If you are expecting a baby, the epidural is probably the form of labour pain relief you have heard most about, and the one that raises the most questions. This guide explains in plain terms what it is, how and when it is given in Singapore hospitals, the benefits and possible side effects as the hospitals themselves describe them, who may not be suitable, and what other options you can ask about.
Labour pain is different for every woman, and so is the right way to manage it. Some mothers want medication from the start, others want to try without it, and many change their minds once labour begins. What helps is knowing your options before the day, so the conversation in the delivery suite is a decision rather than a scramble.
We are a maid agency, not a medical team. Everything below is drawn from patient information published by SingHealth institutions, including KK Women’s and Children’s Hospital (KKH) and Singapore General Hospital, and we link to those pages so you can read them in full. Your obstetrician and the anaesthesiologist on duty are the people who can tell you what is suitable for you.
The main options for pain relief in labour in Singapore
SingHealth’s patient page on pain relief options for women in labour sets out three medical methods. In brief:
- Entonox, often called gas and air or laughing gas, which you breathe through a mask or mouthpiece.
- Opioid injections, such as pethidine, given into a large muscle.
- Regional analgesia through a thin tube in the lower back, placed by an anaesthesiologist.
KKH’s Department of Women’s Anaesthesia also lists patient-controlled intravenous remifentanil and patient-controlled versions of the regional method. Ask your own hospital which options it provides.
What an epidural is, in plain terms
SingHealth describes it as pain-relieving medicine given through a small, soft tube called a catheter, which is placed in the lower back near the spinal nerves. The catheter stays in place during labour so that medication can keep flowing or be topped up as needed. SingHealth states that the aim is to reduce the intensity of labour pain, and calls it the most effective labour pain relief available.
There is also a related technique called a combined spinal technique, or CSE, which, as the name suggests, combines a spinal injection with the catheter method. KKH says it was the first hospital in Singapore to adopt CSE for labour, in 1997, and that it offers faster onset of relief and higher patient satisfaction.
It is a common choice: KKH reports that about 40% of the mothers who labour there opt for it.
How it is given, step by step
SingHealth describes the procedure like this:
- A drip is placed in a vein in your hand or arm.
- You sit bending forward, or lie curled on your side, while your back is cleaned with antiseptic.
- Local anaesthetic is injected to numb the skin.
- A needle is inserted into your lower back, the catheter is threaded through it, and the needle is removed, leaving only the catheter in place.
- The catheter is taped down. You need to keep still while it goes in, but you are free to move once it is secured.
Setting up takes about 15 to 20 minutes, and the medication then takes about another 15 to 20 minutes to work. While it is in place, your blood pressure is checked regularly and your baby’s heart rate is monitored continuously.
Relief can be continued with top-up doses, a slow infusion pump, or a patient-controlled pump. If relief is not good enough, the anaesthesiologist may adjust the dose or the catheter position, or reinsert it. If you need an emergency Caesarean section, the same catheter can usually carry stronger local anaesthetic, though SingHealth notes that a spinal or general anaesthetic may be needed if it does not work well enough for surgery.
When can you ask for it?
A common worry is asking too early or leaving it too late. HealthXchange, SingHealth’s health information site, reports on a systematic review involving KKH researchers that looked at nine studies covering 15,752 first-time mothers. It found that early and late administration had very similar effects, and that early administration did not increase the risk of Caesarean or instrument-assisted delivery. The KKH anaesthesiologist quoted in the article says it should be given when mothers ask for it.
In practice, set-up and onset together take around half an hour or more, so if you think you will want it, tell your midwife early. Whether it is still possible late in labour is a clinical judgement for the team in the room.
Benefits and possible side effects
The benefits SingHealth lists are effective pain relief with minimal side effects for the baby, and particular value for mothers with high blood pressure, heart or lung problems, or morbid obesity. In complicated labours or twin births, having a catheter already in place may allow a quicker delivery if urgent intervention is needed. HealthXchange adds that it can help keep blood pressure from rising to critical levels in women with pregnancy-induced high blood pressure.
Common side effects, usually minor and short-lived
- A drop in blood pressure
- Weak legs
- Slight fever
- Difficulty passing urine
- Shivering and itchiness
Less common effects
- A longer second stage of labour. SingHealth reports that vacuum or forceps delivery happens in 17% of births with this kind of pain relief, against 12% without.
- Pain relief that is not good enough, in about 1 in 10 to 20 women, which may need adjustment or reinsertion.
- Not enough numbness for an emergency procedure, in about 1 in 8 to 10 women.
- A severe headache that is worse when sitting or standing, in 1 to 2% of women. It can last days or weeks if untreated, so tell your doctor if it happens.
Rare risks
SingHealth lists short-lived nerve damage in about 1 in 3,000 women and long-lasting nerve damage in about 1 in 80,000 to 320,000. Rarer still are a blood clot around the spine (about 1 in 168,000), a deep infection or abscess (about 1 in 145,000), and meningitis (about 1 in 100,000).
