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

The risks and side effects associated with an epidural can be viewed here.

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.