Epidural analgesia

• The anaesthetist inserts a needle into your lower back and places a thin tube (epidural catheter) near the nerves in your spine.
• The needle is removed, but the catheter stays in place to deliver pain relief medicine.
• The medicine is usually a local anaesthetic with a small dose of opioid.
• It takes about 20-30 minutes for the epidural to work.
• It can be topped up if you need a ventouse, forceps, or caesarean birth.

Most people can, but certain conditions may make it unsuitable. These include spina bifida, some back operations, or problems with blood clotting. Speak to your midwife early in pregnancy to check. They may refer you to an anaesthetist to discuss your options.

Your midwife or doctor may recommend an epidural if you have a long labour, a premature baby, twins, or other medical issues. In some cases, it can make birth safer.

• Your anaesthetist cleans your back with antiseptic solution.
• You then receive a small injection of local anaesthetic to numb the skin. This will make putting in the epidural more comfortable.
• The epidural catheter is carefully placed near your spine. It is secured with a dressing.
• You must stay still while it is inserted, but once taped in place, you can move.
• Pain relief medicine is then given through the catheter.

Your midwife will check your blood pressure regularly. The anaesthetist may test the epidural by placing an ice cube or cold spray on your tummy and legs.

If it doesn't work well at first, your anaesthetist may adjust it or give more medicine. In rare cases, they may need to replace the catheter.

Your midwife can top up your pain relief with an injection or through a pump. Some pumps have a button you can press to give yourself pain relief medicine.

Each hospital offers different options, so ask your midwife or anaesthetist. Your midwife will continue checking your blood pressure after each top-up.

Some hospitals offer mobile epidurals, which use a lower dose of medicine and are not attached to pumps. This means you may be able to stand and walk around. Ask your midwife if this is available.

• Provides the most effective pain relief during labour
• Allows you to stay awake and alert while reducing discomfort
• Can be topped up as needed for ongoing pain relief
• Helps you rest if labour is long or exhausting
• Can be adjusted for assisted births (ventouse, forceps) or caesareans
• Does not make you drowsy or sick like some other pain relief options
• An epidural will not affect your baby
• Can improve safety in certain high-risk labours
• Do not make it more likely to need a caesarean birth
• Do not make the use of forceps or ventous more likely
• Do not make your baby drowsy or cause long-term harm
• Do not cause back pain after birth

About risk and epidurals

Everyone is different and it is not possible to know who will experience a side effect or risk.

Knowing about risks can help you discuss options with your healthcare team and make informed decisions about your care or birth plan.

The risks below are averages obtained from research studies. You can find out about the research used in our regional anaesthesia and risk evidence table, which is available to view here: www.rcoa.ac.uk/patientinfo/epidural-evidence-table.

Your risks might be higher or lower than these numbers. If you are thinking about having an epidural for surgery, your anaesthetist will discuss with you the risks that are more likely or significant for you.

If you’re thinking about having an epidural during childbirth, you might not meet the anaesthetist until you’re in labour. Since labour can be unpredictable, you might decide to have an epidural even if you hadn’t planned to. Whether an epidural is part of your birth plan or not, reading this information can help you prepare for the unexpected and think about any questions you might have.

Risks and epidurals during childbirth

According to the latest evidence, epidurals:

• do not make you more likely to need a caesarean birth
• do not make the use of ventouse or forceps (instruments used to help guide a baby out during a vaginal birth) more likely
• do not make your baby drowsy or cause them long-term harm
• do not cause backpain after childbirth.

Choosing an epidural for pain relief during labour may help lower the chance of serious complications, such as heavy bleeding (haemorrhage), infections, blood clots or the need for intensive care.

Epidurals can make childbirth safer if:

• you live with obesity
• you have existing health problems
• you are expecting more than one baby
• your baby is premature (born early).

What happens if the epidural does not work?

Epidurals do not always work as well as they should and sometimes they do not work at all. They take about 20 minutes to set up and up to 30 minutes before you feel the full effect. If it is not working well for you, tell your midwife or anaesthetist. They can:

• give you more anaesthetic through the catheter
• ask you to change your position
• move the catheter to a different place in your back (re-siting)
• suggest a different type of anaesthetic.

Out of 100 people who had an epidural during labour

About 10 needed additional pain relief, as well as the epidural – 90 did not

About 5 had to have the epidural re-sited – 95 did not

Risks and side effects associated with epidurals

These numbers are out of every 100 people who had an epidural

The risks below are rare

These numbers are out of every 1,000 people who had an epidural

These numbers are out of every 20,000

These numbers are out of every 50,000 people who had an epidural

These numbers are out of every 200,000 people who had an epidural

These numbers are out of every 500,000 people who had an epidural

Disclaimer

We try very hard to keep the information in this leaflet accurate and up-to-date, but we cannot guarantee this. We don’t expect this general information to cover all the questions you might have or to deal with everything that might be important to you. You should discuss your choices and any worries you have with your medical team, using this leaflet as a guide. This leaflet on its own should not be treated as advice. It cannot be used for any commercial or business purpose. 

Download an English language leaflet of epidural risk information

No, it does not affect your baby or make breastfeeding harder.

Yes, if your epidural is working well, it can be used for a caesarean. A stronger dose of medicine numbs the lower half of your body, so you stay awake and experience your baby's birth.

In about 1 in 20 cases, the epidural may not work well enough. If this happens, you may need a spinal or general anaesthetic. Your anaesthetist will discuss this with you if needed.

Spinals provide fast pain relief with a one-off injection into the spine. Some hospitals combine this with an epidural (CSE) to give quick pain relief while waiting for the epidural to work.