Medical Disclaimer: The information in this article is intended for general informational purposes only and does not constitute medical advice. Discuss the risks and benefits of an epidural with your obstetric team based on your individual health history and birth plan.
An epidural is the gold standard of labour pain relief. For many women, it is the difference between an experience they can manage and one that feels completely overwhelming. Yet the decision to have an epidural can also bring guilt or anxiety, particularly for women who hoped for a natural birth. This article gives you the facts, clearly and without judgment, so you can make the choice that is right for you.
What Is an Epidural?
An epidural is a regional anaesthetic administered by a specialist doctor called an anaesthetist. A thin, flexible catheter is placed into the epidural space in your lower back, just outside the membrane surrounding your spinal cord. Local anaesthetic and sometimes an opioid are then delivered through this catheter, blocking the nerve signals that carry pain from your uterus and cervix to your brain.
The result, for most women, is either complete or near-complete pain relief from the waist down while you remain fully awake and conscious.
How Is an Epidural Given?
The procedure typically takes 10 to 20 minutes and involves the following steps:
- You will be asked to sit on the edge of the bed and curl forward, or lie on your side in a curled position, to open up the spaces between your vertebrae
- The anaesthetist cleans the area with antiseptic and injects local anaesthetic to numb the skin
- A needle is used to guide a thin catheter into the epidural space, after which the needle is removed and the catheter is taped in place
- A test dose is given first to confirm correct placement, followed by the full dose
- It takes 20 to 30 minutes for full effect to be felt
- Top-up doses can be given through the catheter throughout labour, or you may have a patient-controlled device allowing you to self-administer additional doses within set limits
The Pros of an Epidural
Highly Effective Pain Relief
No other pain relief method comes close to an epidural for effectiveness. Around 90 percent of women who have one report significant or complete relief. For a long or complicated labour, this can be genuinely transformative, allowing you to rest, sleep, and regain the energy needed for the pushing stage.
Allows Rest During Long Labours
Labour can last many hours, and exhaustion is real. An epidural allows you to sleep between contractions during a prolonged labour, which can make the difference between a vaginal birth and a caesarean section driven by maternal exhaustion.
Can Be Used for a Caesarean
If you need an emergency or planned caesarean, having an epidural in place means the dose can be topped up to provide surgical anaesthesia, avoiding the need for a general anaesthetic in most cases.
Reduces Anxiety and Blood Pressure
For women with severe anxiety about pain or pre-existing high blood pressure, an epidural can reduce stress responses that might otherwise complicate labour.
The Cons of an Epidural
Reduced Mobility
Once you have an epidural, you will be confined to your bed or a chair. You cannot walk freely, and position changes require help from your midwife. This can slow the progress of labour by reducing the effect of gravity and the baby’s ability to rotate.
Longer Pushing Stage
Because an epidural reduces or removes the sensation of needing to push, the second stage of labour is often longer. You may need to wait until the anaesthetic wears off slightly before effective pushing is possible, or your midwife may need to guide you closely.
Higher Risk of Instrumental Delivery
Studies consistently show that epidurals are associated with a higher rate of instrumental delivery (forceps or ventouse), partly because of the longer second stage and reduced pushing sensation. This does not mean it will happen to you, but it is a real statistical increase.
Side Effects
Common side effects include a drop in blood pressure (which is routinely monitored and managed), itching, shivering, difficulty urinating (a urinary catheter is usually inserted), and in some cases a severe headache if the epidural inadvertently punctures the dura (the membrane around the spinal cord). This occurs in around 1 in 100 cases and is treatable.
Does Not Always Work Perfectly
A small number of women find their epidural is patchy, providing relief on one side but not the other, or leaving a window of sensation. In these cases, the anaesthetist can reposition the catheter or adjust the dose.
What to Expect Immediately After
Once the epidural is working, you will be continuously monitored with a blood pressure cuff and a foetal heart rate monitor. A urinary catheter will be inserted. You will need to change position regularly (with help from your midwife) to prevent the baby lying in one position for too long and to help labour progress. Many women with epidurals sleep for several hours during a long labour.
Helpful Products for Your Epidural Birth Plan
Frequently Asked Questions
Is an epidural safe for my baby?
Extensive research shows that epidurals do not cause lasting harm to babies. The medications used are not absorbed into the bloodstream in significant amounts and do not pass through to your baby in the way that systemic opioids do. Your baby will be continuously monitored throughout.
Can an epidural cause back pain?
Many women report back pain after an epidural, but large-scale studies have not found a causal link between epidurals and long-term back pain. Post-birth back pain is very common regardless of pain relief method and is often related to the physical demands of labour itself.
Can I change my mind about an epidural during labour?
Absolutely. You can request an epidural at any point during the first stage of labour. Similarly, if you had planned an epidural but labour is progressing very quickly, it may not be possible. Your birth plan should ideally include preferences but allow for flexibility.
Sources
- NHS. Epidural. www.nhs.uk
- ACOG. Labor Pain. www.acog.org
- Royal College of Anaesthetists. Epidurals for Labour. www.rcoa.ac.uk
- Cochrane Reviews. Epidural versus non-epidural or no analgesia for pain management in labour. www.cochrane.org
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