when my nurse came in to check me, my leg fell over and almost pulled me off the bed because it was so heavy. 

As I work in the birthing community, I see many epidurals given, and they are now much lighter than my earlier experience. My clients can move their bodies better than one would think. I even had one client push with an epidural in a squatting position. Of course, we offered assistance, but she was able to feel enough without feeling the sensations labor was bringing. 

Although epidurals are considered safe to use when going for a VBAC, there are some risks and pros and cons. You can read more about the pros and cons of receiving an epidural and going unmedicated in our post on the benefits of a natural birth.

Epidural & C-section rates

Does having an epidural lower your chances of having a VBAC? 

Studies have shown that women are 2.5 times more likely to have a C-Section when receiving an epidural. 

An epidural blocks the nerve endings, creating less feeling in the lower half of the body. When we tell our body not to feel, our bodies can react by slowing down a little, and taking some time to process what happened. For example, if you were to trip and fall on the ground, a typical instinct is not to jump right up. You stop and sit for a moment to process what just happened. 

Having an epidural makes it harder to move freely, and that also may be the cause of a slower labor pattern. If labor slows, it leads to a higher chance of your medical team using a synthetic version of the hormone oxytocin, called Pitocin. Oxytocin can help speed up labor, causing the body to contract. Pitocin has been shown as a safe option for VBAC, but is a concern for many providers. 

Many providers are not comfortable with VBAC induction. If the baby is not birthed by a certain week, they will suggest scheduling a repeat C-Section vs. offering a TOLAC, even though it is known to be a safe option when used gently.  

If your provider does not offer a Pitocin induction, they have the option of breaking the bag of waters. Although it may seem like a more natural option, breaking the bag of waters can be less ideal than you would think. 

If a baby is high up in the pelvis or in the wrong position when the bag of waters is released, this may cause the baby to come down in a funky position, cord prolapse, and raise the risk of infection to the mother and baby. These events can also result in the need for a c-section. The body typically releases the membranes on its own when it is ready. If water breaks before the body is prepared, there is simply no way to confirm that labor will progress in the desired way. 

Because it may be possible that an epidural slows labor down after receiving it, it’s encouraged to hold out as long as you can before getting one. I know many people who have received an epidural and still gone on to have a VBAC. 

If the body is in an active labor pattern before receiving anesthesia via an epidural, it may help labor continue to progress without further intervention. In this case, it can decrease the likelihood of the epidural slowing down the labor pattern. 

Alternatives to epidural for VBAC

When looking into everything you can do to have a successful VBAC, many parents wish to avoid having an epidural. They may decide they want to labor at home, or desire an unmedicated birth.

If you are planning a VBAC home birth, you won’t have access to an epidural.

In that case, there are other options to help with pain management during labor. One of the biggest things we suggest to parents is doing your research on what is best for you. 

Remember, there is no wrong way to labor, and it is essential to not feel in any way less of a person if you change your mind about having an epidural along the way. Things don’t always go according to your VBAC birth plan, and it’s your choice. 

These are some other ways to cope during labor, other than receiving an epidural:

• Counter pressure from your support person(s): Receiving counter pressure on the hips, back, sacrum, or knees may eliminate some of the intensity during a contraction’s peak.
  
• Water: Taking a bath or shower has been described as nature’s epidural by many moms.
  
• Changing positions: This not only helps with the progression of labor but also helps with coping. A baby may be in a position that intensifies contractions more than it would in others, so changing things can help take some of that discomfort away.
  
• Fentanyl: This is an opioid that can be used in a hospital setting, administered during labor via IV. It is shown that it is safe to use during labor. Fentanyl typically offers a 30-45 minute “rest,” taking the edge off. You can receive multiple doses, but a provider must approve it. Fentanyl does travel to the baby and can make them sleepy. Because of this, providers are less likely to give it close to or during transition.
  
• Hire a doula: There are many benefits of hiring a doula. A doula is trained in supporting birth and usually has been trained on how to help get a baby into a more ideal position. When a baby is in a good position, this can shorten labor and sometimes decrease the intensity.  

Everyone copes differently in labor, and it is vital to prepare once you know the desired route you would like to take. With labor comes intense contractions, which can sometimes bring tension to the woman in labor. Labor can stall due to stress or inability to relax. An epidural may be ideal for someone who is tired or has contractions creating tension that’s too much to cope with at that moment.

As a doula, I once worked with a client who wanted to go unmedicated, and in fact, she planned a home birth for her VBAC2C. After laboring on and off for five days, she and her team of trained midwives discussed her options. They decided it would be best to go to the hospital and receive some deeper help with an epidural. 

Once she received the epidural, her body was able to get some much-needed rest and release some tension. She pushed out her sweet baby girl vaginally, achieving the VBA2C birth she was hoping for. You can hear this and many more VBAC stories on The VBAC Link podcast. 

Bottom Line on VBAC and Epidurals

The medical community has not found specific evidence that epidural analgesia necessarily lowers the chances of successful VBAC. In fact, VBAC with epidurals are considered safe and compatible.

I believe that epidurals can be a fantastic tool in our toolbox. Either way, always assess the situation in real-time as it unfolds and choose what’s best for you and your birth journey.

If you want to learn more about all the factors that can influence your VBAC, including finding a supportive provider and preparing mentally and physically, check out our VBAC course for parents! We made this course for parents like you, to help you make informed, confident decisions about your birth.