SingHealth also states what it does not do: it does not increase the chance of a Caesarean section, and it does not cause long-term backache. For context, KKH’s own audit of more than 1,000 mothers who had the combined technique reported postpartum headache in 2.5%, urinary retention in 5% and motor block (reduced leg movement) in 1%.
Who may not be suitable
SingHealth notes that some women may not be able to have it. The reasons it gives include:
- certain medical problems;
- abnormalities of the spine, such as spina bifida;
- previous back operations;
- problems with blood clotting.
If any of these apply, or you are unsure, raise it with your obstetrician before labour. SingHealth suggests booking a consultation with an anaesthesiologist ahead of time if you are in doubt. Also tell your doctor about every medicine and supplement you take, so the team has the full picture.
Other options: gas, pethidine and non-drug methods
Entonox (gas and air)
Entonox is a mix of 50% nitrous oxide and 50% oxygen. SingHealth says it works within a few breaths, wears off within minutes, causes no harm to the baby and can be combined with other methods. However, it gives only partial relief and can cause light-headedness, nausea and vomiting.
Pethidine and other opioid injections
These are injected into a large muscle and take about 30 minutes to work, with relief lasting a few hours. Side effects for the mother include drowsiness, nausea or vomiting, and slowed breathing. SingHealth notes that they may make the baby drowsy or slow to take its first breath, especially if birth happens 1 to 4 hours after the injection, which can affect early feeding. For that reason they may not be given if delivery is close.
Non-drug methods
HealthXchange mentions breathing exercises and relaxation techniques, such as a gentle back massage from your partner. Your midwife can suggest what suits your hospital’s delivery suite.
Putting it into your birth plan
A birth plan is a note of your preferences, discussed with your obstetrician during pregnancy. It is not a contract, but it helps the team understand what matters to you. Useful questions to ask at an antenatal appointment include:
- Which pain relief methods does the hospital offer, and are any unavailable at certain times?
- Is there anything in my medical history that affects which options are safe for me?
- Should I see an anaesthesiologist before labour?
- What is the estimated cost of each option, and what will my package or insurance cover?
On cost, the hospital pages we reviewed do not publish a fixed price, so ask your hospital for a written estimate.
If you are worried about your health or your baby’s at any stage, contact your doctor or your hospital’s maternity unit. KKH’s pregnancy information page lists vaginal bleeding, fever, severe headaches, vision changes, abdominal pain and reduced baby movements as reasons to seek medical help. In an emergency, call 995.
Planning for the first weeks at home
Recovery from birth takes time, and many families arrange extra support well before the due date. Our guide to hiring a maid for newborn care explains the timeline, and our live-in help for newborn and confinement care page shows how we match helpers to that stage. Our pieces on confinement food and postnatal depression may also help.
Related guides: Nanny or Babysitter in Singapore? Why Families Pick a Helper and Helper Childcare Routine: How Your Maid Can Help Your Family.
Frequently Asked Questions
Does having the procedure hurt?
SingHealth explains that local anaesthetic is injected to numb the skin before the needle is inserted into the lower back, and you will be asked to keep still while the catheter is placed. Experiences vary, so ask your anaesthesiologist what to expect.
Will it affect my baby?
SingHealth describes the side effects for the baby as minimal, and your baby’s heart rate is monitored continuously while the catheter is in place. This differs from pethidine, which can make a newborn drowsy or slow to breathe if birth follows soon after the injection. Your doctor can explain how each option applies to your pregnancy.
Is it ever too late to ask for one?
Research reported by HealthXchange found that early and late administration had very similar effects, so there is no need to wait for a particular point. Setting up and taking effect together take around 30 to 40 minutes, so tell your midwife early if you think you will want it. Whether it is still possible very late in labour is a decision for the clinical team.
Does it make a Caesarean more likely?
SingHealth states that it does not increase the chance of a Caesarean section, and a review involving KKH researchers found early administration did not raise the risk of Caesarean or instrument-assisted delivery. It may, however, lengthen the pushing stage and slightly raise the chance of a vacuum or forceps delivery.
Conclusion
The most useful thing you can do before labour is learn the options while you are calm. Regional pain relief through a catheter is the most effective method according to SingHealth, it is chosen by a large share of mothers at KKH, and most side effects are minor and short-lived. It is not suitable for everyone, though, and can lengthen the pushing stage.
Take your questions to your obstetrician, see an anaesthesiologist ahead of time if any of the conditions above apply, and keep your plan flexible.
If you are also planning help at home for after the birth, our consultants are happy to talk it through. You can get in touch with the Femme5 team to discuss your family’s needs, read more about how we work with employers, or explore what a good placement looks like.
The Femme5 Team
Maid placement specialists, Femme5 Maid Agency
Our consultants work with Singaporean and expatriate families on helper matching, contracts and MOM compliance, and we verify the regulatory guidance in our articles directly against the Ministry of Manpower’s published requirements.
