Epidurals: fact vs. fiction

Do they lead to C-sections? Will they harm the baby? Answers to your questions about this popular labor-pain reliever.

Considering that at least 60 percent of American women today have an epidural for pain relief during labor, it’s surprising how misunderstood this procedure is. For starters, even doctors use the word “epidural” generically, to encompass three similar yet distinct procedures: epidurals, spinals and the combined spinal epidural (CSE), or “walking” epidural.

Since deciding whether or not to have an epidural means becoming informed about the benefits and risks well before labor begins, here are the facts to help you make sense of some common misconceptions.

Perception: An epidural and a spinal are the same procedure.

Reality:  An epidural involves injecting painblocking medication into a space between the vertebrae and the spinal fluid; it usually takes about 15 minutes to work. A spinal is an injection directly into the spinal fluid; it is given as part of the CSE technique, usually before a Cesarean section, and takes effect in five minutes. With either an epidural or CSE, the catheter that delivers the drug is left in the epidural space until the baby is born so the medication can be administered continuously. An increasingly popular option is patient-controlled epidural analgesia (PCEA), which allows the laboring woman to control the amount of pain relief she gets without the risk of overdosing.

“What medication is given, how much and for how long all vary depending on the individual and the hospital; some routinely combine epidurals with spinals and some do not,” says Laura Riley, M.D., medical director of labor and delivery at Massachusetts General Hospital in Boston and author of Pregnancy: The Ultimate Week-by-Week Pregnancy Guide (Wiley). Being educated about the procedures used where you will deliver can help you make a decision that is right for you.

Perception: The needle used for both procedures is gigantic, and it hurts when inserted.

Reality: The epidural needle is left in place for only a minute or two—just long enough to insert a catheter the size of a pencil lead into the epidural space. The spinal needle is smaller—the width of a thick piece of hair. Before this happens, the injection site is numbed with a local anesthetic, at which point you’ll feel a pinch and sting for about 10 seconds. You’ll feel pressure, but not pain.

Perception: You can’t get an epidural early in labor.

Reality: Research published in The New England Journal of Medicine found that women who received low-dose CSE when their cervix was less than 4 centimeters dilated had labors that were on average 80 minutes shorter than women who received a narcotic injection early in labor, followed by an epidural when the cervix was at 4 centimeters. Cesarean section rates were about the same.