Birth with an epidural

Epidural | Pregnancy Birth and Baby

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An epidural is a type of pain relief for women in labour or who are having a caesarean section.

What is an epidural?

An epidural is a procedure that injects a local anaesthetic in to 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 an epidural, you will usually have a drip for fluids put into your arm.

You can sit up and bend forward over a pillow, or lie on your side curled up into a ball. This makes it easier for the needle to be inserted into the right place. You will be asked to stay still.

Your lower back will be washed with cold antiseptic. A small amount of local anaesthetic will be injected into the skin of your lower back. A needle will be inserted between the bones of your spine into the space around your spinal nerves. Your anaesthetist will insert the epidural needle when your contraction stops, so it is important that you tell them when you have a contraction.

A small soft plastic tube will be inserted and the needle will be removed. That tube delivers the anaesthetic that will numb your pain.

It usually takes between 5 and 30 minutes for your pain to be relieved by the epidural.

You usually only have an epidural during the first stage of labour — but it can be given at any stage of labour.

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 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

Whether you have an epidural or not makes no difference to the chance of you having a caesarean section.

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.
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 a few women get permanent nerve damage.

What to discuss with your doctor or midwife

You can check:

if you can have an epidural at your chosen hospital or birth centre
what their epidural procedures are
the type of pain relief that might suit you best

Sources:

Australia and New Zealand College of Anaesthetists (Epidurals and childbirth), Government of Western Australia Department of Health (Epidurals for childbirth), Mater Mothers' Hospital (Epidural), They Royal Women's Hospital (Epidural information), Royal Australian College of Obstetricians and Gynaecologists (Pain relief in labour and childbirth), Queensland Health (Epidural analgesia in labour - clinical guidelines)

Learn more here about the development and quality assurance of healthdirect content.

Last reviewed: January 2020

TENS (Transcutaneous electrical nerve stimulation)
Gas (Entonox)
Non-medical pain relief during labour
Pain relief during labour
Making a birth plan
Giving birth - stages of labour

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Natural Birth vs. Epidural: What to Expect

Giving birth can and should be a beautiful experience. But the prospect of delivery may give some women anxiety because of the anticipated pain and discomfort.

While many women opt to receive epidurals (medication for pain relief) to have a more comfortable labor, many more are choosing “natural” or unmedicated births. There is growing fear about the side effects of medicated births and epidurals.

Discuss the options with your doctor or midwife to determine which method is best for you and your child. In the meantime, here are some of the most important points to consider.

An epidural decreases pain in a specific area — in this case, the lower part of the body. Women often choose to have one. It’s also sometimes a medical necessity if there are complications, such as those resulting in a cesarean delivery (C-section).

An epidural takes about 10 minutes to place and an additional 10 to 15 minutes to work. It’s delivered through a tube via the spine.

Benefits

The greatest benefit of an epidural is the potential for a painless delivery. While you may still feel contractions, the pain is decreased significantly. During a vaginal delivery, you’re still aware of the birth and can move around.

An epidural is also required in a cesarean delivery to ease pain from surgically removing a baby from the womb. General anesthesia is used in some cases as well, where the mother isn’t awake during the procedure.

The National Institutes of Health (NIH) report a 72 percent increase in the number of cesarean deliveries from 1997 through 2008, which might also explain the enduring popularity of epidurals.

While some cesarean deliveries are elective, most are required if vaginal delivery can’t be accomplished. Vaginal birth after cesarean section is possible, but not for all women.

Risks

Some risk factors of an epidural include:

back pain and soreness
headaches
persistent bleeding (from puncture site)
fever
breathing difficulties
drop in blood pressure, which can slow down the baby’s heart rate

It’s important to note that, while such risks exist, they’re considered rare.

The fact that mothers can’t feel all of the elements of delivery with an epidural can also lead to a host of other problems, such as increased risk of tearing during vaginal delivery.

Risks with cesarean deliveries aren’t necessarily related to the epidural. Unlike vaginal births, these are surgeries, so recovery times are longer and there’s a risk of infection.

Cesarean deliveries have also been linked to greater risk of childhood chronic diseases (including type 1 diabetes, asthma, and obesity). More research is needed.

The term “natural birth” is usually used to describe a vaginal delivery performed without medication. It’s also sometimes used to distinguish between a vaginal delivery and a cesarean delivery.

Benefits

Unmedicated births have increased in popularity due to concerns that epidurals can interfere with natural body responses to labor and delivery. Ashley Shea, a birth doula, yoga teacher, student midwife, and founder of Organic Birth, has also witnessed this trend.

“Women want to be able to move around untethered to machines, they want to stay home as long as possible before heading to the hospital, they don’t want to be disturbed or excessively monitored, or have too many cervical checks (if at all), and they want to have immediate and uninterrupted skin-to-skin contact with their newborn and wait until the cord stops pulsating to clamp and cut the cord,” said Shea.

