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.

Perception: An epidural makes pushing difficult.

Reality: “One advantage of combining spinals with epidurals is that it typically allows for less medication to be given, so you get pain relief without total numbness,” says William Camann, M.D., director of obstetric anesthesia at Brigham and Women’s Hospital in Boston. More good news: The lower dose makes pushing easier than with a higher-dose epidural, which reduces the likelihood of needing a forceps-or vacuum-assisted delivery.

Perception: A woman can move around throughout labor if she has a “walking” epidural.

Reality: “Most women do not walk with one,” says Gilbert J. Grant, M.D., director of obstetric anesthesia at New York University Medical Center and author of Enjoy Your Labor: A New Approach to Pain Relief for Childbirth (Russell Hastings Press). Continuous fetal monitoring and an IV are needed, and many doctors do not encourage women to walk with these, he explains. “A better name would be ‘epidural lite’; it has to do with the lower dosage.”

Perception: None of the medications used in an epidural or CSE reaches the baby.

Reality: “Any pain-relief medication will reach the baby,” Grant says. “However, with an epidural, the amount that enters your bloodstream is quite small, and with a spinal, it’s even smaller.” While further studies are needed, the small amount of medication absorbed by the baby is not known to cause harm, says Cynthia Wong, M.D., chief of obstetrical anesthesia in the department of anesthesiology at Northwestern University Feinberg School of Medicine in Chicago.

Perception: Epidurals pose a risk of complications and serious side effects.

Reality: Epidurals are very safe for the majority of patients. Complications do occur, though, and can range from the short term and bothersome to the (far more rare) long-lasting or life-threatening. The most common side effect is hypotension, a drop in maternal blood pressure that could affect the baby; this occurs more with higher doses of medication. “With treatment, hypotension has no consequences to mother or baby,” Camann says. Other relatively common and treatable side effects are nausea, which affects roughly 20 to 30 percent of women who receive epidurals; and itching, which affects approximately 30 to 50 percent.

Another possibility is that the mother will develop a fever if an epidural is in place for six hours or more; this can lead to diagnostic testing and, sometimes, antibiotics for mother and child. “With first births, about 20 percent of mothers have an elevated temperature,” Camann says.

A much rarer complication is a severe headache. “This occurs in less than 1 percent of patients in this hospital, but it can last for several days and be very uncomfortable,” Riley says. Other rare risks include infection, bleeding and nerve damage near the injection site. If the drug is accidentally injected into the bloodstream, this can slow or stop breathing, cause seizures or even death. However, Camann says, “most anesthesiologists go through a whole career and never see a case of these rare complications.”

Perception: You can’t get an epidural if you have a tattoo on your lower back.

Reality: Unless you have a new tattoo that hasn’t fully healed, you don’t have to worry; you can get an epidural.

Do epidurals lead to C-sections?
A common argument against epidurals is that they increase Cesarean section risk, but a cause-and-effect relationship hasn’t been shown. “Women who request an epidural have more severe pain and/or larger babies, which are predictive of difficult labors that may have required a C-section anyway,” says Cynthia Wong, M.D., who has conducted several published studies on labor-pain relief. However, no studies have compared labors with epidurals or other pain relief to labors with no pain medication (such studies are difficult, if not impossible, to conduct). Further research is needed.

For information on alternatives to the epidural, go to fitpregnancy.com/painrelief.

Editor's note: Anecdotal evidence for and against the use of epidurals abounds. Some women insist an epidural hindered their ability to push, while others say that the pain-relief medication allowed them to relax, facilitating childbirth. We stand by the objective clinical research citied in this article and hope that it serves to clear up some common issues so that women can make educated, informed decisions for themselves.