Epidural - Newcastle Hospitals NHS Foundation Trust

What is an Epidural?

An epidural is a form of anaesthetic that is given via a small tube (epidural catheter) that is placed between two bones in your lower back. The anaesthetic is delivered through the tube while you are in labour.

Will they work for me?

An epidural is over 90% effective in providing total pain relief. 1 in 12 epidurals do not work as effectively and some people will experience pain in specific area. Additional drugs can be given to help with this. Some epidurals need to be removed and placed again so that they work more effectively if they are not providing enough pain relief. This is not common.

When are they most effective?

Epidurals can be sited at any stage of labour, although it is better to have one sited during the first stage of labour. It takes around 20-25 minutes, longer in some cases, for an epidural to be sited and start working effectively. Whilst it is possible for an epidural to be sited during the second stage of labour, babies are normally born before the epidural has a chance to work properly. It can also be more difficult to site an epidural in the second stage of labour. This is because you need to be sitting upright and remain very still. This can be extremely difficult and uncomfortable if you are closer to the birth of your baby.

How are they performed?

An epidural is sited by an anaesthetist (a doctor who is an expert in pain relief medicines). You will be asked to sit upright on the edge of the delivery bed and curl your back outwards into a ‘C’ shape. This makes it easier to put the epidural between two of the bones in your lower back.

The anaesthetist will inject some anaesthetic to numb the area around where the tube (epidural catheter) will be placed into your back. Once the area goes numb, the anaesthetist threads the tube into a hollow area of your spine (epidural space) near the nerves that carry the pain signals from your womb (uterus) to your brain.

Once the epidural is in place, you will be helped into a comfortable position by your midwife. The anaesthetist will give you an initial dose of the pain relief medication. After this you will be given a further dose from a pump every hour into your back throughout your labour. You will be given a button to press. This will give you an additional dose of the medication if you need it. A drip will be placed into your hand so that we can give you fluids if you require them.

Because epidurals need to be placed by one of the anaesthetists, there may be a slight delay if they are in the middle of an operation in theatre. It is good to let your midwife know early in your labour if this is something that you would like. This will allow them to let the anaesthetist know. The anaesthetist will site your epidural as soon as they are able.

Are there any risks to my baby?

The epidural anaesthetic does not directly affect your baby. However, if you have an epidural you will be unable to move from the delivery bed. 1 in 100 people will experience a sudden drop to their blood pressure so we monitor this closely. Usually this can be corrected quickly with fluids or other medications. These things can cause a change in your baby’s heart rate pattern. If you have an epidural, we will monitor your baby’s heartbeat continuously throughout your labour. This will allow us to can act on any changes we might see.

What other things should I consider?

Due to being unable to move around the room, you may find it difficult to use the toilet with an epidural. Your midwife can assist you onto a bed-pan on the bed. Due to the lack of sensation, some people find it difficult to urinate this way. It may be that we offer to place a tube into your bladder (a catheter) to help you empty it every 4 hours until baby is born.

Some people find it difficult or frustrating to alter their position in the bed when they have an epidural as their legs are ‘heavy’ so your midwife may need to support you to do this.

Between 1 in 100 and 1 in 50 people experience a severe headache after an epidural that needs to be corrected with another injection into your back.

1 in 10,000 epidurals can cause nerve damage to your back. This is very rare.

Epidurals do not cause back pain. Any back pain you may experience after birth is due to the additional weight caused by pregnancy.

If you have an emergency procedure in theatre such as an emergency caesarean section, additional medication can be given by epidural. This is to ensure you are comfortable for the procedure.

How many times can I have them?

You should only need one epidural for labour and birth. It can be re-sited if the first one does not work effectively.

You can have an epidural even after you’ve tried all other forms of pain relief. You won’t need to use any other pain relief with an epidural. Entonox can still be used with an epidural, although you shouldn’t need to.