What is it?

The epidural is a very efficient way to alleviate pain during labour. The anaesthesiologist injects local anaesthetic around the nerves at the level of the spinal cord. The nerves are responsible for transmitting pain signals to the brain. The administered medication blocks these pain signals.

The anaesthetised site

The part of the body that is numb depends on the site where the epidural is given.

  • With a low epidural, you will not feel sensation in the bottom half of the body (often used for hip or knee replacement surgeries).
  • An epidural placed at a higher level makes it so that you do not feel sensation in the abdominal area (often used for abdominal surgeries).

Pain pump

The anaesthesiologist will leave a thin plastic tube (e.g. catheter) in the epidural space. A pain pump will be connected to this catheter and can give continuous anaesthetic. The midwife will remove the catheter after the birth.

Effect on pushing?

A well-placed epidural will provide pain control and will have no impact on the strength you will have to push during birth. Since it can have an effect on your blood pressure and make your legs feel numb, you will be asked to stay in bed after the epidural is placed.

Read more here about anaesthesia for labour and birth or a caesarean section.

Possible risks

In some circumstances, the anaesthesiologist cannot place an epidural:

  • if you are allergic to local anaesthetic.
  • if you have an infection at where the injection site would be (e.g. lower back).
  • if you have already had a prior back surgery at the level of where the injection site would be.
  • if you have a coagulation disorder or if you took blood thinners in the past few days.

Possible side effects

The epidural is a safe technique, but even so, it may have some side effects.

Blood pressure drop

This is why an IV is always placed before an epidural. A drop in blood pressure can be treated by giving extra fluids and, if needed, with medication that is administered intraveneously.

Reduced sensation in the legs (e.g. ‘fuzzy’ legs).

This is a normal effect of the medication that was administered. This is also why you are asked to stay in bed after the epidural injection.

Itching

This is also a side effect from the medication and is not dangerous. The itching will go away after the medication wears off.

Headache

Rarely, you may have a headache afterwards. This happens when a small hole was made accidentally in the spinal cord membrane. This is usually temporary and treated with a period of bedrest where you lie flat in bed. In exceptional cases, a ‘blood patch’ may be necessary. This requires that a new epidural be placed and that a small amount of blood be injected at that site in order to close the hole. That will almost always result in an immediate improvement in the symptoms.

Persistent nerve pain or paralysis

Persistent nerve pain or paralysis are extremely rare complications.

Centres and specialist areas

Anaesthesia

Latest publication date: 05/02/2021
Supervising author: Dr Vanoverschelde Henk