Much has been said about epidurals. A quick Internet search can often reveal plenty of conflicting information about its benefits and its risks. Some say, for instance, that epidurals increase the need for things like forceps delivery, while others say that they don’t. It can be confusing to know who to listen to! While so many women have a natural birth, there are many other women who opt for an epidural, and sometimes, the choice may not even be yours. Oftentimes, when labor strikes, complications and other circumstances can arise may not leave the pregnant mother with the choice.
To get to the bottom of this, we’ve dug through actual scientific research and data that studies the effects of epidurals in the hope of debunking some of the myths associated with it.
15 Increased Need for Assisted Delivery
First of all, a fact: epidurals do increase labor times, at least with some mothers. This is why some people believe that they inherently increase the need to use instruments such as forceps or a vacuum in delivery. While these methods are, for the most part, safe, they also come with quite a few risks that many mothers want to avoid.
However, a meta-analysis that spans almost 40 years found that despite the fact that epidurals mean longer labor time, it did not increase the need for assisted delivery.
14 Pushing Later is Bad
Perhaps one of the reasons why epidurals get such a bad rap is that some medical personnel don’t adjust the rest of the delivery to its effects. Many women say that getting an epidural decreases their urge to push. But that isn’t necessarily bad. At least two meta-analyses found that women who received epidurals and were encouraged to push early in labor had worse outcomes than women who received the same medication and were encouraged to wait for passive descent before pushing.
Women who pushed earlier had increased rates of both fetal and maternal acidosis, as well as other complications like tearing. Ultimately, it seems that getting an epidural and waiting to push is beneficial for both mom and child.
13 Increased Need for C-Sections
This can be tricky since some studies do show that epidurals do increase rates of C-sections. However, a 2006 meta-analysis shed light over this particular piece of information. It turns out that timing matters. If epidural anesthesia is given before the active phase of labor, the chance of needing a C-section increases. However, if the epidural is given during the active phase of labor, there is no increase in the rates of C-sections versus vaginal deliveries.
12 Harmful for the Baby
While some of the medication used during the epidural does reach the baby, only a tiny amount of it actually does. Studies show that it’s not likely that this causes any adverse effects on the baby. In fact, babies whose mother’s had properly timed epidural administration (that is, during the active stage of labor) did not have decreased Apgar scores, the measure by which medical personnel assess the baby’s well-being after birth. Other studies even show that babies delivered with the assistance of epidural pain relief have lower levels of stress hormones compared to those who were delivered without pain relief.
11 Spinal Headaches are Common
Spinal headaches, not to be confused with regular headaches, are an adverse effect of epidurals that is a result of loss of cerebrospinal fluid through the puncture hole. Many people believe it is a common occurrence in people who get epidurals. This is partially true. If you lived in the early 1900s, that is. The needles used in epidural and spinal anesthesia in those times tended on the large side, which made for great losses in CSF. Nowadays, however, modern technology has developed needles that are fine and reduce the incidence of CSF loss.
In fact, today’s incidence of spinal headaches is estimated to be anywhere between 0 and 2.6%. The incidents are higher, with an inverse relationship to the experience of the anesthesiologist. Basically, if you want to avoid a spinal headache, make sure you get a seasoned anesthesiologist.
10 Debilitating Paralysis is Common
Another much-circulated horror story about epidurals is that paralysis resulting in the puncture of the spinal cord or the surrounding blood vessels is a common occurrence. This is a real risk when it comes to epidurals, considering the proximity of the procedure to the spinal cord. However, a large study on the side effects of epidurals found that the risk for permanent paralysis is, at most, is 1 in 23,000. Pretty low odds, really. Temporary paralysis is also a possibility, but it is also rare and usually subsides within six months.
As with spinal headaches, getting an experienced anesthesiologist will greatly reduce your odds of getting complications such as this.
9 The Needle Stays in There
Many people confuse spinal anesthesia and epidurals. While both may contain similar drugs and be infused in the same location, the two are very different. You may know that spinal anesthesia involves injecting the anesthetic with a needle. Epidurals stay in your back, but the part that infuses the medication is not the needle.
