From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
It is generally not recommended to administer an epidural during the late second stage of labor (the pushing phase) or when delivery is imminent, as stated in the most recent review on epidural analgesia in labor 1. Ideally, epidurals should be placed during the active phase of the first stage of labor, when cervical dilation is between 4-7 cm. Administering an epidural too late in labor can be problematic because it takes approximately 15-20 minutes for the medication to take effect. When delivery is imminent, there may not be enough time for the epidural to provide adequate pain relief before the baby is born. Additionally, the pushing phase requires coordinated muscle effort, and a newly placed epidural might temporarily interfere with a woman's ability to push effectively. There are also practical concerns, as it can be difficult for a woman to maintain the necessary position for epidural placement during intense, frequent contractions of late labor. In emergency situations requiring immediate delivery, other pain management options may be more appropriate, such as nitrous oxide or intravenous opioids, as discussed in recent studies 2, 3. The use of epidural analgesia has been extensively studied, and while it is considered safe and effective, it is associated with longer labor, more operative intervention, and increased costs, as noted in earlier research 4, 5. However, the most recent narrative review on the topic provides the most up-to-date guidance on the use of epidural analgesia in labor, emphasizing the importance of careful consideration of the timing of epidural placement to ensure optimal outcomes for both mother and baby 1.
Some key points to consider when deciding on the timing of epidural placement include:
- The stage of labor and cervical dilation
- The likelihood of imminent delivery
- The woman's ability to maintain the necessary position for epidural placement
- The potential impact of epidural analgesia on the pushing phase and delivery
- The availability of alternative pain management options, such as nitrous oxide or intravenous opioids. Overall, the decision to administer an epidural should be made on a case-by-case basis, taking into account the individual woman's needs and circumstances, and guided by the most recent and highest-quality evidence available 1.