BOOK YOUR CLASS

Epidural

The most effective pain relief in labour

An epidural is a form of regional anaesthesia that numbs your lower body, providing very effective pain relief during labour and birth. This page explains what is involved, what to expect, and the side effects to be aware of, so you can make an informed decision.

An epidural is best avoided until labour is established. This page also includes practical tips for managing labour without one for as long as you want to.

Ways to delay or avoid an epidural

An epidural is best avoided until labour is established. Many women find they cope well in early labour, and some never need an epidural at all. The following can help you manage:

  • Have a supportive partner in labour to coach you and help with contractions.
  • Use alternative positions (sitting, squatting, kneeling, leaning forward, using a birthing ball) to help your baby through the birth canal and ease back pain.
  • Use breathing and meditation techniques to cope with contractions.
  • Take it one contraction at a time. Just get through the next half hour. Don’t get overwhelmed by how long the labour might be.
  • Ask to be assessed before making a decision. You might be more advanced than you think.
  • Trust your midwife. She will guide you.
  • A warm bath or shower can be remarkably effective.

If you decide you would like an epidural, ask. The anaesthetist will come to you.

What is involved in having an epidural?

Step 1. A drip will run fluid through a needle into a vein in your arm.

Step 2. While you lie on your side or sit up in a curled position, the anaesthetist will clean your back with antiseptic.

Step 3. A small area of skin will be numbed with local anaesthetic.

Step 4. A fine needle is then used to introduce a thin tube (catheter) into the epidural space in your back. The needle is removed; the tube stays in place to deliver the medication.

Step 5. The first dose is given, and an infusion pump is set up to keep the pain relief topped up. Your midwife or the anaesthetist can give additional doses if needed.

Timings: It usually takes around 20 minutes to insert an epidural, and another 20 minutes for it to work. It does not always work perfectly at first and may need adjusting.

Your contractions and the baby’s heart rate will need to be continuously monitored once the epidural is in. You will be in bed for the duration of your labour after the epidural is inserted (the peanut ball can help with positioning).

Effects and side effects

What's good about an epidural

  • It is the most effective pain relief in labour.
  • It is not associated with a longer first stage of labour or an increased chance of caesarean birth.
  • It can be topped up by your midwife or the anaesthetist if needed.
  • It is the standard form of anaesthesia used for caesarean birth, so if you go on to need a caesarean, you are already prepared.

What to be aware of

  • An epidural may make your legs feel heavy, depending on the local anaesthetic used. However, you will still be able to change positions in labour.
  • Some women experience shivering, nausea, vomiting or itching due to some of the drugs administered.
  • About 20% of women experience some level of low blood pressure (hypotension). The fluid given through the drip in your arm helps to maintain good blood pressure.
  • A catheter may be inserted into your bladder after the epidural, as you may not feel the urge to pass urine. It is usually removed just before delivery.
  • About 1 in 100 women get a headache after an epidural. If this happens, it can be treated.
  • Your back might be a bit sore for a day or two. Epidurals do not cause long-term backache.
  • About 1 in 2,000 women feel tingles or pins and needles down one leg afterwards. This is more likely to be the result of childbirth itself rather than the epidural.
  • Epidural solutions contain opioids, which cross the placenta. In larger doses, they may make the baby drowsy and may cause short-term breathing difficulties for the baby.

After delivery

The epidural catheter may be removed before you leave the labour ward. Full sensation usually returns within a few hours.

A catheter may be inserted into your bladder again after delivery until sensation returns. You will be asked to remain in bed until sensation in both legs returns, and you must be accompanied the first time you get out of bed.

The doctor or midwife will advise you when you can move freely.

When an epidural may not be suitable

An epidural is not suitable for every woman. The following may make the procedure technically more difficult, or inadvisable:

  • A significant deformity of the spine, or previous back surgery.
  • A high BMI, which can make the procedure more challenging.
  • Certain medical problems and pregnancy complications (for example, high blood pressure).
  • Certain medications, such as anticoagulants, which affect the way your blood clots.

You may be referred to an anaesthetic consultant during pregnancy if there are any concerns about your suitability for an epidural. This is a routine antenatal consultation; many women have it and go on to receive a successful epidural.