What Is an Epidural? A Complete Guide for Expectant Parents

epidural injection

When it comes to labour pain relief, epidurals are one of the most talked-about — and misunderstood — options. Many expectant parents aren’t sure how they work, what to expect, or how they might affect birth.

This guide breaks down the facts in calm, simple language — with evidence-based information to help you feel confident in your choices.

🩺 What Is an Epidural?

An epidural is a type of pain relief used during labour. It works by numbing the nerves that carry pain signals from your uterus and birth canal, so you can still feel pressure and movement, but not intense pain.

It’s given through a small flexible tube (catheter) placed into the epidural space in your lower back by an anaesthetist — a doctor who specialises in pain relief.

You stay awake and alert throughout, and your midwife and anaesthetist monitor you and your baby closely.

⚙️ How It Works

Once the catheter is in place, a local anaesthetic (such as bupivacaine or ropivacaine) mixed with a tiny dose of opioid is given.

This combination:

• Blocks pain without completely numbing your body

• Allows you to rest and conserve energy

• Often means you can still move your legs or change position in bed (sometimes called a “walking epidural”)

The effects usually start within 10–20 minutes, and the dose can be topped up or adjusted as labour progresses.

(Source: National Institute for Health and Care Excellence — NICE Intrapartum Care Guidelines, 2021)

👩‍⚕️ What to Expect Step-by-Step

Here’s what typically happens when you request an epidural during labour:

1. Preparation – Your midwife will explain the process, check your blood pressure and baby’s heart rate, and help you sit or curl up in a specific position.

2. Insertion – The anaesthetist cleans your back, numbs a small area with local anaesthetic, and carefully inserts the needle and catheter.

3. Testing – A small dose is given first to make sure it’s in the right place.

4. Pain Relief Begins – You’ll feel warmth and numbness spread over your bump and down your legs.

5. Monitoring – Your blood pressure is checked regularly, and your baby’s heart rate is continuously monitored.

6. Topping Up – The epidural pump gives regular doses automatically, and some hospitals let you press a button for a small “boost” when you need it.

💡 The Benefits

• Highly effective — the most reliable pain relief available in labour

• Adjustable — the amount of medication can be increased or reduced as needed

• You stay awake and alert — so you can still experience your baby’s birth

• Helps you rest — especially useful in long or induced labours

• Can be converted to anaesthesia if a caesarean is needed

⚠️ Possible Side Effects and Considerations

Most people have a smooth experience, but it’s important to be aware of potential side effects:

• Drop in blood pressure (quickly managed by fluids and medication)

• Longer pushing stage or higher chance of needing instruments (forceps or ventouse), although this risk is smaller with modern low-dose techniques

• Temporary loss of bladder sensation, so a catheter may be used

• Mild back soreness at the insertion site for a few days

Serious complications (like infection or nerve damage) are extremely rare — around 1 in 20,000–50,000 births.
(Source: Obstetric Anaesthetists’ Association, UK)

🧣 The Scarf Trick for Pushing (Even With an Epidural)

When you have an epidural, you may not feel strong urges to push — or you may find it difficult to know how to push effectively. That’s where the scarf trick comes in.

What Is It?

The scarf trick (also called tug-of-war pushing) uses a long, strong scarf or sheet to help you bear down effectively while conserving energy.

How to Do It

1. Position yourself: Sit upright or semi-reclined with good back support.

2. Hold the scarf: Your birth partner (or midwife) holds one end, and you hold the other.

3. During a contraction:

   • Take a deep breath.

   • Pull firmly on the scarf as your partner gently resists — like a calm, controlled tug-of-war.

   • Engage your core and push downwards into your pelvis as you pull.

4. Between contractions:

   • Rest, breathe, and refocus.

Why It Helps

• Activates your abdominal and upper body muscles, improving the strength of your pushes

• Promotes effective downward pressure even if you can’t feel the urge to push

• Keeps you active and engaged in your birth

• Allows your partner to take a hands-on supportive role

Midwives often use this technique in UK hospitals and birth centres to support effective pushing with epidurals, and it can shorten the second stage of labour by improving coordination and effort.

(Based on evidence from biomechanical birth techniques and research on assisted pushing strategies, e.g. Sampselle et al., JOGNN, 2020.)

❤️ Can You Still Have a Positive Birth with an Epidural?

Absolutely. An epidural doesn’t take away your ability to:

• Stay connected with your baby and birth partner

• Breathe, rest, and focus on the experience

• Welcome your baby skin-to-skin immediately after birth

If physiological birth is your goal, you can still create a calm environment with soft lighting, music, and gentle communication — oxytocin (the “love hormone”) still plays a role in your birth journey.

🕊️ Key Takeaway

An epidural can be a safe, effective, and empowering option for pain relief in labour when it’s right for you. The most important thing is informed choice — knowing what to expect, understanding your options, and feeling supported no matter how your birth unfolds.

✨ References

• NICE. Intrapartum Care for Healthy Women and Babies (2021)

• Chen et al. Epidural Analgesia and Severe Maternal Morbidity: A Population-Based Cohort Study. BMJ 2024.

• Obstetric Anaesthetists’ Association (UK) — Epidural for Pain Relief in Labour

• Anim-Somuah et al. Cochrane Review: Epidural vs Non-Epidural Pain Relief for Labour (2023)