Epidural

An epidural is a type of local anaesthetic. It numbs the nerves that carry the pain impulses from the birth canal to the brain. It should not make you sick or drowsy.

In most cases, an epidural gives complete pain relief. It can be helpful if you are having a long or particularly painful labour.

An anaesthetist is the only person who can give an epidural, so it will not be available at home. If you think you might want one, check whether anaesthetists are always available at your hospital.

How much you can move your legs after an epidural depends on the local anaesthetic used. Some hospitals offer "mobile" epidurals, which means you can walk around.

However, this also requires the baby's heart rate to be monitored remotely (by telemetry).

An epidural can provide very good pain relief, but it's not always 100% effective in labour. The Obstetric Anaesthetists Association estimates that one in 10 who have an epidural during labour need to use other methods of pain relief.

How does an epidural work?

To have an epidural:

• a drip will run fluid through a needle into a vein in your arm
• while you lie on your side or sit up in a curled position, an anaesthetist will clean your back with antiseptic, numb a small area with some local anaesthetic, and then introduce a needle into your back
• a very thin tube will be passed through the needle into your back near the nerves that carry pain impulses from the uterus. Drugs (usually a mixture of local anaesthetic and opioid) are administered through this tube. It takes about 10 minutes to set up the epidural, and another 10-15 minutes for it to work. It does not always work perfectly at first and may need adjusting
• You are given a button to top the epidural up yourself to get it to the level that suits you. It has a lock out time of 20 minutes
• your contractions and the baby's heart rate will need to be continuously monitored. This means having a belt around your abdomen or possibly a clip attached to the baby's head

Side effects of epidurals in labour

There are some side effects to be aware of.

An epidural may make your legs feel heavy, depending on the local anaesthetic used.

Your blood pressure can drop (hypotension), but this is rare because the fluid given through the drip in your arm helps to maintain good blood pressure.

Epidurals can prolong the second stage of labour. If you can no longer feel your contractions, the midwife will have to tell you when to push. This means that forceps or a ventouse may be needed to help the birth of your baby (birth by forceps/ ventouse).

When you have an epidural, your midwife or doctor will wait longer for the baby's head to come down (before you start pushing), as long as the baby is showing no signs of distress. This reduces the chance you'll need birth by forceps/ventouse. You may find it difficult to pee as a result of the epidural. If so, a small tube called a catheter may be put into your bladder to help you.

You may get a headache after an epidural. This happens in about one in 100 cases and can be treated.

Your back might be a bit sore for a day or two, but epidurals do not cause long-term backache.

You may feel tingles or pins and needles down one leg after having a baby. This happens in about one in 2,000 cases. This is more likely to be the result of childbirth itself rather than the epidural.