Epidural in labour: how it works, benefits and risks

An epidural is the strongest pain relief you can have in labour. Here is how it works, what it does to your labour, and the risks, using figures from the anaesthetists’ own guidance.

How it works

The NHS says an epidural is a local anaesthetic that numbs the nerves carrying pain signals from your birth canal to your brain. An anaesthetist puts a thin tube in your back and the medicine, usually a local anaesthetic mixed with an opioid, goes through it. It takes about 10 minutes to set up and another 10 to 15 for it to work. It is only available in hospital obstetric units.

The benefits

The NHS says it usually gives complete pain relief, shouldn’t make you sick or drowsy, and can help in a long or very painful labour. Some units offer a ‘mobile’ epidural that lets you walk around.

The downsides

It is not always fully effective. The Royal College of Anaesthetists’ 2025 leaflet says about 10 in 100 people need extra pain relief alongside it, and about 5 in 100 have it re-sited.
It can make your legs heavy. Your blood pressure can drop, though this is uncommon, and fluids through a drip help prevent it.
The NHS says an epidural can make the second stage longer, and that forceps or ventouse may then be needed to help deliver your baby, although your midwife may wait longer before you push to reduce that chance. The Obstetric Anaesthetists’ Association information card also says it may slow the second stage slightly. The Royal College of Anaesthetists’ 2025 leaflet says epidurals do not make ventouse, forceps or caesarean birth more likely. These sources differ, so ask your midwife or anaesthetist how it applies to you.
Itching is a possible side effect and usually wears off after a few hours.

Rarer risks

The Royal College of Anaesthetists’ 2025 leaflet gives these averages, and says your own risk may be higher or lower:

Headache: 0.5 to 1 in 100
Temporary nerve damage: 8 in 20,000, usually recovering by itself. Permanent damage: about 1 in 20,000.
Meningitis: 1 in 50,000
Spinal infection: 2 in 200,000
Blood clot around the spine: 1 to 2 in 200,000
Paralysis: 2 in 500,000

Epidurals and back pain

Both the NHS and the anaesthetists say epidurals do not cause long-term backache after childbirth.

Deciding

Reviews of maternity care have found many people aren’t given full information about labour pain relief. The anaesthetists have produced infographics so you can think it through during pregnancy, without pressure. Ask your midwife about them. Your choice is yours, and it can change in labour.

Questions people ask

Will an epidural slow my labour down?

The NHS says it can prolong the second stage, and the Obstetric Anaesthetists’ Association card says it may slow it slightly. The Royal College of Anaesthetists says epidurals do not make a caesarean or an assisted birth more likely. Your team will tell you what they see in your labour.

Can I still push with an epidural?

Usually, yes, though you may feel less of the urge. Your midwife will guide you.

Can I have an epidural at a home birth or in a midwifery unit?

The NHS says epidurals aren’t available at home. They are only offered in obstetric units. See where to give birth.

Can I have one after being induced?

Yes. The NHS says induction doesn’t restrict your pain relief options.