Epidural

What is an epidural?

An epidural is a procedure that injects a local anaesthetic into the space around the spinal nerves in your lower back.

This anaesthetic usually blocks pain from labour contractions during birth very effectively. With an epidural you can usually still push your baby out when you need to.

An epidural is usually done by an anaesthetist.

What does an epidural involve?

Before an epidural, you will usually have a drip for fluids put into your arm.

You will need to sit up and bend forward over a pillow, or lie on your side curled up into a ball. This makes it easier to insert the needle into the right place. It is important that you stay very still during the procedure to avoid complications.

Your lower back will be washed with antiseptic. A small amount of local anaesthetic will be injected into the skin of your lower back. Your anaesthetist (specialist doctor) will insert the epidural needle between contractions, so it is important that you tell them when you have a contraction. The needle will be inserted between the bones of your spine into the space around your spinal nerves.

A small soft plastic tube will be inserted, and the needle removed. The plastic tube delivers the anaesthetic that will numb your pain.

It usually takes between 5 and 30 minutes for the epidural to relieve your pain.

When can I have an epidural?

Usually, if you have an epidural to help you give birth, you will have it during the first stage of labour. You can also have an epidural at any stage of labour.

Who can have an epidural?

Most people can safely have an epidural, but there are some medical reasons that mean it is not possible. It’s a good idea to think about your options for pain relief before the birth. Discuss these with your doctor or midwife, who can help you decide between options that are suitable for you.

Epidurals are available at most hospitals, but not in birth centres or during home births.

What are the advantages of an epidural?

Epidurals have many advantages:

• They are usually very effective.
• They are generally very safe.
• After an epidural, you may still be able to move around in bed and push when you need to.
• If you have a long labour, an epidural allows you to sleep and recover your strength.
• If you're having a caesarean, you can stay awake and your partner can be there.

What are the disadvantages of an epidural?

If you have an epidural, you will usually develop some temporary weakness in your legs. This means that you will need to stay in bed to avoid falls.

Since epidurals can cause low blood pressure, you will need to have your blood pressure monitored. You might also need to have fluids given to you through a tube in your arm.

You will also usually need a catheter (tube) in your bladder to help you pass urine, as an epidural can make you lose feeling in your bladder.

Your baby will need to be closely monitored during your labour.

Having an epidural does not make it more likely that you will need a caesarean section. However, it may slow down the second stage of labour, and increase your chance of needing an assisted delivery.

What are the risks of having an epidural?

An epidural is effective and generally safe. But there are some risks:

• Some people feel cold or itchy.
• A small number of people get little or no pain relief.
• Some people develop a bad headache 24 to 48 hours after an epidural.
• There is a small chance of developing an infection.
• Very rarely, an epidural can cause permanent nerve damage.

Epidurals do not directly affect your baby.

What should I ask my doctor or midwife about having an epidural?

You can check:

• If you can have an epidural at your chosen hospital or birth centre.
• What their epidural procedures are.
• If there are any extra costs or fees involved.
• The type of pain relief that might suit your personal circumstances best.