Epidural analgesia

Epidurals can be slow to work, especially if you have been given on one late in labour. If the painkillers are injected into the bag of fluid surrounding the nerves in your back, they work much faster. This is called a spinal. Unlike an epidural, it is given as a one-off injection without a catheter. If an epidural catheter is put in at the same time, this is called a combined spinal-epidural.

In some hospitals, a combined spinal-epidural may be given to most women who ask for an epidural for stronger pain relief. In other hospitals, a combined spinal-epidural is only used for a selected number of women who may benefit most from this particular type of epidural.

Most people can have an epidural, but certain medical conditions (such as spina bifida, a previous operation on your back or problems with blood clotting) may mean that it is not suitable for you. The best time to find out about this is before you are in labour. If you have a complicated or long labour, your midwife or obstetrician may suggest that you should have an epidural as it may help you or your baby.

If you are overweight, it may take longer to put in an epidural. Once it is in and working, you can have all the benefits.

First, a cannula (a fine plastic tube) will be put in a vein in your hand or arm, and you will usually have a drip (intravenous fluid) running as well (you may also need a drip in labour for other reasons, such as to give you medication to speed up your labour or to treat you if you are feeling sick).

You will be asked to curl up on your side or sit bending forwards, and your anaesthetist will clean your back with an antiseptic solution. Your anaesthetist will inject local anaesthetic under your skin, so that putting in the epidural does not usually hurt much.

The epidural catheter is put into your back to be near the nerves in your spine. Your anaesthetist has to be careful not to puncture the bag of fluid that surrounds your spinal cord so to avoid you getting a headache afterwards. It is important to keep still while the anaesthetist is putting in the epidural, but after the epidural catheter is stuck into place with a dressing and tape you will be free to move. Once the epidural catheter is in place, you will be given painkillers through it.

It usually takes about 20 minutes to set up the epidural and 20 minutes for it to give pain relief. While the epidural is starting to work, your midwife will take your blood pressure regularly. Your anaesthetist will usually check that the epidural painkillers are working on the right nerves by putting an ice cube or cold spray on your tummy and legs and asking you how cold it feels. Sometimes, the epidural doesn’t work well at first and your anaesthetist needs to adjust it, or even take the epidural catheter out and put it in again.

During labour, you can have extra doses of painkillers through the epidural catheter either as a quick injection (a top-up), a slow, steady flow using a pump, or with a patient-controlled epidural analgesia (PCEA) pump. With patient-controlled epidural analgesia, you can give yourself doses of the painkiller when you need them by pressing a button attached to the pump.

In each hospital there will usually only be one, or possibly two, of these methods for keeping the epidural pain relief going.

After each epidural top-up, the midwife will take your blood pressure regularly in the same way as when the epidural was started.

A mobile epidural is where the pain of labour is reduced without making the lower part of your body very numb or making your legs feel weak. The epidural cannot be adjusted exactly, so if you want to have some feeling when your baby is delivered, there is more chance that you may have an uncomfortable sensation during labour as well.

Having an epidural should not affect the condition of your baby when it is born, in fact newborns are less likely to have acid in their blood. Having an epidural does not make it any harder to breastfeed.

Sources:

• Anim-Somuah M, Smyth R, Howell C. Epidural versus non-epidural or no analgesia in labour. Cochrane Database of Systematic Reviews 2005, Issue 4. Article number: CD000331. Date of issue: 10.1002/14651858.CD000331.pub2.

• Reynolds F, Sharma S, Seed PT. Analgesia in labour and funic acid-base balance: a meta-analysis comparing epidural with systemic opioid analgesia. British Journal of Obstetrics and Gynaecology 2002; 109: 1344-1353.

• Wilson MJA, MacArthur C, Cooper, GM, Bick D, Moore PAS, Shennan A. Epidural Analgesia and breastfeeding: a randomised controlled trial of epidural techniques with and without fentanyl and a non-epidural comparison group. Anaesthesia 2010 65: 145-153.

If you need a caesarean delivery, the epidural is often used instead of a general anaesthetic. A strong local anaesthetic is injected into your epidural catheter to make the lower half of your body very numb for the operation. This is safer than a general anaesthetic for you and your baby. Occasionally the epidural may not work well enough to be used for a caesarean birth. This can happen in one in 20 people. If this happens to you, you may also need another anaesthetic such as a spinal or general anaesthetic.

No, with an epidural, you do not have a higher chance of needing a caesarean birth. There is also no greater chance of long-term backache. Backache is common during pregnancy and often continues afterwards. You may have a tender spot in your back after an epidural which, on rare occasions, may last for months. There is no increased chance of long-term backache.

Sources:

• Anim-Somuah M, Smyth R, Howell C. Epidural versus non-epidural or no analgesia in labour. Cochrane Database of Systematic Reviews 2005, Issue 4. Article number: CD000331. Date of issue: 10.1002/14651858.CD000331.pub2.

• 16 Russell R, Dundas R, Reynolds F. Long term backache after childbirth: prospective search for causative factors. British Medical Journal 1996; 312: 1384-1388.

• One in every 100 women who have an epidural may get a headache. You can read more about this on our headache after an epidural or spinal injection page.
• Permanent nerve damage is very rare with an epidural, affecting about 1 in 13,000 women. Find more information on our Epidural Information Card. 
• For 1 in 8 women, the epidural might not work well enough to reduce labour pain so you need to use other ways of reducing the pain. 
• Strong solutions of local anaesthetic in your epidural can increase the risk of instrumental delivery but there is no evidence that this is the case for most commonly used “low dose” epidurals.
• With an epidural, the second stage of labour (when your cervix is fully dilated) is longer and you are more likely to need medication (oxytocin) to make your contractions stronger.
• You have more chance of having low blood pressure.
• Your legs may feel weak while the epidural is working.
• You will find it difficult to urinate. You will probably need to have a tube passed into your bladder (a bladder catheter) to drain the urine.
• You may feel itchy or develop a slight fever.
• To get more information on the side effects of epidurals and spinals, please see our Epidural Information Card.

In about one in every 100 women who have an epidural the bag of fluid which surrounds their spinal cord is punctured by the epidural needle (this is called a ‘dural puncture’). If this happens to you, you could get a severe headache that could last for days or weeks if it is not treated. If you do develop a severe headache, your anaesthetist should talk to you and give you advice about the treatment you could have. You can read more about this on our headache after an epidural or spinal injection page.