Epidural

An epidural is a form of pain relief that can be used during labour and birth. It works by delivering anaesthetic medicine through a very thin tube placed in your back, close to the nerves that carry pain signals. For many people it provides very effective pain relief, although it does not always remove pain completely.

Choosing pain relief can feel like a big decision, particularly if you are unsure what an epidural actually involves. You do not need to decide how you will feel about it before labour begins. You can discuss your options with your midwife during pregnancy and change your mind during labour if your circumstances or preferences change.

What is an epidural?

An epidural is a type of regional anaesthetic. Rather than making you unconscious, it reduces sensation in part of your body.

During labour, medicine is given through a small plastic tube called an epidural catheter. The catheter sits in the epidural space in your back, near the nerves that carry pain signals from the lower body.

The NHS says epidurals can provide very good pain relief during labour, although they are not always completely effective and may sometimes need adjusting.

An epidural must be given by an anaesthetist, so it is generally available in hospital obstetric units rather than at home. Availability can also differ between maternity units.

What happens when you have an epidural?

Before the epidural is inserted, a drip is usually placed in your arm.

You will normally be asked to sit and lean forwards or lie on your side. The anaesthetist cleans your back and uses local anaesthetic to numb a small area of skin.

A needle is then used to position the fine epidural catheter near the nerves in your back. The needle is removed afterwards, leaving the catheter in place so pain-relieving medicine can continue to be given.

According to the NHS, an epidural generally takes around 20 to 30 minutes to take full effect, although timing varies. If the pain relief is uneven or incomplete, the epidural may need to be adjusted.

Once it is working, your legs may feel heavier or weaker than usual. The amount of movement you have depends partly on the medicines used.

How effective is an epidural?

Epidurals are one of the most effective forms of pain relief available during labour.

The NHS says that in most cases an epidural gives complete pain relief, but it does not always work perfectly. Some people continue to feel discomfort or find that one area remains more sensitive than another.

If an epidural is not providing enough pain relief, tell your midwife or anaesthetist. They can assess what is happening and discuss what can be done.

Having an epidural also does not mean you have to experience labour in one particular way. Your care team can explain what movement, positions and other comfort measures are possible in your circumstances.

Can you move around with an epidural?

Movement varies depending on the type and strength of anaesthetic used and how your body responds.

Your legs may feel heavy, numb or weaker while the epidural is working. Some hospitals offer lower-dose epidurals, sometimes called mobile epidurals, which may allow more movement.

Even where a mobile epidural is offered, the equipment and monitoring available at your maternity unit can affect how freely you can move.

If staying mobile matters to you, ask your midwife what your local maternity unit offers before labour if possible.

What monitoring is needed?

The NHS advises that your contractions and your baby’s heart rate will need continuous monitoring after an epidural.

Your blood pressure will also be checked because epidurals can lower blood pressure. A drip is usually in place so fluids and, if necessary, medicine can be given.

Because an epidural can affect the nerves controlling the bladder, you may not feel when your bladder is full. A urinary catheter may therefore be needed.

Your maternity team will explain the monitoring and equipment being recommended and what this means for your movement and labour positions.

Can you still feel contractions and push?

The amount of sensation you have varies.

An epidural is intended to reduce pain, but you may still notice pressure or tightening. Some people can feel contractions clearly without finding them painful, while others have much less sensation.

The NHS explains that if you cannot feel your contractions, your midwife can guide you about when to push.

An epidural can lengthen the second stage of labour. Your maternity team may allow additional time for your baby’s head to descend before active pushing begins, provided you and your baby are well.

Does an epidural increase the chance of an assisted birth?

The NHS states that epidurals can prolong the second stage of labour and that forceps or ventouse may sometimes be needed to assist birth.

This does not mean that having an epidural automatically leads to an assisted birth. Labour is influenced by many factors, and your maternity team will assess what is happening in your individual circumstances.

If this is something you are concerned about, ask your midwife or obstetrician to explain how epidural pain relief may affect your labour and what options would be discussed if assistance became necessary.

What are the possible side effects?

Epidurals are commonly used and are generally considered safe, but side effects and complications can occur.

The NHS lists possible effects including:

a fall in blood pressure
heavy or weak-feeling legs
difficulty passing urine
itching
feeling sick
headache
incomplete pain relief

A headache can occasionally happen if the needle accidentally punctures the membrane surrounding the spinal cord. The NHS advises that this can be treated, so tell your maternity team if you develop a significant headache after an epidural.

Nerve damage is also listed as a possible complication, but it is rare.

Your anaesthetist can explain the benefits, common side effects and less common complications in more detail before the procedure.

Does an epidural cause long-term back pain?

Your back may feel sore around the insertion site for a short time after an epidural.

The NHS states that epidurals do not cause long-term backache. Back pain itself is common around pregnancy and after birth, which can make the timing understandably confusing.

If you develop persistent or worsening back pain, weakness, numbness or other symptoms after birth, seek medical advice rather than assuming they are simply an expected effect of the epidural.

Can you have an epidural anywhere you give birth?

No.

An epidural must be administered by an anaesthetist and requires appropriate monitoring, so it is not available during a home birth. Freestanding midwifery units also do not usually have epidural services.

Hospital obstetric units have access to anaesthetists, although availability and waiting times can vary.

If an epidural is important to your birth preferences, ask your midwife what is available at the place where you are planning to give birth and what would happen if you requested one.

Can an epidural be used if you need a caesarean?

An epidural that is already working during labour can sometimes be topped up with stronger anaesthetic if an unplanned caesarean birth becomes necessary.

The anaesthetic team will assess whether this is appropriate in your circumstances. Other forms of anaesthesia may be recommended depending on how well the epidural is working, the urgency of the birth and your clinical situation.

Your anaesthetist will explain the recommended approach if this situation arises.

Questions you may want to ask

You can ask about epidural pain relief during an antenatal appointment, when discussing your birth preferences or during labour itself.

Useful questions might include:

Is an epidural available at the maternity unit where I plan to give birth?
When during labour can I request one?
How long might I wait for an anaesthetist?
What monitoring will I need?
Will I be able to move or change position?
What are the common side effects?
What are the rare complications?
What happens if the epidural does not work properly?
How might it affect the pushing stage?
What other pain relief options are available?

You do not have to view your pain relief preference as a promise. Labour can change, and it is reasonable for your choices to change with it.

When to get professional advice

If you have questions about whether an epidural may be suitable for you, discuss them with your midwife, obstetrician or anaesthetist. This is particularly useful if you have a medical condition, take regular medicines, have previously had problems with anaesthesia, or have concerns about your back or spine. Your maternity team can assess your individual circumstances rather than relying on general information.

After an epidural, tell your maternity team promptly if you feel unwell or have symptoms that concern you. NHS guidance advises seeking medical assessment for possible epidural complications, including a severe headache after the procedure or symptoms that do not improve as expected.

If you have gone home and develop concerning symptoms after an epidural, contact your maternity unit or seek urgent medical advice through NHS 111. Call 999 if you have a life-threatening emergency.