Epidural in Labour: How It Works, How It Feels, Real Risks and Myths

It is two in the morning, your cervix is 4 centimetres dilated and the contractions come every three minutes. The midwife asks whether you would like the epidural. For a large majority of women, the answer is yes: in France, 82.7% of women giving birth received one in 2021, and more than 80% of women giving birth at the Geneva University Hospitals (HUG) use one.

For others, the decision is less simple, fed by stories heard in the family: the needle in the back, the "ruined back" for ever, the fear of feeling nothing. Here is how this anaesthetic is carried out, what it really feels like, and what the figures say about its side effects.

What exactly is an epidural?

It is a local anaesthetic, placed in the lower back by an anaesthetist. A very fine tube, the catheter, is slipped between two lumbar vertebrae, into the so-called "epidural space", very close to the nerves that carry pain from the uterus and perineum. A local anaesthetic is delivered through it, most often combined with a low dose of an opioid, a drug from the morphine family.

You stay fully conscious. The contractions go on and the uterus keeps working, but the pain fades or is reduced to a feeling of pressure. Many maternity units connect the catheter to a pump that you operate yourself to add a dose when the pain returns. In France, this pump was used in 74.2% of cases in 2021, against 53.8% in 2016.

The anaesthetic consultation: compulsory or not?

It depends on the country and the maternity unit. In some French maternity units, it is requested from every woman: at Louis-Mourier hospital (AP-HP), it is scheduled around the 8th month. At HUG, a specialist consultation is offered to women with a particular health problem, and an information class on the epidural is held before 38 weeks. At CHUV in Lausanne, the anaesthesia consultation is reserved for a minority of patients with a particular health issue: a questionnaire handed out from the 2nd trimester is used to identify them.

These differences come down to organisation, not safety: everywhere, the anaesthetist checks there is no contraindication before placing the catheter, at the latest in the delivery room. In Morocco, practices vary from one establishment to another. Ask when you register whether a consultation is planned and whether an anaesthetist is on site day and night. Our guide to choosing a maternity unit in Morocco lists the other questions to ask.

How is it placed?

The sequence is almost always the same:

1. A drip is set up in your arm. It hydrates you and lets the team quickly correct a drop in blood pressure.
2. You sit on the edge of the bed with your back rounded, or lie on your side with knees drawn up to your chest.
3. The anaesthetist disinfects the skin, which feels cold, then numbs it with a small injection of local anaesthetic, which stings and burns a little.
4. The needle is inserted between two vertebrae, the catheter is threaded through it, then the needle is withdrawn. Only a soft tube remains, taped along your back.

During the procedure, you need to stay still. Tell the anaesthetist when a contraction comes: they will wait for it to pass. A brief electric-shock feeling in one leg may occur; report that too. According to the UK's NHS, placement takes about ten minutes, and relief arrives 10 to 15 minutes later. HUG speaks of 15 to 20 minutes, and Naître et grandir, in Quebec, of about thirty minutes in all, from the start of the procedure to relief.

When can you ask for it?

When the pain becomes hard to cope with. There is no minimum dilation to reach, say Naître et grandir and the Louis-Mourier maternity unit, which sometimes places it beyond 8 centimetres if the baby has not yet engaged. The Quebec guide Mieux vivre does advise waiting until labour is well established, and warns that it can come too late if birth is imminent, for lack of time to act before pushing.

Two practical conditions therefore matter: an available anaesthetist, and time to place it. If the epidural is part of your plan, say so as soon as you arrive in the delivery room, without waiting until you are at the end of your tether. To know when to leave home, see our article on the signs that labour has started.

What you feel afterwards, and what it changes for the birth

Your legs often become heavy or numb. Depending on the drugs and doses, you may sometimes be able to get up and walk, accompanied: some maternity units offer these so-called "ambulatory" epidurals, others do not. The monitor continuously tracks the contractions and the baby's heart. If the bladder empties poorly, a urinary catheter is placed for a few hours, painlessly.

The sources agree on one point: an epidural does not increase the risk of caesarean. They differ a little on pushing. Naître et grandir, the NHS and Louis-Mourier observe slightly longer pushing and somewhat more frequent use of forceps or vacuum. HUG sees no notable effect on the length of labour, and the Obstetric Anaesthetists' Association (OAA) considers that it does not increase the use of instruments. To limit this risk, the team often lets the baby descend before asking you to push, and sometimes reduces the doses late in labour. The course of pushing is detailed in our article on the stages of a vaginal birth.

Side effects and risks: the real figures

The epidural is safe, but not free of effects. The table gives the frequencies published by HUG, supplemented by the NHS and AP-HP.

And for the baby? The drugs reach them in tiny amounts. Their heart rate may slow for a few minutes after placement, usually without consequence, and the team monitors it. HUG, the OAA and Naître et grandir find no effect on breastfeeding.

Epidural and back pain: where does this idea come from?

It is the most widespread fear, and it is unfounded. The NHS is clear: the back may stay tender for a day or two at the puncture site, but the epidural does not cause lasting back pain. Naître et grandir and the OAA say the same.

The idea persists because back pain is very common during and after pregnancy, with or without an epidural, as HUG points out. After the birth, you carry the baby for hours, breastfeed leaning over, sleep little. The back suffers, and the injection given in labour is quickly blamed.

Who cannot have an epidural?

Contraindications are rare, but they exist:

• a blood-clotting disorder; blood-thinning treatment is discussed with the anaesthetist before your due date;
• an infection of the skin in the lower back, or a general infection with high fever;
• significant bleeding under way;
• certain neurological or spinal conditions, including spina bifida, and certain back operations;
• a major emergency that leaves no time to place it.

The anaesthetist always decides, case by case, and offers another solution if needed. If the birth ends in a caesarean, an epidural already in place is most often used for the operation.

With or without an epidural, the decision is yours. Other ways to ease pain, from the birthing ball to the warm bath, are presented in our article on preparing for birth.