Epidurals for pain relief in labour

But with all medical procedures, there are risk factors to consider, and other things you might not have thought about. For example, epidurals aren’t available to everyone – and did you know you can’t tell if you’re going to pee while you’ve got one?

So, before you decide you want an epidural as part of your birth plan, it’s important to know all the facts. In this article, we’ll answer just about every epidural question under the sun, including:

• How are epidurals put in?
• How effective are epidurals in getting rid of pain?
• What are the risks of an epidural?
• How long does it take epidurals to wear off?
• Do epidurals give you backache?
• What are the advantages and disadvantages of an epidural?
• What's the difference between epidurals and spinal blocks?

By clicking the links above, you can skip ahead to read on your chosen topic. We’d really recommended reading this whole, piece, though.

What is an epidural?

An epidural is an anaesthetic (painkiller) that can take away the pain of your contractions.

It’s a local anaesthetic – which means it’s regional, only blocking pain from the lower party of your body, numbing you from the waist down.

It’s injected into your back, through a hollow needle into the space just outside of your spinal cord’s outer membrane.

To keep the dose of painkiller topped up, a plastic tube (known as an epidural catheter) is fed through the needle and left there until you’re done needing it.

How is an epidural given?

“First, the anaesthetist will ask you to lie on your left side, with your knees curled up, or sit on the edge of the bed, with your feet on a chair and your chin tucked in,” says midwife Anne Richley.

“Although you’ll be having frequent contractions at the time, it’s important for you to stay as still as possible when the epidural’s administered.”

Then you’ll be giving a little injection of local anaesthetic to numb the area where the needle’s going to go in.

The needle will then be placed, and the epidural catheter will be positioned.

Does getting an epidural hurt?

Getting an epidural won’t necessarily hurt, but you may find it uncomfortable having a needle in your back.

You’ll have a little bit of anaesthetic put around the area where the needle goes in, to try and minimise the discomfort.

We think it really depends on your pain threshold how you’ll find this bit, to be honest. We're sure many would agree the discomfort is worth it compared to the labour pains to follow.

The epidural itself feels like liquid ice numbing your tummy, bottom and legs, and deadening the nerves that carry pain signals from your uterus.

Your midwife can top it up – you tell her when the contractions start to hurt again.

Some maternity units will use PCA (patient controlled analgesia) this allows you to top up the epidural yourself by pressing a button when you feel you need pain relief. It comes with a cut-off which stops you from accidentally administering too much.

What’s a mobile epidural – and how’s it different?

A mobile epidural is set up in the same way as a regular epidural, but the ‘cocktail’ of drugs is slightly different.

You may able to move around a little bit more. Some mums will have some sensation in their legs, while others will be able to stand, or move a little, with support.

With a regular epidural, you’ll be completely numbed from the waist down, so you won’t be skipping off anywhere anytime soon.

How are epidurals different from spinal blocks?

A regular epidural and a mobile epidural are similar to spinal blocks in that they both involve an injection in your back to give you local anaesthetic.

But with epidurals, there’s also a tube in your back, meaning you can have regular top-ups of painkillers as needed. As there’s no tube, spinal blocks are faster to do, but the pain relief only lasts a couple of hours.

Often, spinal blocks are used during C-section, ventouse or forceps deliveries.

Here’s everything you need to know about spinal blocks

How effectively do epidurals stop labour pains?

The good news is that epidurals are VERY effective in relieving labour pains – a reported 96% of women get ‘excellent’ pain relief from them.

In the other 4% of cases, says midwife Anne, women may find they get a ‘partial block’ on one side.

This can be countered by the anaesthetist trying to re-site the epidural to help distribute the drug more evenly.

How soon can you get an epidural?

Typically, epidurals are started once you’re in what’s called ‘active labour’: having regular contractions, and about 4 – 5 cm dilated.

“Usually, you’ll be in established labour when you’re given an epidural,” notes Anne. “If you’ve kept mobile for some time, you’ll have helped the baby descend lower into the pelvis.

But she adds: “There isn’t really a cut-off point for an epidural.

“For some women, it’s still appropriate even if your cervix is 8cm dilated, as progress may have been slow with your baby in an awkward position.”

However, if you’re in the 2nd stage of labour and it looks like you’re heading for a forceps delivery, you might be looking at a spinal block for quickness’ sake.

Can anyone have an epidural?

Although most mums-to-be giving birth in hospital can have an epidural, some can’t, such as:

• Women with pre-existing back problems
• Women with blood-clotting disorders
• Women who take blood-thinning tablets
• Women experiencing lots of bleeding during labour
• Women on certain other medications (talk to your docs about any meds you’re on in advance).

Some mums may also be recommended against having epidural, especially if their labour is moving super quick, or if they’re hoping for a vaginal birth after a previous caesarean (VBAC).

This is because there may be faster-acting pain relief, and VBAC mums need to be aware of any pain coming from their C-section scar, to avoid any complications.

Finally, and this is an important one: you may be told you can’t have an epidural purely because there is no anaesthetist available at the hospital at the time you’re giving birth.

There’s no real way of predicting this one, so if you think you’re definitely gonna want an epidural, make sure your midwife knows in advance to try and make it happen.

