Epidural and Pain Relief Options in Labour

There are many ways to ease pain in labour. Some use no medicine, such as breathing, movement, massage and warm water. Others use medicines, such as gas and air, an injection, or an epidural. None is right for everyone, and you can change your mind at any time.

This guide explains each option in simple terms, what an epidural feels like, the possible downsides, and the questions worth asking before labour starts.

Plan, but stay flexible

Labour can be unpredictable. A plan helps you understand your choices, but it is fine to change it. The aim is a safe birth with pain you can manage, not a perfect script. Talk about pain relief with your doctor during antenatal visits so you are not deciding for the first time in a painful moment.

Non-drug options

The NHS lists several approaches that may help, especially in early labour:

• Knowing what to expect. Learning how labour works can lower fear, and fear can make pain feel worse.
• Breathing and relaxation. Slow, deep breaths through each contraction.
• Movement and position changes. Walking, rocking, kneeling or leaning forward on a birthing ball or pillows.
• A birth companion. Having a trusted person with you for comfort and encouragement.
• Massage and warm water. A warm bath or shower may ease contractions. In a birth pool the NHS advises keeping the water below 37.5 degrees Celsius.
• TENS machine. A small battery device that sends mild pulses through pads on the back. The NHS says it is not proven to help in active labour, but it may help early on and has no known side effects.

The NHS adds that most alternative therapies, such as acupuncture or aromatherapy, are not proven to work for labour pain. Discuss them with your doctor or midwife before using them.

Medicine options other than an epidural

Simple painkillers

Your doctor may suggest a mild painkiller for early labour. Do not take any medicine without asking first.

Gas and air

This is a mixture of oxygen and nitrous oxide that you breathe in through a mouthpiece. You control it yourself. The NHS says it takes 15 to 20 seconds to work, so you start breathing it in as a contraction begins. It takes the edge off the pain but does not remove it. It can cause dizziness, nausea or drowsiness, and these pass quickly once you stop.

Opioid injection

A stronger painkiller may be given as an injection into the thigh or buttock. The NHS says it takes about 20 minutes to work and lasts 2 to 4 hours. It can cause drowsiness, nausea and forgetfulness. If given too close to birth it can affect the baby's breathing and the first feed, so it is usually avoided when you are near the pushing stage. Your doctor will decide if it suits you.

Epidural: what it is and how it is given

An epidural is a local anaesthetic that numbs the nerves carrying pain from the birth canal. Only a trained anaesthetist or anaesthesiologist can place it. Cleveland Clinic says it can usually be given at any point in labour.

1. A drip is placed in a vein in your arm.
2. You lie on your side or sit curled forward while your back is cleaned and the skin is numbed. You may feel a pinch, then pressure.
3. A thin tube (catheter) is placed in your back near the nerves, and the needle is removed.
4. Medicine flows through the tube. The NHS says setup takes about 10 minutes and relief builds over a further 10 to 15 minutes; Cleveland Clinic says an epidural can take around 20 to 30 minutes to work.
5. Your contractions and your baby's heart rate are monitored continuously. The dose can be topped up if needed.

Tip: keep very still while the needle is placed, and tell your anaesthetist if a contraction comes. They can pause and continue safely.

Benefits of an epidural

• It often gives strong pain relief, which can help in a long or very painful labour.
• It may let you rest and conserve energy.
• Large reviews cited by Cleveland Clinic found no increased risk of caesarean birth.
• It can be topped up for as long as labour needs.

Risks and downsides

The NHS and Cleveland Clinic list these:

• Heavy or numb legs, and limited movement. You may need to stay in bed.
• A drop in blood pressure, which is usually managed with fluids.
• Difficulty passing urine, sometimes needing a catheter.
• Itching or nausea.
• A longer pushing stage, because you may not feel the urge to push. This raises the chance of forceps or ventouse help, according to the NHS.
• A headache after the procedure in about 1 in 100 cases, per the NHS. It can be treated.
• A sore back for a day or two. Epidurals do not cause long-term back pain.
• Rarely, infection, bleeding or nerve damage.

It does not always work perfectly, and sometimes the tube needs adjusting or replacing. An epidural is usually not advised if you have a bleeding disorder, a low platelet count or an allergy to the anaesthetic, so tell your team about your medical history.

When to be cautious: tell your care team at once about a sharp pain during the procedure, a severe headache that is worse when you sit or stand, new fever, weakness or numbness in the legs that lasts longer than expected, or loss of bladder or bowel control.

Questions to ask your doctor

• Is an epidural suitable for me, given my health and blood tests?
• Will an anaesthetist be available when I go into labour, day and night?
• How will it affect my movement and pushing?
• What other pain relief can I use if I decide against it?
• How will my baby be monitored?

When to see a doctor

Speak to your doctor early if you have fears about labour pain, a bleeding problem, back surgery, or a condition that may affect your options. For more on how labour unfolds, read our guide to the stages of labour, and see how the options differ in normal delivery vs C-section. Planning ahead is part of good antenatal care.

Talk to a doctor

If you have questions about your own situation, you are welcome to book an appointment or call us on +91 944 103 0587. Chaitanya Hospital in Kadapa offers 24/7 delivery and emergency care, and teleconsultation is available. This article is for general awareness and is not a substitute for a doctor's advice.