Epidural during birth
Epidural | Pregnancy Birth and Baby
Epidural | Pregnancy Birth and Baby beginning of content5-minute read
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Key facts
- An epidural is procedure used to relieve pain during labour and birth.
- It uses an injection of local anaesthetic in the space around the spinal nerves in your lower back to block pain from contractions.
- Epidurals are usually done during the first stage of labour.
- After an epidural, you’ll need to stay in bed because your legs will be weak, and so that your health and your baby’s health can be monitored.
- An epidural does not increase your risk of needing a caesarean section, but it may prolong the second stage of labour and increase your chance of needing an assisted delivery.
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 pain from labour contractions during birth very effectively. With an epidural you can usually still push your baby out when you need to.
An epidural is usually done by an anaesthetist.
What does an epidural involve?
Before an epidural, you will usually have a drip for fluids put into your arm.
You will need to sit up and bend forward over a pillow, or lie on your side curled up into a ball. This makes it easier to insert the needle into the right place. It is important that you stay very still during the procedure to avoid complications.
Your lower back will be washed with antiseptic. A small amount of local anaesthetic will be injected into the skin of your lower back. Your anaesthetist (specialist doctor) will insert the epidural needle between contractions, so it is important that you tell them when you have a contraction. The needle will be inserted between the bones of your spine into the space around your spinal nerves.
A small soft plastic tube will be inserted, and the needle removed. The plastic tube delivers the anaesthetic that will numb your pain.
It usually takes between 5 and 30 minutes for the epidural to relieve your pain.
When can I have an epidural?
Usually, if you have an epidural to help you give birth, you will have it during the first stage of labour. You can also have an epidural at any stage of labour.
Who can have an epidural?
Most people can safely have an epidural, but there are some medical reasons that mean it is not possible. It’s a good idea to think about your options for pain relief before the birth. Discuss these with your doctor or midwife, who can help you decide between options that are suitable for you.
Epidurals are available at most hospitals, but not in birth centres or during home births.
What are the advantages of an epidural?
Epidurals have many advantages:
- They are usually very effective.
- They are generally very safe.
- After an epidural, you may still be able to move around in bed and push when you need to.
- If you have a long labour, an epidural allows you to sleep and recover your strength.
- If you're having a caesarean, you can stay awake and your partner can be there.
What are the disadvantages of an epidural?
If you have an epidural, you will usually develop some temporary weakness in your legs. This means that you will need to stay in bed to avoid falls.
Since epidurals can cause low blood pressure, you will need to have your blood pressure monitored. You might also need to have fluids given to you through a tube in your arm.
You will also usually need a catheter (tube) in your bladder to help you pass urine, as an epidural can make you lose feeling in your bladder.
Your baby will need to be closely monitored during your labour.
Having an epidural does not make it more likely that you will need a caesarean section. However, it may slow down the second stage of labour, and increase your chance of needing an assisted delivery.
What are the risks of having an epidural?
An epidural is effective and generally safe. But there are some risks:
- Some people feel cold or itchy.
- A small number of people get little or no pain relief.
- Some people develop a bad headache 24 to 48 hours after an epidural.
- There is a small chance of developing an infection.
- Very rarely, an epidural can cause permanent nerve damage.
Epidurals do not directly affect your baby.
What should I ask my doctor or midwife about having an epidural?
You can check:
- If you can have an epidural at your chosen hospital or birth centre.
- What their epidural procedures are.
- If there are any extra costs or fees involved.
- The type of pain relief that might suit your personal circumstances best.
Sources:
Royal Women's Hospital Melbourne (Epidural information), Queensland government (Epidurals), Queensland Health (Epidural analgesia in labour - clinical guidelines), RANZCOG (Pain Relief in Labour and Childbirth), WA Health (Epidurals for childbirth)Learn more here about the development and quality assurance of healthdirect content.
Last reviewed: July 2022
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Related pages
- 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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Epidurals: Meaning and Side Effects of Anesthesia During Labor
An epidural is the most common type of anesthetic used for pain relief during labor. Here’s what you should know before having an epidural, including information that dispels some common myths.
