Epidural and anaesthesia in labour and birth

What is an epidural and what anaesthesia is used in labour and birth?

Labour can be very painful, and women and birthing people have a range of pain-relief options. An epidural is one of the most effective. It involves an anaesthetist placing a very fine tube (catheter) into the space around the nerves in the lower back, through which local anaesthetic and pain-relieving medicines are given. It can be topped up as labour goes on.

Related techniques include a spinal (a single injection that works fast and is often used for a caesarean) and a combined spinal-epidural. For most planned and emergency caesareans, a spinal or epidural is preferred because the mother stays awake and can meet her baby straight away; a general anaesthetic is sometimes needed in an emergency or if regional anaesthesia is not possible.

An epidural gives good pain relief and can help a woman feel more in control. It has very little effect on the baby and does not make breastfeeding harder. It does have effects worth knowing: it can lower blood pressure, make moving and passing urine harder, prolong the pushing (second) stage, and is linked with a higher chance of an assisted (forceps or ventouse) delivery. It does not increase the chance of a caesarean.

Whether to have an epidural is entirely the woman's choice. Good care explains the benefits and the effects honestly, supports whatever she decides, and never pressures her either way.

Types, options & approaches

There may be different ways to do this. The right approach depends on the clinical question and your circumstances.

Epidural vs other labour pain relief

Other options include water, TENS, breathing techniques, gas and air and opioid injections. The best choice is personal and can change during labour.

Preparing for your treatment

• Read the OAA epidural information so you can weigh up the benefits and effects before you are in strong labour.
• Discuss your pain-relief preferences with your midwife and, if you wish, an anaesthetist — ideally before labour if you have particular concerns.
• Tell the team about back problems, bleeding disorders, blood thinners, or any previous problems with anaesthetics.
• Know that you can ask for an epidural during labour, and can also choose other options first and change your mind.
• Understand that an anaesthetist needs to be available, so there can sometimes be a wait, especially if the unit is busy.
• Ask how the epidural will affect moving, pushing and monitoring in your unit.
• Remember the decision is yours — you should never feel pushed towards or away from an epidural.

What happens

When you ask for an epidural, an anaesthetist comes to see you, checks your history and explains the procedure and risks. A drip is placed in your arm, and you are helped into a curled-up sitting or lying position. The skin of your lower back is cleaned and numbed, and the anaesthetist places the fine epidural tube, then removes the needle, leaving the soft tube taped in place.

The medicines are given through the tube and usually start to relieve pain over about 20–30 minutes. Your blood pressure and the baby's heartbeat are monitored, especially at first. You can usually still feel pressure and move your legs a little, but heavy sensation and pain are reduced.

The epidural is topped up as needed, sometimes by you pressing a button within safe limits. If it does not work well enough on one side or in patches, the anaesthetist can adjust it or occasionally re-site it. For a caesarean, a stronger top-up or a spinal makes the whole area numb while you stay awake.

Is this treatment right for me?

A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.

Before you decide

Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.

Comfort, sedation or contrast choices

If local anaesthetic, sedation, contrast or pain relief is used, ask what is planned, why, and what it means afterwards.

An epidural is generally very effective, and serious complications are rare, but it is important to understand the common effects: lower blood pressure, harder mobility and passing urine, a longer pushing stage and more assisted deliveries — while it does not increase the chance of a caesarean. The most useful things to discuss are the chance the epidural may need re-siting, the small chance of a severe headache, and the very rare nerve risks. The decision is always yours.

Published figures to discuss

Effectiveness and risks vary between people and units. An epidural is usually very effective but a minority need a top-up, adjustment or re-siting. Serious complications are rare, and the figures below come from UK obstetric-anaesthesia patient information. Your anaesthetist will explain how these apply to you.

These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.

What happens afterwards

After birth the epidural is stopped and the tube removed; feeling and movement return over a few hours. Most effects settle quickly, though it can take a little while before you can walk steadily and pass urine normally.

• Heavy or tingly legs that gradually return to normal over a few hours
• Needing help to stand and walk the first time
• Mild tenderness or bruising at the epidural site in the back
• Needing a bladder catheter for a short time
• Feeling shivery or warm for a while

Aftercare

• Ask for help the first time you get up, as your legs may still be weak.
• Tell staff when you have passed urine, and report if you cannot.
• Report a severe headache, especially one worse when sitting or standing up.
• Report any ongoing leg weakness, numbness, or loss of bladder or bowel control.
• Take simple pain relief as advised for any site tenderness.
• Keep the area clean and watch for redness, swelling or fever (signs of infection).
• Ask the team any questions about how your labour and birth went.
• Know who to contact after going home if symptoms develop.