Basically, an epidural is done by inserting a needle into your back, and then withdrawing it but leaving behind a flexible plastic cannula. This allows a continuous infusion of medication through the procedure rather than a one-off dose. No needles remain in your back during the process. If you’ve ever had an IV line inserted, you may have seen something similar in action. Plastic cannulas are, after all, less likely to cause any damage when they remain in your body.
8 Patient-Controlled Analgesia Increase Risk for Overdose
Another common misconception is that women who opt for patient-controlled analgesia are likely to experience an overdose. A bit of context: patient controlled analgesia is one in which the epidural catheter is attached to a machine that delivers medication to your body. There will be a button on the machine that you can press if you want to increase the dose of painkiller in your body. This is a method that allows patients to control their dose of analgesia.
Because the patient has control on pain relief, many fear that this could increase the risk for overdose of the medication. However, PCA machines have actually been pre-programmed by the anesthesiologist. The anesthesiologist will have set a ceiling dose, so that you can never go beyond the safe dose for your age and weight no matter how much you press that button.
7 Chance That it Won’t Work
According to some personal accounts, there is a big chance that epidural anesthesia may not have an effect at all on the mother in labor. However, in studies of women who experience inadequate pain relief during labor, in many cases this was simply the result of a too-small dose of analgesic or a misplaced catheter. Both of these situations are pretty easy to remedy without the need for a reinsertion.
In cases where the epidural did provide inadequate pain relief, these were in particularly painful pregnancies such as with a posterior presentation that resulted in back labor or childbirth that was prolonged. In most cases, however, the epidural was effective in providing pain relief.
6 You Can’t Have it Late
Sometimes, moms who initially decided to have analgesic-free labor might change their minds and might actually want pain relief during the process of childbirth. Some moms do not state this need in the belief that you can’t have an epidural when in labor.
In most cases, however, you can still have an epidural during the active stage of labor. It’s really only too late to get one if your baby is crowning, or when his scalp has already presented in your vaginal orifice.
Some claim that following the use of epidurals, women are more likely to experience backaches. One study, however, followed women for a year after childbirth and found that there was no significant difference between incidence of backache in women who got epidurals and those that didn’t.
It seems likely that those who do get backaches and got epidurals were more likely to blame their aches on the procedure.
4 Riskier than Other Pain Relief
There are people who believe that epidurals are an inherently risky form of pain relief especially when compared with other options. However, studies find that the are no more riskier than other pain relief options during labor.
In fact, when compared to intravenous opioid analgesics, epidurals had less side effects on both the mother and the baby.
3 Tears and Episiotomies
Because labor can be longer with the use of epidural anesthesia, many believe that the incidence of tears and the need for an episiotomy increase. However, this is not the case. Studies find that there is no increase in the incidence of tears or other forms of birth canal trauma with the use of episiotomies.
Any trauma that results after childbirth is most likely the result of other factors, not the episiotomy in itself.
2 Not Needed if with Childbirth Training
Many mothers believe that attending prenatal classes that include childbirth training means that they will not have the need for an epidural during childbirth. However, this is just not the case. Despite receiving childbirth training, most mothers still opt to have an epidural during the process of childbirth, whether it was planned or not.
Moms should definitely consider epidurals and natural childbirth methods as complementary therapies, rather than competing disciplines that they have to choose between.
1 Discourages Breastfeeding
This is yet another tricky subject. Some research does show that women who have epidurals are less likely to breastfeed and, even if they do, they breastfeed for a shorter time. Some studies, however, show that there is no difference in breastfeeding practices between women who had epidurals and those who don’t. In women who received epidurals, there may be a delay in the time when the baby first suckles. For other data, however, it did not have any effect.
Most likely, it’s other factors that contribute to low breastfeeding rates. For instance, regardless of whether they received medication or not, those who scored low in the infant breastfeeding assessment tool were overall less likely to breastfeed for very long.