Your Pregnancy Matters
9 myths about epidurals – debunked
March 23, 2021
Epidurals are one of the safest, most effective, and most widely used forms of pain management for women in labor around the world. More than 60 percent of laboring patients choose to get an epidural, according to the American Society of Anesthesiologists.
Research has shown that getting an epidural is safe and effective for nearly all laboring moms and their babies. But nevertheless, myths persist.
Choosing a labor pain relief method is a personal decision. You deserve the facts to make an educated choice. So, we've put together a list of the nine most common myths about labor pain epidurals, based on questions that patients have asked my colleagues and me. Let's get to debunking!
Myth: There's a limited window to get an epidural in labor
Reality: There's no specific cervical dilation range to wait for to get an epidural.
We can place your epidural at the beginning, middle, or even toward the end of labor – we have safely placed epidurals in women who were dilated to 10cm. UT Southwestern has anesthesiologists on staff 24/7 to provide an epidural as soon as you want it. The only timing criteria are that you:
- Are in active or induced labor, which your Ob/Gyn or midwife will confirm.
- Can remain still and calm for five to 10 minutes for the procedure, which might be tough if you're close to delivering.
Once in a while, patients are within minutes of delivering when they get to the hospital. In those cases, there simply may not be time to give the epidural. This is uncommon but tends to happen more frequently in women who've given birth before.
Related reading: What to do when the baby’s coming – right now
Myth: Any laboring mom is eligible for an epidural.
Reality: Nearly every patient is eligible, but there are a few exceptions.
Epidural might not be recommended for patients with certain health conditions, such as:
- Bleeding disorders
- Conditions that require blood thinners
- History of severe brain or spine problems
If you are concerned about your risks, talk with your doctor. They can set up a consultation with an anesthesiologist to discuss your options.
Myth: Getting an epidural might harm the baby.
Reality: Epidural medication is considered safer than IV labor pain medication.
Many drugs, from Tylenol to the medication in an epidural, can potentially cross the placenta and affect the baby, but research has shown that the amount of medication that enters your bloodstream and the baby's when you have an epidural is quite low.
Studies have shown that getting an epidural does not negatively affect the baby's Apgar scores (newborn functional testing), nor does it increase the risk of needing neonatal intensive care.
Related reading: Should I stop taking medication when I’m pregnant?
Myth: Moms who get epidurals need C-sections more often.
Reality: Epidural doesn't increase the likelihood of a C-section, studies show.
Several landmark studies have shown that getting an epidural does not increase the chance you'll need a cesarean section delivery. Previously, we thought epidurals may increase your risk of vacuum- or forceps-assisted delivery, but more recent evidence has suggested this is no longer true.
While the epidural should block most of the pain of labor, it should not complicate labor or prevent you from pushing. Epidural medication will not cause fetal distress or cause the baby to "get stuck." When this happens, it's likely that the situation would have occurred regardless of whether the patient had received an epidural.
Myth: Labor will take longer and I'll be stuck in one spot if I get an epidural.
Reality: There is no credible research to suggest this is true.
Labor is typically divided into two stages – progressive cervical dilation to 10cm and pushing. Getting an epidural has no effect on how long stage one takes. Some research suggests the pushing stage might be a bit longer if you are more relaxed and pushing is less urgent, but we're likely talking minutes, not hours.
Advancements in epidural medication administration over the last 20 years have allowed us to control pain without making you feel as weak. You'll still be able to feel pressure from contractions (with less or no pain), and you'll still be able to push. The anesthesia team will securely tape the catheter in place after it is inserted so that you can move comfortably in the bed and switch positions as you like.
Myth: Epidurals cause prolonged back pain after delivery.
Reality: Getting an epidural will not cause chronic back pain.
The more likely culprit is that your body is sore from the pregnancy and delivery experience, and the constant bending and lifting required for newborn care.
After any injection, from a flu shot to an epidural, you'll likely feel some pain and swelling at the injection site, which should resolve within a week. Me personally, I felt like the tenderness was a fair trade for three less painful labors and deliveries.
Myth: The injection might cause nerve damage or paralyze me.
Reality: Permanent nerve damage due to an epidural is exceedingly rare.
While not impossible, permanent nerve damage or paralysis is extremely unlikely – estimated at less than 1 in 240,000 patients. Pushing and positioning during labor can cause temporary injuries, such as nerve compression (a "pinched" nerve). Pushing is a very physical, stressful body event that can cause swelling and nerve irritation. Even in these cases, temporary damage is extremely rare.
Myth: I have a lower-back tattoo, so I can't get an epidural.
Reality: Patients with low-back tattoos can safely get epidurals.
Theoretically, there is some risk that the tattoo ink could be introduced into the spinal canal. But reports of tattoo-related epidural complications are very rare and controversial. To avoid that tiny risk, we will find a suitable spot on the spine where there is little to no ink.
Myth: Getting an epidural is failing at 'natural' childbirth.
Reality: We don't hand out awards based on how moms give birth.
Labor pain is very intense – I know firsthand from having my own babies. Choosing an epidural is not a failure. It's a choice to help you stay calm and focused, which is so important for a successful delivery. There are plenty of things to worry about as a mom – so you shouldn't feel defeated if your birth plan changes and you decide to get an epidural.
Getting an epidural: What to expect
If you, your partner, or your labor support person can't tolerate the sight of needles, tell your doctor right away. Epidural needles are thin but long – depending on your weight, the needle will be 9 to 11cm long.
Your anesthesiologist will ask you to hold as still as possible for five to 10 minutes. We ask patients to curl forward, with their back arched like a shrimp. They will numb a spot on your spine, then insert the needle and a tiny tube into your spine. It will feel like a pinch, and you will feel some pressure as the needle is positioned – we're looking for just the right spot for maximum pain relief without disturbing the spinal nerves.
Within 10 to 20 minutes, you should feel little to no pain from the waist down. You won't be able to walk while the medication is flowing and your legs will feel weak – that is normal. Feeling and mobility will return within an hour or so after the needle is removed.
Your injection site might be sore for a few days after delivery. Fewer than 1 percent of patients develop a severe headache due to leakage of spinal fluid. Some women report feeling itchy or nauseous as the medication wears off.
Choosing your preferred pain relief method for labor and delivery is a personal decision. Whether you plan to have an epidural or decide to update your birth plan during labor, we will be ready to help you manage your pain. At the end of the day, your health and safety – and that of your baby – is the most important part of the birth experience.