Easing That Epidural

How to reduce risks and optimise your experience

But I'm not planning on having an epidural

If you are planning to give birth in hospital, it is worth taking time to understand epidurals, even if you currently feel certain that you will not want one.

Labour is more vulnerable to the cascade of interventions in hospital and decisions are often made at moments of intensity, fatigue, or vulnerability.

You are also more likely to be offered interventions such as artificially breaking your waters or artificial oxytocin, which can make contractions more painful.

Other things like being on a continuous monitor with limited movement, or being on your back in a bed, being in a bright environment and being observed, can also make natural contractions feel more intense and unbearable.

Having information beforehand allows those decisions to be made from a place of understanding rather than pressure.

An epidural can be a positive and supportive option for some people. Like any medical intervention, it also comes with risks and knock on effects that are not always fully explained.

This blog outlines what an epidural is, how it works, what it feels like, and how it can influence labour and birth. It also includes practical ways to reduce some of the associated risks if you choose one.

What is a epidural?

An epidural is a form of pain relief used during labour that works by reducing the pain signals travelling from the uterus and pelvis to the brain. It is administered by a specialist doctor called an anaesthetist and involves placing medication close to the nerves in the lower back.

An epidural does not stop labour itself, but it changes how pain is perceived. The level of numbness varies widely between individuals. Some people experience significant pain relief with limited sensation, while others continue to feel pressure and movement but with reduced intensity.

How an epidural is given

To place an epidural, you will usually be asked to sit leaning forwards or to lie on your side with your knees drawn up towards your chest. This position helps open the spaces between the vertebrae and allows the anaesthetist to access the correct area.

Your lower back will be cleaned and a local anaesthetic will be injected to numb the skin. A needle is then used to guide a fine plastic tube, known as an epidural catheter, into position near the nerves that transmit pain signals. The needle is removed, leaving the catheter in place so medication can be given continuously.

Once medication is started, it usually takes around twenty to thirty minutes for the epidural to reach its full effect.

What is in an epidural?

Epidurals typically use a combination of medications, including a local anaesthetic and an opioid. These drugs work together to block pain signals in the spinal nerves so that fewer pain messages reach the brain.

Medication may be given as a single dose, a continuous infusion, or through a patient controlled pump. The method used depends on hospital policy and available equipment, which is why experiences can vary between hospitals.

What an epidural feels like

The initial injection of local anaesthetic can feel sharp or sting briefly. When the epidural needle is placed, most people describe a feeling of pressure rather than pain. Remaining still during contractions can be challenging, and support during this time can be very helpful.

As the epidural takes effect, your abdomen, pelvis, and legs may begin to feel heavy, numb, or disconnected. Some people are able to move their legs, while others cannot, and this can affect mobility and positioning during labour.

When should I get an epidural?

A Cochrane review has shown that the timing of epidural placement does not significantly change the likelihood of having an instrumental birth or a caesarean section.

There is, however, some observational evidence suggesting that epidurals placed before around six centimetres dilation may increase the length of both the first and second stages of labour. This does not mean early epidurals are unsafe or inappropriate, but it is an important factor to consider when weighing up pain relief options.

Do epidurals make labour less painful?

Epidurals are one of the most effective pain relief options.

A cochrane review found that epidurals may relieve labour pain more effectively than opioids, and more women may be more satisfied with epidural as pain relief.

Why might I choose an epidural?

You may choose an epidural because you do not want to experience pain in labour, before making this choice I would encourage you to look at your fear of pain, and learn about the physiological purpose of pain in labour. It is unlikely you will get an epidural as soon as you are in labour (as you may well be at home!), so it is a good idea to have some other pain relief options in your tool kit as well.

Some women choose an epidural when contractions become to painful for them to continue without it, quite often these labours are induced or have been augmented or interrupted in some way, panic and fear can sometimes cause contractions to become very painful as well.

If your baby is in a suboptimal position, contractions can feel stronger, continuous or more painful, sometimes an epidural can allow the mother to relax and create more space for the baby to move into a different position but it can also make it harder for your body and baby to correct themselves as you are limiting your instinctual movement.

Another reason women choose an epidural is to give themself a rest or break if they have had a very long labour, being able to sleep can give some women the boost they need to continue with a vaginal birth.

If you want to learn more about other pain relief strategies you can read my other blogs below.

Non-Medical Coping Tools

Medical Coping Tools

Gas and Air

What else is usually needed with an epidural

If you have an epidural, you will need a cannula so that fluids can be given, as epidurals are associated with a drop in blood pressure. These fluids help reduce the risk of complications related to low blood pressure.

