As an anesthesiologist working in a hospital with a busy labour and delivery unit, I hear a lot of incorrect beliefs about epidurals. To help ensure that expectant parents are making informed decisions about epidurals and pain relief during labour, I’ve attempted to dispel some of the common myths I hear most frequently.
An epidural does not increase the likelihood of a C-section, but it may increase the chances that you’ll need a vacuum or forceps to help pull your baby out.
While an epidural does provide “freezing” and will make your legs feel numb and somewhat weak, you should still be able to push. Some hospitals offer a “walking epidural,” which allows you to move around, while others require you to stay in bed once the epidural is in place.
Epidural dosing can be adjusted to provide more or less sensation—although you’ll feel more discomfort if the epidural is “turned down.” The only time an epidural should provide numbness to the point of complete immobility is if it’s being used to provide anesthesia for a C-section.
Any theoretical concerns—such as the risk of introducing tattoo dye into the spinal canal—remain controversial, and actual reports of problems are extremely rare. Women with tattoos on their lower backs can almost always still have epidurals. Usually the anesthesiologist will try to find an area where there is no tattoo dye and place the epidural needle there. If this is not possible, they may use a small needle to make a hole prior to inserting the epidural needle to reduce the risk of picking up some ink.
Backaches during and after pregnancy and labour are very common. You may have a bit of a sore spot on your back for a few days after the epidural, but epidurals themselves do not cause long-term backaches.
Permanent nerve damage after an epidural is extremely rare. A review of 27 studies that included 1.37 million pregnant women who received epidurals or spinals estimated the risk of persistent neurological injury at one in 240,000 and temporary neurological injury at one in 6,700.
About one in 100 to one in 200 women may experience a complication called a post-dural puncture headache a day or two after the epidural. This occurs if the epidural needle pierces the membrane just beyond the epidural space, causing a leakage of spinal fluid. The headache usually responds to painkillers; if it doesn’t, another procedure called an epidural blood patch can be offered. Depending on the severity and timing of your headache, you may have the procedure done before you leave the hospital with your baby or you may be advised to go home and try painkillers first and return for the procedure if the headache doesn’t subside. You will not have to stay overnight in the hospital after the blood patch procedure. An anesthesiologist will follow up with you closely if you do develop a post-dural puncture headache. Long-term issues from a post-dural puncture headache are extremely rare.
Having an epidural should not affect your baby at all—for example, epidural medications will not make your baby sleepy. If you can’t have an epidural and receive intravenous pain killers instead, these can potentially make your baby sleepy, but this sleepiness is usually transient and easily reversible. Furthermore, studies have shown that having an epidural doesn’t make it any harder to breastfeed.
Most women can, but there are some instances in which an epidural may not be safe, including if you have certain bleeding disorders, take certain blood-thinning medications or suffer from specific spinal and neurological problems. Usually your obstetrician or midwife will refer you for an antenatal consultation with an anesthesiologist if you fall into any of these categories so that other pain relief options, such as intravenous patient-controlled analgesia (PCA), can be discussed.
Saroo Sharda is a staff anesthesiologist at Hamilton Health Sciences in Hamilton, Ontario, and an assistant clinical professor in the department of anesthesia at McMaster University.