Shivering After an Epidural: Why It Happens and What Helps

Shivering after an epidural is one of the more common things moms feel during labor, and it usually passes. It can come on soon after the medication starts and it can look dramatic from the outside. The American College of Obstetricians and Gynecologists lists shivering among the known side effects of an epidural, alongside things like itching and a drop in blood pressure. In most cases it's a response your body has to the medication and to labor itself, not a sign that something is wrong.

If you're reading this in the middle of labor, here's the short version. Your anesthesia team has seen this many times. They're already watching for the smaller number of situations where shivering matters more, and they have simple tools that tend to help.

#How Common Is Shivering With an Epidural?

Quite common. In an early survey of 200 moms who had an epidural in labor, half shivered soon after the first dose of medication. A review of 21 studies of spinal and epidural anesthesia, mostly for surgery, found a median of 55% of patients shivering in the comparison groups that got no preventive treatment. For cesarean birth under a spinal or epidural, a narrative review of perioperative shivering puts the reported range at 29 to 54%. The exact number depends on the technique and the study, but the overall picture is that shivering is far closer to expected than to unusual.

In that same labor survey, most moms who shivered saw it as a minor symptom, and only 13% described it as very irritating.

#What's Actually Happening When You Shiver After an Epidural

A few things can drive shivering during labor, and often more than one is at play at the same time. Researchers are still working out the full picture, so think of these as the leading explanations rather than a settled answer.

The first is how your body manages temperature when an epidural is working. The block affects more than pain nerves. According to the review of shivering during cesarean birth, neuraxial anesthesia impairs your body's temperature control and lowers the temperature at which shivering kicks in, and the effect is stronger with a dense spinal than with an epidural.

The second is the movement of heat inside your body. The medication relaxes blood vessels in the parts of your body where it's working. That same review describes how warm blood from your core moves out toward your skin, where heat is lost more easily, and calls this redistribution the main reason body temperature drops during spinal and epidural anesthesia.

The third is labor itself. A study of moms in labor, some with an epidural and some with opioid pain medication instead, saw shivering-like tremor both before and after delivery. Higher pain scores were linked to more shivering, and some of the tremor happened while moms had a normal temperature and were not showing the usual signs of being cold.

That last point matters. Shivering with an epidural is not always tied to a measured drop in temperature. An older study of moms with labor epidurals found that core temperature did not change significantly even though 46% of them shivered, and a review of shivering after anesthesia notes that it can happen in patients whose temperature is normal.

None of these mechanisms mean the medication is doing something wrong. They mean your body is responding to a real change.

#Do You Still Get the Labor Shakes With an Epidural?

You can, and the shakes are not only an epidural thing. In the older study of moms in labor, 11 of 24 moms with an epidural shivered, and so did 1 of the 9 moms without one. The numbers are small, but they fit with the labor study above, which concluded that shivering around birth has more than one cause.

Shaking can also show up near the end of labor and right after birth. Cleveland Clinic describes postpartum chills as shivering that usually starts within a couple of hours of birth and can begin toward the end of labor. It can happen after a vaginal or a cesarean birth, and even in a warm room. The cause isn't fully understood, though fluid or heat loss and hormone changes may play a part. If your shaking continues after your baby arrives, this guide to shaking after giving birth walks through that stretch.

What's less clear is how much of the shaking in any one mom comes from the epidural and how much comes from labor and birth. The studies can show that both are involved, but they can't sort it out for an individual.

#How Long Does Shivering After an Epidural Last?

There isn't one reliable number for shivering during labor, and it varies from mom to mom. What the research does show is that it responds to treatment. In a small trial within that labor survey, a dose of medication through the epidural stopped or clearly reduced shivering within ten minutes in every mom who received it.

For shaking after birth, the Cleveland Clinic article notes that it passes and rarely lasts longer than an hour after delivery. If it's going on longer than you expected, or it's keeping you from resting, let your nurse know.

#Is Shivering Ever a Warning Sign?

Most of the time, it's not. The shivering is uncomfortable, sometimes startling, and usually short. Still, it's worth knowing about the times it can matter more.

Some moms who labor with an epidural develop a fever during labor, sometimes called epidural-related maternal fever. A review in the American Journal of Obstetrics & Gynecology estimates it affects 15% to 25% of moms who receive a labor epidural. It's thought to be mostly non-infectious, likely linked to inflammation, but that review also notes it can't easily be told apart from an infection of the uterus and membranes, so any fever in labor gets checked and treated as needed.

That's why your team monitors your temperature, your blood pressure, and your baby's heart rate throughout labor. The shivering itself is not the alarm. The pattern around it, like your temperature trend, how you feel overall, and how your baby is doing, is what your team is reading.

Cleveland Clinic draws a useful line here. Teeth-chattering shivering, like you just stepped outside in the cold, is typical of postpartum chills. Flu-like chills with an ache you can feel in your bones can mean a fever, which can point to an infection. Either way, the advice is the same: tell your doctor or nurse so they can check your temperature.

If you start to feel unwell along with the shivering, especially with a fever, increasing pain in a new place, or a sense that something has shifted, say so. That's not overreacting. That's exactly the kind of update that helps your team move quickly if it needs to.

#What Your Anesthesia Team Does to Make It Better

The first move is usually comfort and warmth. The cesarean shivering review recommends warm blankets or a forced-air warming blanket (one that blows warm air over you), a comfortable room temperature, and warmed IV fluids, noting that these have very few side effects. Warming tends to work better the earlier it starts and the longer it's used.

If shivering is intense and not easing, medication is an option. A review of shivering after surgery describes forced-air warming combined with IV meperidine, an opioid, as the best supported approach in that setting, and a dose of the same medication given through the epidural helped in the labor survey. For cesarean birth, adding a small amount of fentanyl to the spinal can lower the chance of shivering, according to a systematic review and network meta-analysis. Because many medicines reach your baby through the placenta, the cesarean review notes that anti-shivering drugs are often given through the epidural or spinal, or saved for after birth. Your team will weigh which option, if any, fits your situation.

Your team is also watching your numbers the whole time. They're noting whether your temperature is climbing, how your blood pressure is reading after the epidural, and how your baby is tolerating everything. The shivering is one piece of information among many, and on its own it rarely changes the plan.

#What You Can Do (and What Your Partner Can Do)

A few practical things tend to help:

• Tell your nurse or anesthesia team that you're shivering, even if you assume they can see it. They can bring warming faster if they know it's bothering you.
• Ask for a warm blanket, or a warming blanket if your hospital has one. Warming is the first step the research points to.
• Don't fight it. Cleveland Clinic suggests not trying to force the shivering to stop, especially after a cesarean, where straining against it can put stress on your incision. Relaxing into it and letting it pass is usually easier.
• After your baby is born, a blanket and a warm drink can be comforting, as the National Childbirth Trust notes. During labor, check with your team before eating or drinking anything.

If you have a partner with you, this is a great moment for them to step in. They can ask for the warm blanket, tuck it around your shoulders so you stay covered, and let your nurse know if anything else feels different. Small, calm steps from someone you trust can make the shivering easier to ride through.

#The Reframe

Shivering after an epidural can look like an emergency from the outside, and feel like one from the inside. It usually isn't. In most cases it's a physical response to a medication that's doing its job, in a body that's also working very hard at the same time.

If the shivering is bothering you, that's reason enough to speak up. If you feel a real change in how you're doing overall, that's a reason to speak up even faster. In between, the right frame is the one your team is already using: this is something to watch, comfort, and ride through, not something to fear.