You may also need a urinary catheter, as numbness can make it difficult or impossible to empty your bladder.

Continuous fetal monitoring is usually recommended, the NICE guidelines state: Perform continuous cardiotocography for at least 30 minutes during establishment of regional analgesia and after administration of each further bolus of 10 ml or more.

This indicates that you can revert back to intermittent fetal monitoring outside of these times but you may find local policies differ.

The NICE guidelines also state that: Encourage women with regional analgesia to adopt whatever positions, including upright, they find comfortable throughout labour, except lying flat on their back.

Advise women with an epidural in situ that if they have sufficient leg strength and sensation, as checked and confirmed by a midwife trained in caring for women with epidurals, they can mobilise with assistance, but their legs may feel heavier than usual.

Again in practice though, many women find they default to lying on their back in a slightly raised position - we will talk later why it is important that you do not do this.

Risks and side effects for the mother

Common side effects of epidurals include low blood pressure, itching, headaches, nausea, and fever.

Many people experience temporary difficulty passing urine and weakness or heaviness in the legs.

Epidurals are associated with longer labours, particularly in the second stage, and increase the likelihood that labour will need to be augmented with artificial oxytocin.

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. (this info is from an NHS leaflet)

Instrumental birth is more likely with an epidural, although this risk has reduced over time due to lower doses of local anaesthetic being used.

You can see the summary of the data here: Cochrane review

One study showed that out of 439 women 32% had hypotension.

Risks for the baby

A small amount of epidural medication does reach the baby, but this amount is significantly lower than with injected opioids or general anaesthesia. Overall, the risks to babies from epidurals are considered low.

Possible effects include temporary fetal distress, which may be linked to drops in maternal blood pressure. The same study I mentioned before where 32% of women with an epidural had hypotension, 11% of babies hada worsening fetal heart rate.

Some studies comparing epidurals with injected opioids have found that fewer babies require medication after birth to reverse side effects when epidurals are used.

Other considerations

If you decide you want an epidural, you may need to wait for an anaesthetist to be available. This wait can feel long and intense during labour.

Being cannulated during strong contractions can also be difficult, as staying still may feel challenging.

If you are labouring at home or in a midwife led unit, choosing an epidural will require transfer to a labour ward, which can change the environment and hormonal flow of labour.

Continuous monitoring and reduced mobility can increase the likelihood of further interventions, particularly if labour slows.

Spending long periods lying on your back is associated with longer labours, increased perineal trauma, and more concerning fetal heart rate patterns.

How to optimise your epidural experience

If you choose an epidural, there are steps you can take to reduce some of the associated risks.

1. You can ask for your birth partner to remain with you during the procedure, and many hospitals will allow this if requested.

2. You can also ask for your cannula to be placed at the elbow rather than the wrist, which often makes movement and feeding easier afterwards.

3. If available, you may wish to ask about a walking epidural, which can allow more movement.

4. Changing position regularly, even while in bed, is important. Side lying with pillows or a peanut ball, leaning forwards, or supported hands and knees positions can help create space in the pelvis. A birth partner can assist by gently moving the legs and hips to encourage movement. In fact one study shows that a peanut birth ball reduces the first stage of labor duration, and lowers cesarean rates in women with epidural analgesia.

5. When it comes to pushing, some people choose not to top up their epidural if it is wearing off, as this can help reconnect with instinctive pushing urges. If the urge to push is absent, delaying pushing may reduce the amount of time spent actively pushing, although it can lengthen the overall second stage.

After the birth

After birth, the urinary catheter may remain in place until the epidural has fully worn off, sometimes overnight. You may need help caring for your baby during this time, it is important to know if your hospital allows partners to stay overnight.

Sensation and strength in the legs can take time to return, so asking for help and using the call bell is important.

You can ask for the cannula to be removed as soon as it is no longer needed, as this can make feeding and holding your baby more comfortable.

Final thoughts

An epidural is not a failure, and avoiding one is not a measure of strength.

What matters most is that you are informed, supported, and able to make decisions that feel right for you.

Preparing for an epidural does not mean you will need one. It simply means that if circumstances change, you will not be making decisions without information.

Knowledge creates options, and options create confidence.

confidence.

Who am I?

I am Charlotte, a Virtual Doula, providing bespoke evidence-based pregnancy support to families who want an empowering birth.

With 10 years + of clinical research experience, a biomedical science degree, and two hospital births under my belt, I use my knowledge to provide pregnancy support to help you make informed decisions about your pregnancy, birth, and postpartum.

I provide pregnancy support for all types of births, including hospital births, helping you to navigate NHS guidelines and have an empowering, positive birth.

Find out more here!