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What is an epidural?
An epidural is a way of giving pain relief during labour. A very thin, soft plastic tube (a catheter) is placed in your lower back, near the nerves that carry pain signals from your womb. A mixture of local anaesthetic and a small amount of an opioid medicine is given through the tube.
The aim is to numb the pain of contractions while you stay awake and alert. You will usually still feel touch and some pressure. An epidural does not make you sleepy.
Before you decide
- You can ask for an epidural at any stage of labour. Your midwife will contact the anaesthetist.
- Sometimes there is a wait, for example if the anaesthetist is looking after another woman or an emergency.
- An epidural may not be suitable if you take blood-thinning medicines, have a bleeding problem, a low platelet count, an infection in your back or blood, or some spinal conditions. Tell your team about these in pregnancy if you can.
- Blood tests are sometimes needed first. The anaesthetist will talk with you about the benefits and risks and ask for your agreement.
How it is put in
- A drip (cannula) is placed in your hand or arm so fluids and medicines can be given if needed.
- You sit on the edge of the bed leaning forward, or lie on your side curled up. Your midwife or support person helps you get into position.
- Your back is cleaned with a cold antiseptic. A small injection of local anaesthetic numbs the skin. This stings briefly.
- A needle is placed between the bones of your lower back and the thin tube is passed through it. The needle is then removed, leaving only the soft tube, which is taped to your back.
- The medicine is started. Pain relief builds up gradually. How long it takes varies from person to person.
It helps to keep as still as you can while the tube is put in. Tell the anaesthetist when a contraction is starting, so they can pause.
What it feels like
- While it is put in, most women feel pressure or pushing in the back rather than pain.
- You may feel a brief tingle or electric feeling down one leg. Tell the anaesthetist if this happens, but try to keep still.
- Once it is working, your tummy and legs may feel warm, heavy or numb. Many women can still move their legs.
- Some women feel itchy or shivery. These usually settle and can be treated.
Your labour and pushing
Once you have an epidural:
- Your baby's heart rate is usually monitored continuously, and your blood pressure is checked regularly.
- You may not feel when your bladder is full. A small tube (urinary catheter) may be used to empty it.
- Whether you can walk around depends on how strong your legs feel and on the hospital's policy. You can usually change position in bed.
- What you can eat and drink in labour depends on your hospital and your situation. Your midwife will tell you.
Effects on labour
- An epidural does not make it more likely that you will need a caesarean.
- It may slow the pushing stage (second stage) of labour a little.
- Repeated stronger doses can make your legs weak. With the low-strength mixtures used today, an epidural does not clearly make a forceps or ventouse (suction cup) birth more likely.
- You may feel less of an urge to push. Your midwife will guide you when it is time.
- Backache after the birth is common after any pregnancy. It is not caused by an epidural.
Top-ups
The medicine is usually given by a pump. Many hospitals use a pump that gives regular doses, often with a button you can press for an extra dose. The pump has safety limits set by the anaesthetist, so you cannot give yourself too much.
Tell your midwife early if:
- the pain is coming back, or you can feel contractions on one side only
- your legs feel very heavy or numb
- you feel unwell, very itchy or light-headed.
The anaesthetist can adjust the dose, give a top-up, or sometimes take the tube out and put in a new one.
Side effects and risks
Serious problems from an epidural in labour are rare. The figures below are from the Obstetric Anaesthetists' Association (UK) information for women having an epidural in labour.
| Side effect or risk | How often |
|---|---|
| A significant drop in blood pressure | Common, about 1 in 50 |
| Not working well enough, so other pain relief is needed | Very common, about 1 in 8 |
| Not working well enough for a caesarean, so a general anaesthetic is needed | Common, about 1 in 20 |
| Severe headache | Uncommon, about 1 in 100 |
| Nerve damage (a numb patch on a leg or foot, or a weak leg) that gets better | Rare, about 1 in 1,000 |
| Permanent nerve damage | Very rare, about 1 in 13,000 |
| Epidural abscess (infection) | Very rare, about 1 in 50,000 |
| Meningitis | Very rare, about 1 in 100,000 |
| Epidural haematoma (blood clot) | Very rare, about 1 in 170,000 |
| Accidental unconsciousness | Very rare, about 1 in 100,000 |
| Severe injury, including being paralysed | Very rare, about 1 in 250,000 |
How often words used on this page: very common means more than 1 in 10; common 1 in 10 to 1 in 100; uncommon 1 in 100 to 1 in 1,000; rare 1 in 1,000 to 1 in 10,000; very rare fewer than 1 in 10,000. Figures are averages from published studies. Your own risk depends on your health and is discussed with you.
Headache
Occasionally the needle makes a small hole in the fluid sac around the spinal nerves. This can cause a headache that is worse when you sit or stand and eases when you lie flat. Tell your midwife if this happens. It can be treated. If it does not settle, a procedure called a blood patch may be offered.
Other common effects
Itching, shivering, feeling sick, a raised temperature and difficulty passing urine can all happen. They can usually be treated.
Other types of pain relief
An epidural is one choice among several. You can use more than one, and you can change your mind.
- Self-help: moving and changing position, warm water (shower or bath), massage, breathing techniques.
- TENS: a small machine with pads on your back that gives a tingling feeling.
- Nitrous oxide ("gas"): breathed through a mouthpiece during contractions. It can make you feel light-headed or sick.
- Opioid injections: can take the edge off the pain. They can make you drowsy or sick, and can make your baby sleepy at birth.
Ask your midwife or obstetrician which options your hospital offers.
If you need a caesarean
If you already have an epidural that is working well and you need a caesarean, a stronger local anaesthetic can usually be given through the tube. This numbs you enough for the operation while you stay awake. You will feel pulling and pressure, but you should not feel pain.
The anaesthetist checks the numbness carefully before surgery starts. If the epidural is not strong enough, a spinal anaesthetic or a general anaesthetic may be used instead. In an urgent situation, a general anaesthetic is sometimes the safest choice. The anaesthetist will explain what is happening.
See anaesthesia for caesarean birth for more.
After the birth
- The tube is removed by your midwife. This does not hurt.
- Feeling and strength come back gradually. How long this takes varies. Have someone with you the first time you get out of bed.
- Your back may feel a little tender or bruised where the tube was. This usually settles.
- The medicines used in an epidural do not stop you from breastfeeding.
- numbness or weakness in your legs that is getting worse, or that has not gone when you were told it would
- new or worsening back pain, especially with a fever or redness at the site
- a severe headache, particularly one that is worse when you sit or stand
- problems controlling your bladder or bowels.