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.

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

Headache (post-dural puncture headache)

This can happen to 1 person (or less) out of 100 people having an epidural. It can happen between 1 day and 1 week after epidural. The headache can be mild and get better within a few days with over-the-counter painkillers, or it can be severe and require treatment in hospital. You can read more information about post-dural puncture headaches here (add link when leaflet ready)

Had a fever

This happens to between 1 and 10 people for every 100 people having an epidural. Your healthcare team may offer you antibiotics.

Had low blood pressure that needed treatment

Some symptoms of low blood pressure may be experienced by between 5 and 30 people out of 100 people having an epidural. Between 70 and 95 people having an epidural will not have symptoms of low blood pressure requiring treatment. It can make you feel sick, dizzy or drowsy. Your healthcare team can give you medicine to improve your blood pressure.

Felt sick (nauseous)

Out of 100 people having an epidural, between 5 and 20 people have experienced some symptoms of nausea, and 80 to 95 have not. Your healthcare team can give you anti-sickness medicines if it happens.

Itching

New itching may last for a couple of hours until the epidural medicine wears off. Your healthcare team can give you medicine to treat the itching. Out of 100 people having an epidural, it is expected that 30 will have some itching and 70 will not.

Difficulty passing urine

You may not feel if you need to go to the toilet after an epidural, or you may not be able to walk until it has worn off. The healthcare team sometimes recommend a urinary catheter, a thin tube to drain the urine directly from your bladder. This might stay in until the next day.

The risks below are rare. 

These numbers are out of every 1,000 people

Local anaesthetic toxicity (too much anaesthetic in your bloodstream).  

This is serious and can result in complications such as fits (seizures) or cardiac arrest. Your team will treat you quickly if they happen. Out of every 1,000 people having an epidural 999 did not have this complication, but 1 did.

These numbers are out of every 20,000

Weak, numb, tingly leg, buttock or foot (nerve damage)

This can be temporary (days or weeks) and normally gets better by itself which has happened to around 8 in 20,000 people having an epidural (and didn’t happen to 19,992 people).

It can be permanent for 1 person in 20,000 people having an epidural.

These numbers are out of every 50,000

Meningitis

This has happened to approximately 1 out of 50,000 people. Meningitis infection can happen days or weeks after the epidural. Symptoms are headache, fever and vomiting. Meningitis can be treated with antibiotics.

These numbers are out of every 200,000

Infection in or around the spine

Infection can happen days or weeks after an epidural and has occurred in 2 out of 200,000 people having an epidural. It is treated with antibiotics or sometimes surgery to drain an abscess.

Blood clot around the spine (vertebral haematoma)

This is serious and you may need an operation to remove the blood clot immediately.  It can cause leg paralysis if not treated quickly. This has happened to 1-2 people out of 200,00 having an epidural.

These numbers are out of every 500,000

Become paralysed

This occurred for 2 out of 500,000 people having an epidural. This means 499,998 people had an epidural without this happening.

Of note, epidurals do not increase the chance of needing a caesarean. They also do not cause long-term backache. Back pain is common during pregnancy and may continue afterwards. You might have a tender spot where the epidural was placed, but this is rare and usually temporary.

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.