How and when is an epidural for labor pain administered?If you choose to have an epidural, an anesthesiologist will insert a needle and a tiny tube, called a catheter, in the lower part of your back.
The needle is removed and the catheter left in place for delivery of the medication through the tube as needed. You can begin an epidural at any time during your labor — in the beginning, in the middle, or even toward the end — in consultation with your physician.
The anesthesiologist will numb the area where the epidural is administered, which may cause a momentary stinging or burning sensation. But because of this numbing, there is very little pain associated with an epidural injection. Instead, most patients will feel some pressure as the needle is inserted.
What does an epidural do?An epidural provides anesthesia that creates a band of numbness from your bellybutton to your upper legs. It allows you to be awake and alert throughout labor, as well as to feel pressure. The ability to feel second-stage labor pressure enables you to push when it’s time to give birth to your baby.
It can take about 15 minutes for the pain medication to work.
You can continue to receive pain relief through an epidural for as long as you need it. The amount of medication you receive through the epidural can be increased or decreased as necessary.
Can an epidural slow labor or lead to a cesarean delivery (C-section)?There is no credible evidence that it does either. When a woman needs a C-section, other factors usually are at play, including the size or position of the baby or slow progression of labor due to other issues. With an epidural, you might be able to feel contractions — they just won’t hurt — and you’ll be able to push effectively. There is some evidence that epidurals can speed the first stage of labor by allowing the mother to relax.
Can epidurals harm the baby?The amount of medication that reaches the baby from the epidural is very small, and there is no evidence that it causes any harm.
Epidurals are very safe; serious complications are extremely rare. However, as with all medications and medical procedures, there are potential side effects:
- Decrease in blood pressure – The medication may lower your blood pressure, which may slow your baby’s heart rate. To make this less likely, you will be given extra fluids through a tube in your arm (IV), and you may need to lie on your side. Sometimes, your anesthesiologist will give you a medication to maintain your blood pressure.
- Sore back – Your lower back may be sore where the needle was inserted to deliver the medication. This soreness should last no more than a few days. There is no evidence that an epidural can cause permanent back pain.
- Headache – On rare occasions, the needle pierces the covering of the spinal cord, which can cause a headache that may last for a few days if left untreated.
If this situation arises, discuss the treatment options with your anesthesiologist.
A spinal block is sometimes used in combination with an epidural during labor to provide immediate pain relief. A spinal block, like an epidural, involves an injection in the lower back. While you sit or lie on your side in bed, a small amount of medication is injected into the spinal fluid to numb the lower half of the body. It brings good relief from pain and starts working quickly, but it lasts only an hour or two and is usually given only once during labor. The epidural provides continued pain relief after the spinal block wears off.
Anesthesiologists are committed to patient safety and high-quality care, and have the necessary knowledge to understand and treat the entire human body.
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. nine0005
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. nine0005
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. nine0005
Overall, there were little or no differences between upright and horizontal positions for caesarean section or instrumental vaginal (surgical) delivery (8 trials, 4,316 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. nine0005
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. nine0005
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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nine0061 Dear patients!Multidisciplinary Clinic and Maternity Hospital "Paracelsus" informs you, according to the Letter of the Ministry of Finance of the Russian Federation to the Federal Tax Service dated March 25, 2022.
N BS-4-11 / 3605, that subparagraph 3 of paragraph 1 of Article 219 of the Tax Code of the Russian Federation provides for the taxpayer's right to receive a social tax deduction in the amount paid by him in the tax period for medical services provided by medical organizations engaged in medical activities , him, his spouse, parents, children (including adopted children) under the age of 18, wards under the age of 18 (in accordance with the list of medical services approved by the Government of the Russian Federation). nine0005 Joint order of the Ministry of Taxation of Russia and the Ministry of Health of Russia dated July 25, 2001 N 289 / BG-3-04 / 256 (hereinafter - the order of July 25, 2001) approved the form of the Certificate of payment for medical services for submission to the tax authorities of the Russian Federation (hereinafter - the Certificate payment for medical services).
This certificate certifies the fact of receiving a medical service and its payment through the cash desk of a healthcare institution at the expense of the taxpayer.
