As the birth of your baby draws closer, you may be finalising your birth plan. One of the most significant decisions around birth is whether or not you will use medication or give birth naturally.

If you’ve weighed up the options and you’re swaying towards a labour where you feel the least amount of pain, then it’s likely you’ve considered having an epidural.

What is an epidural, and how does it work?

An epidural is an anaesthetic that can be given at any stage of labour to numb the lower part of the body so you do not feel the pain of contractions.

A hollow needle is used to insert a fine plastic tube (an epidural catheter) between two vertebrae in the lower back near the nerves that carry pain messages to the brain. A local anaesthetic is injected into the needle, which flows through the tube into the epidural space. The nerves carrying the pain messages to the brain are coated with anaesthesia, which means pain is greatly reduced or completely blocked.

When are epidurals used?

Epidurals can be used at any time throughout labour. As every woman has different pain thresholds, the time an epidural is requested varies. If you request an epidural late in labour, in order to minimise the risks, you must remain completely still during the insertion of the epidural tube. If your labour has progressed too far, you may be refused an epidural or given a higher dose so it takes effect in time. If possible, try to decide on an epidural as early as possible so that your midwife can discuss any risks and answer any questions you may have.

Are there any side effects?

If you opt for an epidural, there are a few minor side effects to be aware of:

The epidural medication can lower your blood pressure, which means it will need to be monitored. If your blood pressure does fall, you will be given medication and fluids to help stabilise it.

A common side effect that many women experience is itching. This happens when histamine from the opioid component of an epidural is released. Histamine is released by the body during an allergic reaction that causes itching. The itching can be treated, but in most cases, it usually subsides on its own.

It is quite common to experience shivering during an epidural, although this happens more commonly if a concentrated local anaesthetic is used.

What are the pros and cons of an epidural?

Pros

An epidural provides complete pain relief in 90% of cases. The other 10% experience some degree of pain but a significant reduction in pain overall.
Epidurals are completely safe and pose no risk to your baby.
Epidurals can be topped up if needed with the addition of anaesthetics for an assisted delivery or forceps or a ventouse for a Caesarean.

Cons

Approximately 1 in 10 women does not experience complete pain relief during an epidural.
Some women develop a lingering headache that continues even though the epidural has worn off.
Feet and legs can feel heavy, although this is a rare complication.

Are there any risks associated with an epidural?

There are a few very rare risks associated with an epidural:

As with any invasive procedure, there is always a risk of infection. Around 1 in 100,000 women contract meningitis, and around 1 in 50,000 can develop an epidural abscess.
There is a 1 in 170,000 chance of developing a blood clot in the epidural space.
There is a 1 in 100,000 chance of the epidural catheter moving into the fluid around the spine, which may cause unconsciousness.
There is a 1 in 250,000 chance of an epidural causing paralysis.

What is an epidural and how does it work (Part One)?

For Unii’s Giving Birth Journey, we explore all things epidural.