An epidural is the gold standard in pharmacological pain management and an important part of any mum’s antenatal education, whether you want to have one or not. Labour and birth are unpredictable, and each pregnancy is unique. Deciding you want to have an epidural when you didn’t plan for one is perfectly acceptable, if that’s what you want for your birth on the day. However, as an evidence-based resource that wants mums to make informed decisions, Unii wants to answer popular prenatal epidural questions.

What is an epidural bleed (epidural haematoma)?

This is a spinal column bleed following an epidural that can cause back pain or paralysis. It’s important to note that it rarely happens to labouring women. The term “epidural haematoma” is also used to refer to a brain bleed resulting from head trauma, which is completely different and unrelated to pregnancy anaesthetic but can be confusing. Epidural bleeds are most likely to happen to people with clotting problems who are on blood-thinning medication. Your pregnancy and birth care should be tailored to accommodate any blood clotting issues you may have.

What are the other potential side effects of an epidural?

Soreness at the injection site, difficulty urinating, fever, lightheadedness caused by dropping blood pressure, and (rarely) headaches are all potential side effects. It’s important to speak up about these; you don’t need to endure them, and efforts can quickly be made to ensure your safety and improve your comfort. Mild side effects usually resolve by themselves. Severe side effects of an epidural are rare, and your healthcare team will be trained to deal with them.

Will an epidural make my labour longer?

An epidural can make labour longer. Some studies show that epidurals make the pushing stage of labour a comparable length but a little longer than going epidural-free. The increases are usually less than an hour, though obviously this can be perceived as much longer when you are labouring.

Will an epidural make forceps or ventouse delivery more likely?

Yes, assisted delivery is more likely to happen if you have an epidural, especially if you are a first-time mum. This is because conscious pushing is more challenging after you have an epidural, though midwives are trained to support you in this, and epidural doses can be tailored to make the birth you want more likely. If you do need an assisted delivery, the choice of whether a forceps or ventouse cup is used will be the obstetrician’s if you haven’t specified what you want in your birth plan (birth preferences).

Will an epidural make me more likely to need an unplanned caesarean section?

No, research shows you are not more likely to need an unplanned caesarean if you choose to have an epidural, though there are many other things that can make surgery the safest option for your birth. If you do need it, your epidural will usually be topped up in advance. Women having an elective caesarean will often be given a spinal block, though they can be given an epidural instead or additionally.

Will an epidural make a serious tear in childbirth and an episiotomy more likely?

Third- and fourth-degree (serious) tearing in childbirth is hard to predict, but if you have either, you will need an episiotomy. They are more likely with a forceps delivery, during a first-time delivery, with a larger baby, and if you’ve had tearing before. As an epidural can make a forceps delivery more likely, we can say it does make tearing more likely also.

Will an epidural make me feel differently about becoming a mother?

This is an interesting question, and it is true that some women who have medicated births judge themselves harshly or feel judged for not rejecting an epidural. We also do not wish to detract from the work and strength of a mother who labours without anaesthesia. However, it’s important to remember that, beyond the unique nature of every pregnancy, everyone’s body experiences pain differently, and in the end, the greatest mark of a successful labour and birth is a healthy mother and child, not what the mother endured in the process.

For more advice on taking care of yourself in pregnancy, labour, and birth, check out Unii’s Antenatal Classes, with prenatal video episodes taught by senior NHS midwives, an award-winning obstetrician and gynaecologist, and six other leading healthcare experts. Only at unii.com.

Antenatal Class Questions: How does an epidural affect the pushing stage of labour?

This form of labour pain relief has pros and cons.