The Truth About Childbirth Pain Management

More than 60 percent of women in labor receive an epidural, yet epidurals are misunderstood modalities of pain management. Anesthesiologist Nicole Higgins, MD, Northwestern Medicine Prentice Women’s Hospital, shares science-backed facts in the face of epidural myths.

Myth No. 1: They will cause permanent back pain

Labor itself can cause back pain: Pushing for several hours combined with the hormones that cause the muscles in your lower body to relax can strain muscles and ligaments. Carrying extra weight during pregnancy can also impact your back. But epidurals themselves have not been proven to cause to long-term back pain.

“Epidurals can cause temporary, localized back pain due to the nature of the procedure,” says Dr. Higgins. “An anesthesiologist uses a needle to administer the medication, which can cause bruising and disrupt the surrounding tissues.”

Myth No. 2: They can paralyze me.

Myth No. 3: They will harm my infant.

Almost every medication that you take during pregnancy, from acetaminophen to allergy nasal spray, passes to your fetus to some degree. This is the case for epidural medications during childbirth, but the low dose and low concentration of local anesthetics and opioids —lower than what you’d receive in an IV — are considered safe for your child.

Myth No. 4: They will slow labor.

“Epidurals don’t slow down the mechanics of your labor, but they may lengthen the time it takes for the second stage of labor — when you start pushing the baby — to begin”says Dr. Higgins. “After an epidural, you’re in less pain, which means you may have less sensation to cue you to start pushing. The numbness caused by an epidural also may make it difficult to get the hang of pushing.”

Myth No. 5: After I get an epidural, I’ll need a C-section.

A landmark study, conducted by Northwestern University Feinberg School of Medicine in 2005, determined that epidurals do not increase the likelihood of requiring a cesarean delivery.

Myth No. 6: You can only get an epidural during a limited timeframe.

“There is no specific cervical dilation range for epidurals,” says Dr. Higgins. “The only requirement is that you must be able to remain still for roughly five minutes so that your anesthesiologist can safely perform the procedure. Sitting still is sometimes challenging for women in the advanced stages of labor.”

Myth No. 7: You can’t get an epidural if you have a lower back tattoo.

A lower back tattoo won’t prevent you from receiving an epidural, but your anesthesiologist may want to avoid pigmented areas when administering the procedure. There is a theoretical chance that the needle can take a portion of the pigmented skin with it, causing a toxic reaction. However, this has not been scientifically studied. “I’m typically always able to find a spot where I can safely perform the procedure for patients with tattoos,” says Dr. Higgins.

Myth No. 8: Epidurals cause headaches.

A post-dural puncture headache is a known risk for individuals who receive an epidural, but the incidence is about 1.5 percent.

Myth No. 9: Anyone can have an epidural.

Physicians assess epidural eligibility based on medical and personal history.

Women taking anticoagulation medications, or blood thinners, must stop these medications within an appropriate timeframe before labor to be eligible to receive an epidural. Women with other conditions, such as spina bifida, or who have had back surgery, may not be eligible to receive an epidural.

“We highly recommend that women have a pre-birth anesthesia consultation so that the obstetrics and anesthesiology teams can create a care plan for their individual needs,” says Dr. Higgins.