• OAA epidural information read in advance
• Pain-relief preferences discussed and noted in your birth plan
• Relevant history (back problems, blood thinners) shared with the team
• Understanding that you can ask for or decline an epidural at any time
• Birth partner aware of your wishes
• Questions for the anaesthetist written down
• Contact details for advice after discharge

⚠ Get urgent help if…

• A severe headache, especially one that is worse sitting or standing and better lying flat
• Leg weakness or numbness that is getting worse or not recovering after the epidural wears off
• Loss of control of your bladder or bowels
• A high temperature, chills, or increasing back pain at the epidural site
• Redness, swelling or discharge at the site in your back
• A stiff neck with headache and feeling unwell
• Any sudden severe symptom — seek urgent advice

Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.

General guidance — it doesn't replace the specific advice your specialist gives you.

Results & realistic expectations

An epidural is judged a success when it gives you good, comfortable pain relief and you feel more in control, while you and your baby stay safe. Most women get effective relief, though it sometimes takes a top-up or an adjustment, and occasionally needs re-siting.

Choosing an epidural — or choosing not to have one — does not make you a better or worse mother, and good teams support whatever you decide. An epidural does not guarantee a pain-free labour or a particular type of birth, but it is one of the most reliable ways to manage labour pain.

Related tests, treatments or support

An epidural can be combined with, or follow, other pain relief such as gas and air earlier in labour. The same epidural can be topped up to provide anaesthesia for an assisted delivery, stitches, or a caesarean if one becomes necessary, often avoiding a general anaesthetic.

Follow-up & long-term care

Before you go home you should know who to contact if you develop a severe headache, leg weakness, or signs of infection. If an accidental dural puncture caused a headache, the team will explain treatment, which can include a procedure called a blood patch. Many units offer to discuss your anaesthetic afterwards if you have questions.

Repeat, follow-on and what comes next

• An epidural commonly needs topping up, and sometimes adjusting if it works unevenly.
• A minority need the epidural re-sited to work properly.
• The same epidural can often be topped up for an assisted delivery or caesarean, avoiding a general anaesthetic.
• If a dural-puncture headache occurs, a follow-up blood patch procedure may be offered.

Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.

What good aftercare looks like

• Close monitoring of blood pressure and the baby while the epidural is working.
• Help with first mobilising and a check that you can pass urine.
• Clear advice on warning signs (severe headache, leg weakness, bladder problems) and who to contact.
• Prompt follow-up and treatment if a dural-puncture headache occurs.
• An offer to discuss your anaesthetic and answer questions after the birth.

What affects the cost

Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:

• Whether you are under NHS or private maternity care
• Anaesthetist availability and involvement
• The type of pain relief or anaesthesia used (epidural, spinal, combined)
• Whether a caesarean or assisted delivery is needed
• Length of labour and number of top-ups
• Treatment of any complication, such as a blood patch for a headache
• Postnatal monitoring and follow-up

• Whether anaesthetic services are included in a private maternity package
• The anaesthetist's fee and availability day and night
• Facility and monitoring fees
• What is covered if a caesarean or assisted delivery is needed
• Treatment of complications such as a post-dural-puncture headache
• Postnatal care and follow-up
• The cancellation or change-of-plan policy

On the NHS? Epidurals and obstetric anaesthesia are a core part of NHS maternity care, available day and night where staffing allows; private maternity care may offer more choice over consultant and setting.

You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.

Consent traps and marketing red flags

These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.

Choosing a specialist safely

• Check the specialist is on the GMC Specialist Register for this area.
• Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
• You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
• Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
• You're entitled to your total cost in writing — including any follow-up — before you decide.

How Vuemedics verifies every consultant →

Take this to your consultation. A good specialist will welcome every one of these.

• What are the benefits and the effects of an epidural for me specifically?
• How will it affect my mobility, pushing and monitoring in this unit?
• How likely is it to need topping up or re-siting, and who responds if it doesn't work?
• What pain relief is available if I don't want an epidural, or while I wait?
• If I need a caesarean, can my epidural be used so I stay awake?
• Who should I contact afterwards if I get a severe headache or leg weakness?
• Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
• Will you be the specialist who carries out my treatment, and who looks after me afterwards?
• What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
• What does a realistic result look like — and what can this treatment not achieve?
• What are my options, including waiting, doing nothing for now, or choosing a different approach?
• Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
• What is the total cost in writing, including any follow-ups, and how much time do I have to decide?

Find a verified specialist for epidural and anaesthesia in labour and birth

Every consultant is GMC-checked and independently reviewed. Search by postcode and distance, or switch to a map. Ordered by rating, relevance and recency — never by who pays.

How we made this page

Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →

Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.

Sources & standards: OAA / Labour Pains — Pain relief and anaesthesia choices during labour OAA / Labour Pains — Epidural information card NHS — Epidural and pain relief in labour RCoA — Epidural anaesthesia during and after surgery RCoA — Nerve damage associated with a spinal or epidural injection

Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.

Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.