Epidural: What Is it?

As you count down to the big day when you’ll finally get to meet your baby, you may be thinking about your pain relief options for labour. A common method you might have heard about is the epidural injection.

Read on to find out exactly what an epidural is, how it works, and what the risks and side effects can be.

What Is an Epidural?

An epidural is one of the pain management options that may be available to you during labour.

The biggest benefit of an epidural anaesthesia is that it allows you to remain alert and awake throughout labour and delivery while eliminating all or most of the pain by blocking the nerves that carry pain signals from your lower abdomen and birth canal.

Once you’re on the epidural, you can still move and push. How much you’ll be able to move your legs while the epidural is acting depends on the type of anaesthetic that’s used. At some maternity units you may be offered a ‘mobile epidural’, which allows you to walk around during your labour.

If you think you might like to have an epidural or want to know more about your options, talk to your midwife or doctor about what is available at the hospital or birthing centre where you plan to give birth.

If you’re working on a birth plan, you might like to include your pain relief preferences. It’s also a good idea to discuss how you feel about the various options with your birth partner or doula if you have one.

Of course, when the time comes, it’s perfectly OK to change your mind. Just let your midwife or doctor know.

When Is an Epidural Given?

Usually, you can ask for an epidural at any time after your midwife or doctor has confirmed that you are in labour. Keep in mind that it can take up to 25 minutes for the pain relief to fully take effect. Talk to your midwife or doctor about what timing could work best for you.

You may be offered or advised to have an epidural if your labour is induced, because the contractions can be more painful in this case.

Epidurals are sometimes used during caesarean sections, too. For example, you may be given an epidural during a planned vaginal delivery only to find out that you’ll need to undergo a caesarean section. In this case, with the epidural catheter already in place, your anaesthetist can administer a stronger dose of anaesthetic to prepare you for surgery.

Alternatively, a quick-acting spinal block may be given if you have an unscheduled caesarean section and you haven’t already been given an epidural.

Labour isn’t the only time when you may be given an epidural. If your little one is in the ‘breech’ position (that is, he or she has not turned head down in readiness for birth) by the time you’re around 37 weeks pregnant, you may be offered a procedure called ECV, or external cephalic version. This is where your doctor or midwife attempts to turn your foetus around by applying gentle but firm pressure to your uterus.

If this is unsuccessful the first time, a second attempt may be made after administering an epidural, as this can help relax your uterus to make turning your foetus easier and less uncomfortable for you.

How Is an Epidural Given?

Before you’re given the epidural, a drip will be attached to your arm so you can easily be given fluids while the epidural is being administered.

You’ll be asked to sit down leaning forwards, or on your side with your knees pulled up. A small area on your lower back will be cleaned and numbed using a local anaesthetic.

Then, an anaesthesiologist will use a needle to insert a very fine tube – called an epidural catheter – into the space between the bones of your back.

The pain relief medication is delivered through this catheter, which remains in place during your labour and delivery. You won’t need another injection once the epidural catheter is in place.

When Does an Epidural Start to Work?

Preparing the epidural can take around 10 minutes, and then it takes about another 10 to 15 minutes for the anaesthetic to take effect.

Your midwife can adjust the amount of medication as you need it, meaning the pain relief can last as long as you need it to.

In some hospitals, you may be able to control your own dosage by pressing a button programmed to release safe amounts of anaesthetic at your command throughout your labour.

Epidural Risks and Side Effects

Are epidurals safe? This is something every mum-to-be will want to know. Epidural anaesthesia has a low level of risk, but it’s still worth being aware of some of the potential side effects and complications. These include:

  • Reduced blood pressure (this is rare, however, because the fluids you receive through the drip in your arm help prevent a drop in your blood pressure)

  • Feeling sick

  • Soreness or tenderness at the injection site

  • Back pain

  • Temporary loss of bladder control, or difficulty peeing

  • A headache

  • Itchy skin

  • Labour lasting longer than it might without an epidural.

In very rare cases epidural anaesthesia can lead to temporary or lasting nerve damage. Ask your midwife or doctor for personalised information about the possible epidural after-effects, risks and benefits of this kind of pain relief in your case so you can weigh up your options together.

Does Getting an Epidural Hurt?

Having an epidural needle and a catheter inserted into your lower back may sound painful; but before the epidural goes in, you’ll be given a local anaesthetic to block this pain. It’s also reassuring to know that this procedure is done by a highly skilled anaesthetist, so you’ll be in the best hands.

Other Types of Pain Relief During Labour

An epidural is one of several types of regional anaesthesia you may have access to during your labour. Other types include spinal anaesthetic and combined spinal-epidural anaesthetics.

Your midwife and doctor can help you decide which type might be right for you depending on various factors, including whether you plan to give birth vaginally or by caesarean section.

  • Spinal anaesthetic. In this case, the anaesthetic is injected directly into the spinal fluid in the spinal cord. It generally takes effect more quickly than an epidural, but the pain relief wears off more quickly, too (usually after one to four hours), because there is no catheter in place to continuously administer the medication.

  • Combined spinal-epidural (CSE) anaesthetic. As its name suggests, this method of pain relief can give you the benefits of both the spinal and epidural anaesthetics. The spinal is given first to provide fast pain relief, and the epidural catheter is inserted later to ‘top up’ the pain relief if it starts wearing off too early, or to continue easing pain or discomfort after you give birth if necessary.

There are other medical and non-medical types of pain relief you can try, too. You may have learned about some of these in childbirth classes. These labour comfort measures can usually be used whether you’ve had an epidural or not. Some of these options include:

  • Hypnobirthing. This is a relaxation technique that can help reduce fear, anxiety and pain during labour.

  • Massage therapy. Your birthing partner can gently massage your lower back or shoulders, which may help relieve some of the pain of contractions.

  • Breathing exercises. Controlled breathing can also help you relax and manage pain during labour.

FREQUENTLY ASKED QUESTIONS

  • Your doctor may advise against an epidural if you
    • have had major surgery on your lower back
    • take blood-thinning medication
    • have a blood clotting disorder.
  • First, a spot on your lower back will be numbed using a local anaesthetic. Then, a tiny tube called a catheter is inserted into your lower back with a needle. The needle is removed and the epidural medication flows through the tube to be absorbed by several nerves in your lower back.
  • The epidural helps to manage labour pains, but you may still be able to feel contractions. You’ll be awake and alert, but you may not be able to walk around once the epidural medication takes effect.
  • For an epidural, a tube is inserted into your lower back and remains there during your labour and delivery. After about 20 minutes, the pain starts to go away, and the pain relief is continuous.

    With a spinal block, the pain medication is administered as an injection directly into the spinal fluid. The pain relief starts sooner but may only last a few hours.
  • As long as you need it to last. The midwife can top up your medication through the catheter as needed throughout your labour. Sometimes you may even be able to control the amount of pain relief yourself.

Whether you’re nearing full term of your pregnancy or just planning well in advance, it’s never to soon to explore all the pain relief options available to you to find the one you feel most comfortable with. And know that you can always change your mind, even once you’re in labour.

For some mums-to-be, an epidural is the best option, while others may also consider alternative ways to be more comfortable during labour.

Although giving birth can seem daunting and there’s a lot to think about, before you know it your baby will be home and you’ll already be focused on what comes next.

How we wrote this article
The information in this article is based on the expert advice found in trusted medical and government sources, such as the National Health Service (NHS).
The content on this page should not replace professional medical advice. Always consult medical professionals for full diagnosis and treatment.