Epidurals, not just a little prick!

An epidural is one of the most common pain relief options during labour, offering significant relief for many women. It involves the administration of medication into the epidural space of the spine, numbing the lower half of the body. While it’s known for providing effective pain relief, there are important considerations and potential side effects to be aware of. Understanding what an epidural is, how it works, and how it fits into your birth plan can help you make an informed decision about whether it’s right for you.

What is an Epidural?

An epidural is a procedure that injects a local anaesthetic into the space around the spinal nerves in your lower back.

This anaesthetic usually blocks the pain from labour contractions and during the birth very effectively. With an epidural you can usually move and can push your baby out when you need to.

An epidural is usually done by an anaesthetist.

The Procedure

Before receiving an epidural, you’ll likely have an IV drip placed in your arm to keep you hydrated.

To make the procedure easier, you can either sit up and lean forward over a pillow or lie on your side, curled up. This position helps the needle go into the right spot, so you'll need to stay as still as possible during the process.

Your lower back will be cleaned with a cold antiseptic, and a small injection of local anesthetic will numb the skin. Then, the needle will be carefully inserted between the bones of your spine into the space around your spinal nerves. It’s important to let your anesthetist know when a contraction is coming, as the needle is inserted during a break between contractions.

Once the needle is in place, a small, soft plastic tube is inserted, and the needle is removed. This tube will deliver the anesthetic that numbs your pain. A catheter will also be placed to keep your bladder empty during labor.

It typically takes between 5 and 30 minutes for the epidural to take effect and relieve your pain.

Epidurals are generally only given during the first stage of labour, once you're about 4 cm dilated and before you reach the transition phase.

Advantages and disadvantages of an epidural

Epidurals are available at most hospitals but not in birth centres or for home births.

The advantages of an epidural are:

• it is usually very effective

• it is generally very safe

• you can often still move around in bed and push when you need to

• if you have a long labour, it allows you to sleep and recover your strength

• if you're having a caesarean, you can stay awake and your partner or support person can be there

The disadvantages of an epidural are:

• for medical reasons, not everyone can have an epidural

• you might need to have fluids given to you through a tube in your arm, and will need to have your blood pressure monitored

• you might lose feeling in your bladder and need a catheter (tube) in your bladder to help you pass urine

• you might lose feeling in your legs for a few hours

• it might slow down the second stage of labour

• you might not be able to push and need help to give birth

• your baby will need to be closely monitored during your labour

Risks and side effects

An epidural is effective and fairly safe. But there are some risks.

• Some women feel cold or itchy.

• A small number of women get little or no pain relief.

• Some women get weakness in the legs; it wears off after a few hours.

• There is an increased risk of needing forceps or a vacuum to help with the birth (see our blog about the cascade of intervention).

• Some women develop a bad headache 24 to 48 hours after an epidural.

• There is a small chance of developing a skin infection.

• Very rarely - few women get permanent nerve damage.

Ultimately, choosing whether or not to have an epidural is a deeply personal decision. It’s important to weigh the benefits and potential risks based on your own preferences, pain tolerance, and birth plan. Keep in mind that every labour is unique, and flexibility is key. Whatever choice you make, the most important thing is that you feel supported and empowered throughout your journey.

Discuss your options with your healthcare provider, and trust that your decision will help you navigate labour in the best way for you and your baby.