Epidural: Everything You Need to Know

Reviewed content. Last updated: April 2026.

An epidural is the most effective form of pain relief available during labour. Around 1 in 3 people giving birth in the UK have one. If you are considering an epidural or simply want to understand the option, this guide covers how it works, the benefits, the risks, and what to expect.

What is an epidural?

An epidural is a type of regional anaesthesia that blocks pain signals from the nerves in your lower body. A thin catheter (tube) is placed in your lower back, in the space just outside the membranes surrounding your spinal cord. Pain-relieving medication is delivered through this catheter, numbing the nerves that carry pain signals from your uterus and birth canal.

Unlike a general anaesthetic, you remain fully conscious. Most people feel pressure and movement during contractions but not pain.

How is it given?

An epidural is administered by an anaesthetist, a doctor who specialises in pain relief and anaesthesia. Here is what happens:

1. You will be asked to sit up and lean forward, or lie on your side, curling into a ball. Staying still during insertion is important.
2. The anaesthetist cleans your lower back with antiseptic and injects local anaesthetic to numb the skin.
3. Using a special needle, they find the epidural space in your lower back (between the vertebrae in your lumbar spine).
4. A thin catheter is threaded through the needle, and then the needle is removed. The catheter stays in place, taped to your back.
5. A test dose is given first, followed by the full dose once the anaesthetist is satisfied with the placement.

The whole process takes about 10 to 20 minutes, and the pain relief usually starts working within 10 to 15 minutes after that. You will be given a button to press for additional doses as needed (patient-controlled epidural analgesia), or the anaesthetist may set up a continuous infusion.

When can you have one?

You can request an epidural at any point during active labour, though it is most commonly given once contractions are well established. There is no specific dilation threshold you need to reach. NICE guidelines state that an epidural should be available whenever you request one, though there may occasionally be a wait if the anaesthetist is attending another patient.

An epidural is only available in a hospital setting with an obstetric unit. If you are in a midwife-led unit or at home and decide you want an epidural, you will need to be transferred to hospital.

What are the benefits?

Effective pain relief

An epidural provides the most complete pain relief of any option available during labour. For many people, it transforms the experience from one of overwhelming pain to manageable pressure. Research consistently shows that epidurals are more effective at reducing labour pain than other methods such as opioids, gas and air, or TENS machines.

You stay awake and alert

Because it is a regional anaesthetic, you remain fully conscious throughout. You can communicate with your birth partner and midwife, make decisions, and be fully present for the birth.

Can be adjusted

The level of pain relief can be increased or decreased by adjusting the medication. A mobile or low-dose epidural allows you to retain some feeling and movement in your legs, which may make it easier to change positions and push during the second stage.

Useful if labour is long or complicated

If your labour is very long, an epidural allows you to rest and conserve energy. It is also the anaesthesia of choice if an instrumental delivery (forceps or ventouse) or emergency caesarean becomes necessary, as the existing epidural can be topped up quickly rather than requiring a general anaesthetic.

What are the risks and side effects?

Like any medical procedure, epidurals carry some risks and side effects. Most are minor and temporary.

Common side effects

• Low blood pressure. The medication can cause a drop in blood pressure, which may make you feel light-headed. Your blood pressure is monitored continuously, and fluids are given through a drip to help prevent this. Medication to raise your blood pressure can be given quickly if needed.
• Difficulty passing urine. An epidural can reduce your awareness of a full bladder. A catheter is usually inserted to keep your bladder empty.
• Itching. Some people experience itching, particularly if opioid medication is included in the epidural mix. This can be treated if it becomes bothersome.
• Shivering. Shivering is common during labour generally, and an epidural can make it more likely. Warm blankets help.
• Reduced mobility. Depending on the type and dose, you may have limited ability to move your legs. A mobile or low-dose epidural preserves more sensation and movement.

Less common risks

• Severe headache (post-dural puncture headache). If the epidural needle accidentally punctures the membrane surrounding the spinal cord, it can cause a headache that is worse when upright. This happens in about 1 in 100 epidurals. It usually resolves with rest, fluids, and painkillers, but occasionally requires a follow-up procedure called a blood patch.
• Longer second stage of labour. Research suggests that epidurals may lengthen the pushing stage of labour. NICE guidelines account for this by allowing additional time before recommending intervention.
• Slightly higher rate of instrumental delivery. Some studies show a modest increase in the use of forceps or ventouse with epidurals, though the evidence is mixed and this may be partly explained by the fact that longer, more difficult labours are more likely to involve both epidurals and instrumental deliveries.
• Temporary nerve damage. Very rarely, the epidural can cause temporary numbness or tingling in the legs after birth. This usually resolves within days to weeks.
• Infection or abscess at the insertion site. Very rare but treatable.
• Permanent nerve damage. Extremely rare (estimated at around 1 in 24,000 to 1 in 50,000 epidurals).

What an epidural does NOT do

• It does not increase the risk of long-term back pain. This is a common misconception. Research shows no link between epidurals and chronic back pain after birth.
• It does not cross to the baby in significant amounts. Unlike opioid injections (such as pethidine), epidurals deliver medication locally and very little enters the baby's bloodstream.
• It does not increase the risk of caesarean section. Large studies and a Cochrane review have found no increase in caesarean rates associated with epidural use.

Can you still move and push with an epidural?

Modern low-dose and mobile epidurals are designed to relieve pain while preserving as much feeling and movement as possible. Many people with an epidural can still feel pressure during contractions (without the sharp pain), change positions with assistance, and push effectively during the second stage.

Your midwife will help you find good positions for pushing, even with reduced mobility. Side-lying, supported upright, and hands-and-knees positions are all possible with an epidural, sometimes with the help of pillows or a birth partner.

How to decide if an epidural is right for you

There is no right or wrong answer. Some people know from the start that they want an epidural, some want to try other methods first and keep it as a backup, and some prefer to avoid one entirely. All of these are valid choices.

It can help to:

• Discuss your options with your midwife during pregnancy
• Learn about all the pain relief options so you can make an informed decision in the moment
• Include your preferences in your birth plan while remaining open to changing your mind
• Know that requesting an epidural after initially planning not to have one is not a failure. It is a reasonable response to a physically demanding experience.

Key takeaways

• An epidural is the most effective pain relief available during labour, used by around 1 in 3 people giving birth in the UK
• It is administered by an anaesthetist and takes about 20 to 30 minutes to be placed and take effect
• Benefits include highly effective pain relief, staying awake and alert, and the ability to rest during a long labour
• Common side effects include low blood pressure, difficulty passing urine, and itching, all of which are manageable
• Epidurals do not cause long-term back pain and do not increase the risk of caesarean section
• Modern low-dose epidurals preserve some feeling and movement
• You can request an epidural at any point during active labour, and changing your mind either way is completely fine

Sources

• NHS. Epidural. nhs.uk
• NICE Clinical Guideline CG190. Intrapartum care for healthy women and babies. 2014, updated 2023
• Obstetric Anaesthetists' Association. Epidurals for pain relief in labour. 2022
• Anim-Somuah M et al. Epidural versus non-epidural or no analgesia for pain management in labour. Cochrane Database of Systematic Reviews. 2018
• RCOG. Pain relief in labour. Patient information. 2023