As she pointed out, “If you found out you could have a baby in a warm, deep pool of water compared to flat on your back with people yelling at you to push, what would you choose?”

And in case you didn’t already know, mothers do have the right to elect unmedicated births at hospitals.

Risks

There are a few serious risks associated with unmedicated births. Risks often arise if there is a medical problem with the mother or if an issue prevents the baby from naturally moving through the birth canal.

Other concerns surrounding a vaginal birth include:

tears in the perineum (area behind the vaginal wall)
increased pain
hemorrhoids
bowel issues
urinary incontinence
psychological trauma

Preparation

Preparing for the risks of an unmedicated birth is important. Mothers might consider having a midwife come to their home or perhaps complete the delivery process at the hospital.

Childbirth education classes help prepare you for what to expect. This provides a safety net should any complications arise.

Nonmedication methods used to ease labor and delivery can include:

massages
acupressure
taking a warm bath or using a hot pack
breathing techniques
frequent changes in position to compensate for changes in the pelvis

Due to the complexity of labor, there is no one-size-fits-all method when it comes to birthing. According to the Office on Women’s Health, these are just some of the factors doctors and midwives consider when making a recommendation:

overall health and emotional well-being of the mother
the size of the mother’s pelvis
the mother’s pain tolerance level
the intensity level of contractions
size or position of the baby

It’s best to understand all of your options and to know when you might need medication to make sure your baby can enter the world without complications.

Position of women in the second stage of labor with epidural anesthesia

What is the problem?

The second stage of labor consists of a latent or passive phase, when the cervix is fully dilated and the baby's head descends without mother's effort, and an active phase, when the mother tries to push the baby out and he is born.

We wanted to find out whether different positions (vertical or horizontal) in the second stage of labor can change the outcomes of labor in women who received epidural anesthesia and their children. Outcomes included caesarean section, instrumental delivery, major bleeding, or suturing following vaginal lacerations during labor. As for children, we looked at whether they tolerated childbirth well and whether they needed hospitalization for special care. We also wanted to determine women's views on the experience of childbirth and their satisfaction with childbirth. This is an update of a review first published in 2013.

Why is this important?

Epidural anesthesia is the most effective method of pain relief during childbirth. It is common, although it can increase the duration of labor and the need for forceps and a vacuum extractor. Instrumental labor can lead to prolapse, urinary incontinence, or painful intercourse. In recent years, the introduction of low doses of anesthetics, known as "mobile" epidural anesthesia, has become popular. Low doses allow women to be more mobile during childbirth and make it easier to get upright. It has been suggested that the upright position may make childbirth easier.

What evidence did we find?

We looked for evidence in randomized controlled trials in June 2018. This updated review now includes 8 studies involving 4,464 women and their children. One of the new studies was very well done; three-quarters of all women in the survey participated in it. 5 trials were conducted in the UK, 1 in France, and 2 in Spain. They compared different versions of the vertical and horizontal (lying) positions.

Overall, there was little or no difference between upright and horizontal positions for caesarean section or instrumental vaginal (surgical) delivery (8 trials, 4316 women; low-quality evidence). The results of the studies differed significantly. However, when we looked only at high-quality studies, we found clear harm from standing upright (3 trials, 3,609 women). There is evidence of an increased risk of operative delivery (both instrumental and caesarean sections) and an increase in the number of caesarean sections.

There was no difference in the number of women with tears requiring sutures (3 trials, 3266 women; low-quality evidence) or major bleeding (1 trial; 3093 women; moderate-quality evidence). It is unclear whether standing has any effect on instrumental vaginal delivery or duration of the second stage of labor, as the quality of the evidence for these outcomes was very low.

Mothers reported slightly greater satisfaction with horizontal positions (1 trial, 2,373 women). Despite the fact that after birth in the supine position, a higher number of children had high cord blood acidity (2 trials, 3159children; moderate-quality evidence), there was no other evidence of harm to children. Comfortable were horizontal positions on the left or right side, but not on the back and not with legs raised in the stands.

What does this mean?

Overall, the evidence did not show a clear difference in operative delivery in women who received epidural anesthesia in the second stage of labor. This may be due to differences in the design and conduct of studies and the different positions studied. However, high-quality evidence showed better outcomes for women who shifted between side lying positions and avoided lying on their back. These positions result in a more normal birth, are better tolerated, and do not cause harm to the mother or baby compared to the upright position.

Translation notes:

Translation: Tashtanbekova Cholpon Bolotbekovna. Editing: Kukushkin Mikhail Evgenievich. Project coordination for translation into Russian: Cochrane Russia - Cochrane Russia (branch of the Northern Cochrane Center on the basis of Kazan Federal University). For questions related to this translation, please contact us at: [email protected]; [email protected]

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