One of the most common interventions for labor and delivery is an epidural for pain control. There is a lot of information about epidurals, some are myths, and some are facts. So, what exactly is an epidural? Like an IV, an epidural is a tiny plastic tube that delivers medication directly into your body, but instead of delivering medicine into your bloodstream via a vein, it delivers medication into your spine. The medicines given through this catheter tube are called local anesthetics, or numbing agents.1
There are many interventions to consider when creating your ideal birth plan or choosing your preferences. The essential things you can do for a positive birth experience are to select a provider you trust and to inform yourself about available interventions. This includes learning the myths and facts about epidurals, which will help you to make the best decision for your labor and delivery.
Epidural Myths and Facts
Here we outline 10 epidural myths and debunk them with the facts.
1. Myth: Everyone Gets an Epidural
Epidurals do seem to be the norm these days. When a woman shares that she wants to give birth without one, she often gets crazy looks or comments about how she won’t make it. While it is true that most American women get epidurals — 60 percent of American women in 2022 — that is far from everyone.2
This statistic should not be used to coerce or pressure you into getting an epidural. What other women choose for their births does not impact what you do. Not everyone gets an epidural for birth, epidurals are not required, and they need your request and consent.
2. Myth: Epidurals Completely Relieve Your Pain
While epidurals provide good relief from labor pains, they are not guaranteed to remove all the pain of contractions. About 5 percent of the time, an epidural turns out one-sided or ineffective. Usually, in these cases, the anesthesiologist can adjust the epidural without having to redo it, but in rare cases, they may have to start over.3
If your pain control through an epidural is not adequate, the dose of pain medication administered through your epidural can be adjusted. Often, you will be given your own patient-controlled pump to give yourself a limited number of extra doses per hour.3
Most of the time, you do not want complete numbness from the pain and pressure of contractions, particularly toward the end of labor, because these sensations help you know when to push.3
3. Myth: You Can Only Be on Your Back If You Get One
Because your legs are numb and somewhat limp while you have an epidural, it is more difficult to change and hold certain positions when you have one. But with the right care team, achieving other positions is possible. Your partner, nurse, doula, and other care team members can assist you with getting into other positions. For labor and delivery, you can also use props such as pillows, blankets, and a peanut ball to hold you in a comfortable position, such as side-lying.4
4. Myth: Epidurals Slow Down Labor
There is controversy in the birthing world surrounding whether epidurals slow down labor and increase the need for other interventions, such as labor augmentation with Pitocin. However, studies have shown that having an epidural does not significantly lengthen the duration of labor. It also is not likely to increase your risk for an assisted delivery with forceps or a vacuum, nor your chance for a C-section. An epidural may, however, slightly increase the pushing phase of labor by an average of 30 but up to 50 minutes in rare cases.5,6
5. Myth: It Wears Off
An epidural will last as long as needed because it is connected to a pump that delivers continuous pain relief medication. The dose can be adjusted as needed, and the pump is usually turned off and the catheter removed after delivery. Only after the medication is turned off does the pain relief wear off.6
6. Myth: There is a Specific Time Frame to Get One
Because an epidural lasts for as long as you need it, it is rarely too early for an epidural. If your provider has determined you are in labor and admitted you to the labor and delivery unit, you can likely request an epidural whenever needed.
If you are in late-stage labor, it may be too late for an epidural because of the time it takes to prepare for the insertion procedure. You also have to be able to sit still for the epidural insertion, which may be too difficult if you are too far along in your labor.6 With that said, our Editor in Chief has seen laboring women get an epidural at 9 centimeters dilated. If you’re able to sit still and really want an epidural, you still have the right to request one. The medical staff may discourage you because you are so close to pushing and may still need IV fluids administered, or the anesthesiologist might not be immediately available. But ultimately, it is your choice, and you can still ask.
I’ve heard stories of women who were encouraged to get an epidural earlier than needed because they might “miss their window” or the anesthesiologist is about to leave for the day. You should not be pressured into getting an epidural if you do not desire it or do not feel you need it. The only time anesthesia or pain relief is not optional is during a C-section. No one wants abdominal surgery while completely unmedicated!
7. Myth: Anyone Can Get an Epidural
Most laboring women can indeed get an epidural. However, women with certain back or spinal issues or surgeries or with certain blood clotting or bleeding disorders may be unable to because of their increased risk factors. Talk to your provider about your health history. Talk to your provider about alternatives if you are disqualified from getting an epidural and desire pain relief during labor.7
8. Myth: There Are No Alternatives for Labor Pain Relief
An epidural is the most common form of pain relief for labor, but alternative pain medications exist. Some of these alternatives include opioid medications, local numbing agents, inhaled nitrous oxide, breathing techniques, and massage.8,9
A systematic review found that epidurals offered better pain relief with less need for additional pain relief when compared to opioid medications. However, alternative pain control can sometimes provide just the break a laboring woman needs before continuing with a low-intervention birth.10
9. Myth: An Epidural Works Immediately
After requesting an epidural, it can take time for the anesthesiologist to arrive at your bedside. It also takes a few minutes to set up all the materials and prepare a sterile field in the surrounding area.
Once the doctor and the room are prepared, insertion is quick and relatively painless. Most women report that injecting the local numbing agent prior to epidural insertion is the most painful part. And after the doctor inserts the epidural catheter, it usually takes between 5 and 20 minutes to take effect.6
10. Myth: You Can’t Eat If You Get an Epidural
Many hospitals indeed restrict what you can eat and drink while in labor. If they allow food consumption, you are typically limited to light foods such as Jell-O and applesauce and clear fluids like broth, juice, and ice chips. However, these restrictions do not concern whether you have an epidural. The reason is the risk of aspiration or choking if you need a Cesarean section under general anesthesia. But even if you end up needing a C-section, it is rare to require general anesthesia. Because of advances in healthcare and new research, the no-eating-during-labor rule is slowly changing at some hospitals. Talk to your provider about whether you can eat and drink during labor, with or without an epidural.11
Whether you choose to labor with or without an epidural, knowing the myths and facts about this pain control method will help you make an informed decision. Your birth preferences are essential; every mother deserves to feel informed, heard, and satisfied regarding her experience. Remember, an epidural will not harm your baby or interfere with your ability to breastfeed. But regardless of how you labor, you will meet your baby at the end of it all, which is the whole point of birth.6
Sources
1. https://www.nhs.uk/
2. https://pubmed.ncbi.nlm.nih.gov/35277971/
3. https://www.med.unc.edu/1/
4. https://www.lancastergeneralhealth.org/5
5. https://pubmed.ncbi.nlm.nih.gov/11483916/
6. https://www.soap.org/10.pdf
7. https://anesthesiology.hopkinsmedicine.org/04/11-20-018.pdf
8. https://www.hopkinsmedicine.org/23.html
9. https://www.asahq.org/about-asa/20191/10/2
10. https://pubmed.ncbi.nlm.nih.gov/22161362/
11. https://utswmed.org/
