Epidurals for Labour
There are several different ways to provide pain relief during your labour. Epidurals are a safe, effective, and commonly used form of pain relief. About half of all first-time parents choose to have one. The goal of an epidural is to make your labour experience more manageable by reducing pain without affecting your ability to participate in the birth.
The following information is also available in Te reo Māori, Samoan and Tongan. Click here to access the translated versions at the bottom of this page.
A labour epidural involves an injection of numbing medication (local anaesthetic) into the space around the nerves in your lower back to block the pain from contractions. Anaesthetists are specialist doctors who can place an epidural if you choose to have your baby in a hospital. Anaesthetists are highly trained to deliver anaesthesia and help look after you before, during, and after your procedure.
This page shares information to help you understand how an epidural works and some of the risks and benefits involved.
This information is meant as a general guide. It does not replace individual medical advice given by your healthcare providers. You should always ask your healthcare team If there is anything you’re unsure about.
Who can have an epidural?
Most people can have an epidural, but there are some reasons that mean it’s not safe for some people to have one. This includes some spinal conditions such as certain types of spina bifida, infection, or problems with blood clotting.
Your anaesthetist will check you carefully to make sure it’s safe for you.
When can I get an epidural?
You can choose to have an epidural once you’re having regular painful contractions that are opening your cervix. It is not always possible to place one if your baby is going to be born very soon.
How is an epidural given?
An epidural involves inserting a small flexible tube into the space around the spinal cord.
- Before the epidural is given, your midwife will monitor your baby’s heartbeat, and a drip will be placed into a vein to give you extra fluids or medications if you need them.
- The anaesthetist will talk to you about the procedure and answer any questions you might have. This is all part of the consent process.
- You will be asked to sit or lie in a curled-up position and keep still.
- The skin on your lower back will be cleaned with an antiseptic where the injection will go in to keep it sterile.
- A small injection will numb the skin on your back.
- Then, a small hollow needle will be passed through the skin and into the space near your spine (epidural space).
- A very thin, soft plastic tube (a catheter) will be threaded through the hollow needle.
- The needle will then be removed, leaving the tube in place so that medication can be given to make you comfortable.
It is important to keep still while the anaesthetist is putting in the epidural, but once it is in and secured with a dressing, you will be free to move.
The epidural may take about 20 to 30 minutes to work fully, but you’ll probably start feeling better before that.
Once your epidural is in and working well, you will continue to be given some medication down the small tube (catheter) to ensure you remain comfortable. This is usually given by a pump attached to your epidural, either as a dose given at regular intervals, or as an infusion when it is given slowly and continuously.
Your hospital may use a type of pump that gives you a button to press when you need more medication to relieve your pain. This is called Patient Controlled Epidural Analgesia or PCEA and is a very effective way to give you the epidural pain relief. Your anaesthetist or midwife will show you how it works and will support you to ensure that your pain control is adequate. Once working, it should last throughout the rest of your labour.
The sensation and movement nerves can also be affected by the numbing medication – how much varies from person to person. Most people will feel some pressure or tightness during contractions and still have good strength and movement in their legs, especially if a low-dose epidural has been given.
You may be able to move around well in your bed, and sometimes around your room. Your midwife will check the movement in your legs to make sure it’s safe for you to get up.
Both you and your baby will be continuously monitored during your labour once your epidural has been placed.
What are the benefits and risks of an epidural?
Epidurals are generally a safe procedure that gives effective pain relief, especially when performed by anaesthetists, who are highly trained specialists. However, there are some potential risks and side effects that you should be aware of to help you decide if an epidural is right for you.
- It can reduce or even eliminate pain. This may allow you to rest, perhaps sleep, through your contractions.
- You are just as likely to have a vaginal birth without intervention if you have a low dose epidural.
- If a caesarean birth is required, your epidural is typically used as the anaesthetic for the surgery, allowing you to stay awake during the birth of your baby.
- The epidural can also be used for other procedures if necessary.
- Having an epidural should not affect the condition of your baby when they are born.
- Having an epidural is not associated with back pain.
- Having an epidural does not affect your ability to breastfeed.
- An epidural does not cause autism.
- About 1 in 10 epidurals do not work well at first and your anaesthetist may need to adjust it or occasionally take it out and replace it.
- Your blood pressure might drop, making you feel sick or dizzy. This can be treated with fluids or medications.
- Epidural medication can sometimes make your skin itch. This is temporary and can be treated.
- You may find it difficult to pee and need a tube (catheter) in your bladder to help you.
- About 1 in 100 people get a headache. Occasionally their headache is strong or lasts long enough to need treatment and a longer hospital stay.
- Occasionally, numb patches remain lasting up to around 3 months.
- Permanent injury, such as paralysis is extremely rare (around one in 100,000-250,000 people who have an epidural).
- There is a very small chance of developing an infection where the needle goes in your back.
Lasting complications are extremely rare. If you have any questions you should talk to your healthcare team, they will be happy to help.
More information
As a parent, there are many choices you can make for your whānau: from conception, through birth, breastfeeding and beyond. About 65% of pregnant people in Aotearoa New Zealand choose to or require the services of an anaesthetist during labour. This page and the resources linked below are supported by the National Obstetric Anaesthetists’ (NOA) Network. We hope this information on some of the choices where anaesthetists might be involved can help you feel more confident when the time comes to make those decisions.