What are the possible side effects from an epidural?

Epidurals are usually safe, says the NHS, though like all medical procedures, there are a few possible risks and side effects. You may experience:

• low blood pressure, making you feel woozy, dizzy or like you need to be sick -
• nausea
• itchy skin
• headaches
• slow breathing
• infection near the tube site
• temporary loss of bladder control (always a fun one!)

There’s also a small chance it may just not do the trick in stopping your pain. If that’s the case, alternative options will be looked at by your docs.

Please don’t let this panic you, but there is also a VERY tiny risk of:

• temporary nerve damage
• permanent nerve damage.

Can you get paralyzed from an epidural?

In very, very rare cases, the NHS says that epidurals have caused permanent loss or feeling in either one or both legs.

The NHS lists potential causes for this as:

• direct damage from the epidural needle or catheter
• infection deep in the epidural area or near the spinal cord
• bleeding in the epidural area, causing pressure on the spinal cord
• accidentally injecting the wrong drugs down the epidural catheter.

As the NHS says, there are risks to all kinds of medical procedures, and the professionals who perform them are trained to do their best to ensure this kinda thing doesn’t happen.

“These are rare events,” the NHS website stresses, “and anaesthetists undergo extensive training to reduce the chances of these complications.

“Nerve damage can also happen for other reasons during surger[ies] unrelated to the epidural.”

The American Society of Anesthesiologists also calls the possibility of this happening “extremely rare” – so while it’s good to walk into any procedure with your eyes wide open, we also hope this doesn’t cause you any serious stress or worry ?

Do epidurals make labour last longer?

We’ve heard the old adage that says labour can go one of 2 ways: quick and painful (without the drugs) or slower but less painful (with the drugs).

However, a study by US researchers, published in the Obstetrics & Gynecology journal, found next-to-no difference between the length of 2nd stage labours in women with epidurals and a placebo saline injection.

Another US study published in the same journal, which reviewed over 40,000 births, showed that labouring mums who had epidurals tended to have longer periods of pushing.

It is thought that an epidural might slow your contractions some, especially if you get your epidural too early. Best to speak to your midwife about that, though. They’ll be able to guide you through.

Do epidurals make it harder to push?

There’s also the common thought that an epidural makes it harder to know when to push, or harder to push your baby out at all, because you’re so numb from the waist down.

Typically, the dose of the anaesthetic should be reduced by time your ready to push, so you can push and you can feel something happening down below.

Lots of women on the MFM forum noted that their pushing wasn’t painful, but they could definitely feel the urge.

Do epidurals increase the risk of intervention?

That said, epidurals are thought to increase the chances of you needing intervention in your child’s birth, such as episiotomy, forceps, ventouse delivery or even C-section, for the very same reason.

We can’t say it doesn’t increase your chances – but we also haven’t found any concrete stats to say that it 100% does.

Can I go to the loo during my epidural?

In short: no, you can’t go to the toilet while your epidural’s in place.

The epidural causes numbness, which means you won't know when your bladder is full. Your midwife will probably have to insert a catheter to drain the urine.

How long does it take for epidurals to wear off?

Luckily, the effects of your epidural will wear off 1 – 2 hours after your last dose of the anaesthetic has been administered.

You might take a little longer or feel some tingling after, but that’s perfectly normal.

When can you walk after an epidural?

If all else has gone smoothly, after the effects of the drugs wear off over 1 – 2 hours, you may be capable of walking around little bit.

You might find you don’t want to or feel like you can stand for too long straight after, and that’s perfectly OK.

Childbirth’s a BIG deal physically, so don’t rush yourself out of bed, whatever you do!

We’ve definitely seen lots of our MFM mums say they got out of bed and walked 3 hours or so post-birth.

Mum Ellie, who is a member of our MadeForMums community, added: “I had my epidural at around 9.30pm, gave birth at 00.51am and walked to the bathroom for a bath at 3.30am.”

We also think it goes without saying that if things didn’t go as smoothly, you’ve had complications, need stitches, or had a C-section, you may not be able to jump out of bed or walk around for quite some time, for a myriad of other reasons.

How long does your back hurt after an epidural?

Backache or soreness in your back isn’t necessarily a given after an epidural, but it is a possibility.

It’s not the drugs that cause discomfort, rather the awkwardness of the epidural catheter you had placed near your spine and where the needle went in.

Midwife Jean Carpenter told us that your position during labour may impact how your back feels afterwards, too.

“Some women lie in an awkward position during labour because of the numbness. This puts pressure on their backs and may lead to back pain later on.”

Any discomfort or achiness should be short-term, lasting maybe a few days. If you’re experiencing back pain after childbirth, tell your GP, midwife or health visitor as soon as possible.

Pros and cons for epidurals – things to think about

If you’ve read all that, you’re already pretty clued up on epidurals as pain relief during labour.

But if you’re still not sure if you want one, here are some of the advantages and disadvantages to having an epidural:

Advantages of epidurals

• It numbs the area from the waist down and is an excellent form of pain relief – particularly with long labours

• It can lower very high blood pressure

• You’ll feel alert but also well rested, and you’ll be able to sleep if you’re very tired

• They can be topped up easily throughout your labour

• Providing it's left to wear off, you should be able to feel when to push

• The drugs used will have no effect on your baby.

