Comfort Measures in Labour: Epidurals

There a few different types of epidurals (injection with top-ups, continuous infusion, combined spinal epidural and mobile epidural). The anaesthetist will numb your lower back area with a local anaesthetic. They will then guide a fine, hollow needle between the small bones in your spine. Your anaesthetist will pass a tube (epidural catheter) through the needle. They will then gently remove the needle once the tube is in place. The other end of the tube is taped up your back and over your shoulder to help it stay in place and out of your way. An epidural is a regional anaesthetic, so not all of your body will be affected. The injection of the drugs are around the nerves that carry pain signals from your womb (uterus) and cervix to your brain during labour. So effectively it blocks this signal providing you with effective pain relief. Epidurals are only available in hospital in an obstetrics/labour ward and about 30 per cent of women have an epidural or spinal during labour or after the birth.


Some hospitals can provide mobile epidurals, these typically contain a mixture of drugs, a local anaesthetic, plus an opioid. A low-dose epidural should allow you to retain some sensation in your legs and feet. Giving you enough strength in your legs to move around in bed and change position when you want.

What are the benefits?
➡️ It provides total pain relief when effective, most women find they are completely pain free, you will feel more clear headed (unlike other forms of pain relief), and lowers blood pressure.

What are the side effects?
➡️ For about 1 in 8 women an epidural doesn’t work and only works partially. It might mean that it needs adjusting.
➡️ You and baby will need more monitoring, it is likely your midwife will monitor your baby and your blood pressure for 30 minutes at first and then regularly after each top-up.
➡️ The drop in blood pressure can work against you and can mean less blood flow to the baby. You may need to have an IV drip to counteract the risk of your blood pressure dropping too quickly – this can also limit your movement, and as it’s often sited in the hand and remains in after birth and perhaps can get in the way when you are trying to feed your baby.
➡️ Your mobility is reduced even with a more ‘mobile’ epidural this reduction in mobility can slow labour down and increase your chance of intervention including having your labour sped up using a hormone drip.
➡️ If the epidural hasn’t worn off by the time your body is ready to birth your baby, it may take longer for your baby to be born as you may not feel an urge to bear down. If this is the case, and there’s no sign of your baby’s head yet, your midwife should encourage you to wait for an hour, or until you feel the urge to bear down.
➡️ There is also an increased chance of a baby needing help to be born either because you don’t feel the urge to bear down or perhaps reclining on a bed can encourage baby to wriggle into a less optimal position for birth.

Here are some tips I have shared before in classes if someone was considering an epidural:
⭐ Keep the oxytocin levels high. So dim the lights, have familiar smells around you, quiet voices, privacy and limit the number of people in the room. You body is still working hard to encourage your cervix to open and release even if you can’t necessarily feel it. Also as the epidural starts to work, you might begin to assess and reflect. Sometimes you might be grateful with your choice or you might feel disappointed or upset or a mixture of each which is really normal. So perhaps it isn’t a good idea for someone to pass judgement on your decision. Such as “Aren’t you glad you got an epidural?” or “You made the right decision.”
⭐ If you have been labouring for a long time, an epidural can help you to rest or sleep. So if you haven’t already put an eye mask and noise cancelling headphones/ear plugs in your hospital bag to block out any noise. These are useful for the postnatal ward too.
⭐ Use breathing techniques, to help you stay calm and at ease. Centred breath which we practice in Nurtured Pregnancy classes is super helpful when an epidural is being placed too.
⭐ Use massage and touch, consider asking your birth partner/doula/midwife to massage your hands, feet or arms. This can help keep you feeling supported and make you feel present and connected to your body.
⭐ Use position, did you know that even with an epidural, you can still be in an active birth position whether that is side lying using a peanut ball or even upright?. Ask your birth partner and midwife to help you change positions every 30 mins if you can – it really encourages your cervix and pelvis to open and your baby to descend.


Did you have an epidural during your birth?