Coping with pain in labour

Epidurals for pain relief: what you need to know

5 min read

Epidurals can provide pain relief during labour. Here we outline the benefits and risks of having an epidural.

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Whether or not you think you’d like to have an epidural, it’s a really good idea to find out exactly what they are, how they work and where they are available just in case you change your mind during labour.

What is an epidural?

An epidural is a local anaesthetic which is injected into part of your spine and is used for pain relief during labour. It works by numbing the nerves carrying pain messages from the lower part of the body to the brain.

The first step of being given an epidural is having a drip in your arm to help keep your blood pressure stable. An anaesthetist rather than a midwife will then ask you to sit or lie on your left side so that they can insert a needle into a gap in the bones of your spine. A thin plastic tube called a catheter is then fed through the hollow needle. The catheter is taped to your back and the local anaesthetic can be injected through it and topped up throughout labour without causing any pain.

‘Mobile epidurals’ or ‘low-dose’ epidurals use pain-relieving drugs called opioids mixed with a low dose of local anaesthetic. This means the nerves supplying your bladder, abdominal and leg muscles are not blocked, so you can still move around. Full epidurals use a more concentrated anaesthetic and are usually recommended when you need an intervention such as a caesarean or forceps. Find out more about interventions during labour.

A combined-spinal epidural (CSE) is when an epidural is given in combination with another spinal injection of anaesthetic. This has a similar effect to an epidural with the additional advantage of working faster to relieve pain more quickly.

Why might I want to have an epidural?

If you don’t want to experience any pain, an epidural gives very good relief from the pain of contractions. You won’t feel any drowsiness or disorientation, other than the usual tiredness from labour. The pain relief may also help you to relax. This in itself can help your baby to be born as your pelvis will be more relaxed.

If you have had a mobile epidural, you should still be able to stand and move around. Although you won’t feel pain, you should still be able to sense touch and feel your baby being born.

Most women who have an epidural during labour are very satisfied, and say they would request another one in a subsequent labour if needed. We know from a 2014 study of women’s experiences of maternity care in England that first-time mothers are more likely to have one than those who have had a baby before.

Overall, just over a quarter of women giving birth in England choose to have an epidural, according to a 2017 survey by the Care Quality Commission (CQC).

Are there any problems with having an epidural?

An epidural can have a number of consequences for your labour because it affects the nerves in the lower part of your body, but serious complications are rare. Some consequences are listed below:

  • Your labour might slow down: although you’re still able to push, you can stop feeling the urge to do so which can slow your labour down.
  • Intervention: if you have an epidural you have an increased chance of having an assisted delivery such as a forceps or ventouse delivery – around 40% more likely than if using opioids.
  • Headaches: about 1% of women experience a headache following an epidural, which can last for days if not treated.
  • A catheter in your bladder: your loss of feeling can mean that you don’t feel when your bladder is full. If this happens you’ll have a thin tube called a catheter inserted into your bladder, which allows your urine to drain into a bag.
  • Loss of mobility: even though many epidurals now use a combination of drugs to help keep you mobile, your legs might still become a bit wobbly or weak. If this happens, it can make it harder to stay upright and walk around throughout labour, which can also be important to keep labour progressing.

Can I have an epidural wherever I give birth?

Many labour wards have epidurals available 24 hours a day, but not all. If having the option of an epidural is important to you, it would be wise to check whether it will be available in the unit you’re planning to give birth – use our Birth Choice tool to check.

Epidurals are not available in a birth centre or when having a home birth, so you would need to transfer to a labour ward if you decide you need an epidural once you’re in labour. If you’re in an alongside birth centre, your transfer would be within the same hospital site. However, from home or a freestanding birth centre you would need to transfer by road, meaning it may be some time before you could receive your epidural.

What are the alternatives to an epidural?

Depending upon where you give birth, there are a range of other alternatives. Our article on different types of pain relief explains your options.

There are ways to reduce the likelihood of needing an epidural, although not all of them are within your control, so it’s important to remain flexible:

  • Using self-help techniques for working with pain, such as immersion in water, massage, acupuncture and relaxation
  • Staying upright and mobile throughout labour
  • Already knowing the midwife who’ll be with you during labour
  • Having the continuous support of a midwife or other female experienced in birth support
  • Planning birth in a birth centre or at home.

You don’t need to decide before labour if you want an epidural. However, as they’re not available everywhere, knowing how you feel about this option can help you decide where to have your baby.

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References

These are the sources of information used in this article:

Anim-Somuah M, Smyth RMD, Jones L, Epidural versus non-epidural or no analgesia in labour Cochrane Database of Systematic Reviews 2011, Issue 12. Art. No.: CD000331. DOI: 10.1002/14651858.CD000331.pub3. (2011)

Care Quality Commission, Maternity Services Survey 2017 (2017)

Redshaw M, Henderson J, Safely Delivered: a national survey of women’s experience of maternity care 2014, NPEU, University of Oxford (2015)

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