Disadvantages of epidurals

• They’re only available in hospitals, so not an option for home births

• The anaesthetist may not be available. Which means you may miss the opportunity to have one

• There's a possibility it may slow down the pushing phase

• Epidurals increase the risk of needing an instrumental birth and of having an episiotomy

• Your unborn baby needs to be continually monitored

• You’ll have a drip set up in case your blood pressure falls -Your contractions can slow down – you might need another drip to speed things up

• If you can move at all, your movement will be restricted

• You may need to have a catheter for your pee

• There are all those potential side effects to consider (the ones we talked about above).

Mums share their epidural experiences

Every woman will have a different experience of her epidural – the highs and lows, and how effective it is in relieving their pain.

But it doesn’t hurt to hear from mums who’ve had experiences of epidurals from across the board, to give some insight into what to expect, right?

Mum Ruth from our MadeForMums community, really did her research before her epidural – and even says she enjoyed her labour as a result.

“I’m 100 per cent in favour of epidurals! I’m a physiotherapist, so I talked to consultant anaesthetists about pain relief during labour,” she shared.

“Having considered all the options, I decided to go for an epidural. I was induced and, once the pain became intense, I requested and was given an epidural.

“I was able to enjoy the remaining 10 hours of labour and delivery – I actually read an entire book!

“I was completely relaxed and can say that I enjoyed the whole experience. I was very apprehensive about labour, but can now say that I’m looking forward to having my next one – but not just yet though!”

Meanwhile Sophie didn’t have a great time with hers, as she was one of the unlucky few for whom it didn’t work.

"My first labour was long and difficult, so I had an epidural – a big mistake. It didn’t work properly and I could still feel everything,” she tells MFM.

“I was throwing up afterwards and, because I had so many drugs, I can barely remember the birth.

“My second birth, with Emily Louise, I coped with just gas and air for pain relief. I can remember it so well and it was a great experience.”

Mum JoanneMarie had a glowing experience like Ruth:

"My midwife seemed very anti pethidine and advised me to have an epi as she said a speeded up labour was very painful so I went for it.

“It took all the pain away and I had a very relaxed time waiting. I ended up having an emergency section after 16 hour of (speeded up!!) labour as the baby was just to big for me and his head never engaged and I only dilated 4 cms after all that time.

“I know things can go wrong with everything but when I went for a tour of the maternity ward the m/w then said she had been doing the job for 30 years and had never known anyone to end up in a wheel chair because of an epidural.”

While Anita says calls it the worst: “I had an epidural with my first baby and i've had 3 children and it was the worst experience I ever had.

“Although it didn't cause me to have intervention I had back problems for 5 years after having the epidural and at some times in the first few months I couldn't even hold my baby.”

Overwhelmingly, though, we’ve seen lots of positives about epidurals across our forum.

"I didn't want one but had been in labour for 120 hours and was exhausted so needed the rest!" says Pat.

"I would definitely consider having one again though, it was fantastic. I had a catheter which they took out the following day (Toby was born late at night) but didn't feel it at all.

"I could wiggle my toes and move around on the bed the whole time but couldn't get up as I was being monitored.

"The next day when I got out of bed after they took the catheter out I felt a bit woozy and had to sit down but I think that was more because I hadn't stood up for so long rather than after effects from the epidural itself."

"I went 18 hours before being told it would be at least 6 hours before baby arrived. I was exhausted so asked for an epidural. It was the best thing I ever did.

"All the pain was gone, I could just feel tightening, and I even managed to sleep," says Lillian. "It wears off little bit so I felt the tightenings of the contractions and some stretching during the pushing but overall I had a pain free delivery. They let it wear off a little so you know when to push.

"I was terrified of them doing it but they numbed my back first and I didn't feel a thing. I also didn't have to feel my episiotomy or being stitched up.

"The episiotomy wasn't because of the epidurial though. It was because the cord was round my little one's neck.

Fillipa agreed: "Had an epidural and was adamant when I went in I wanted one and as soon as I was 4cm I got one!

"Best thing I ever did! My son showed signs of distress so they insisted everything had to happen fast, so ended up with ventouse and episiotomy and pushing him out in about 3 pushes. I don't think I could have put up with all that going on without the epidural!"

"My advice is just keep an open mind! You will know when its happening if you need one," says Jane. "I had one and don't regret it one bit.

"I only regret not asking for it sooner as it tooks 2hrs to set up and get working because of delays in getting the anaesthetist there and also finding the spot in my back 'cos of my podge!!!

"It was AMAZING. It took every bit of pain away, bliss! I had a "low dose" or "mobile" epidural, although I stayed on the bed as Toby had a fetal monitor attached to his head via my bits!

"When it was time to push, I could totally feel it, but it wasn't painful, I just felt my body telling me to do it."

Images: Getty Images

Read more:

• Pain relief in labour - which option's right for you?
• Spinal blocks - how does it relieve labour pain?
• How pain relief affects your baby