8 Things You Should Know About Epidurals

Hotly debated and frequently misrepresented, here are just the facts about epidurals.

Perhaps no other variable of the childbirth experience is as hotly debated and frequently misrepresented as epidurals. Yes, they take away the pain; but they also raise concerns about the safety of mother and child. Increasingly, though, couples are opting for the procedure during labor: More than 50 percent of childbirths today involve using a regional anesthetic to numb the body from the waist down, easing the discomfort of contractions. “From the perspective of what’s most helpful for women during labor, there’s no question that epidurals ease the pain,” says Raeford Brown, M.D., a professor of anesthesiology and pediatrics at the University of Kentucky Medical Center. Here’s what you should know about the procedure.

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1. It’s less painful than it looks.

Getting an epidural hurts about as much as getting an IV. That is to say, your wife will feel a sting or discomfort for a few seconds after the needle is inserted before it diminishes; the actual numbing kicks in after about 20 minutes. There are actually two needles: The first is for a local anesthetic that numbs the area where the epidural will be placed. The second is a larger needle that leads the catheter into the epidural space. The area should be relatively numb by this point, so the discomfort is minimal.

2. It’s not dangerous.

Despite what you may have heard, an epidural does not harm your baby. “The short answer is that there are no proven adverse direct effects on the fetus/newborn,” says James J. Cummings, M.D. chairman of the American Academy of Pediatrics Committee on Fetus and Newborn. “However, there are potential indirect effects, as it may increase the risk for instrumented delivery (using forceps) or operative delivery (C-section) because of failure to progress in labor.”

3. It goes near, not in, the spinal cord.

Relax, no one is going to be jamming a needle into your wife’s spine. “The spinal cord is surrounded by fibrous elements which in turn are wrapped around a bag-like structure holding water,” says Dr. Brown. “There is a space between the bag and the fibrous elements, and this is where the needle goes.” Once this area is desensitized, the labor can proceed pain-free.

4. Not everyone should get one.

While epidurals are safe for the vast majority of moms-to-be, for a small segment of the population, the procedure is risky. “Women with hypertension that is associated with pregnancy—known as pre-eclampsia—have a problem with the coagulation of their blood,” says Dr. Brown. “Within that group, there is an even smaller subset who experience a dropping platelet count, and for these women, epidurals are not advisable.”

5. It could slightly slow the labor.

Studies suggest how far along a woman is in labor can impact whether the epi slows things down. If given before 5 cm dilation, chances of a slower labor are higher. On the other hand, if contraction pain causes your wife to tense her muscles, labor will take a lot longer, too. Regardless, because your wife is numb, she won’t necessarily know when to push during a contraction. Not to fear, delivery room doctors and nurses do this all day long. They will guide both of you through the process determined by dilation.

6. She may need a catheter to pee.

Because your wife will be number from the waist down, if she needs to urinate during the labor process she may not get the signals she normally would, resulting in an accident. For this reason, the doctor may place a catheter to help keep her bladder empty.

7. There is more than one type.

Two of the most common types of epidurals are continuous infusion, where a catheter continuously feeds the anesthetic into the body, and a walking epidural, so-called because an injection of painkillers allows the woman limited mobility in her lower limbs. (Note: This does not mean you and your wife can take a brisk stroll around the hospital hallways, but it does mean she may be able to go to the bathroom on her own. )

8. Back pain from epidurals is a myth.

While there are risks associated with epidurals — including a drop in blood pressure, an increase in the odds of needing forceps for delivery, breathing difficulties, and fever — long-term back pain is not one of them. “I’ve heard some women say, ‘Now I have back pain because I got an epidural,’” says Dr. Brown. “I tell them, ‘No, you have back pain because you just had a baby!’” In truth, any lower back discomfort after delivery is less likely to have been caused by the anesthesia and more likely to be the result of the very physical activity of labor.

Of course, whether or not your wife chooses an epidural is a personal decision. But rest assured that from a safety perspective, the procedure is routine and something your hospital staff is accustomed to performing all day long.