Considering that at least 60 percent of women today have an epidural for pain relief during labour, it’s surprising how misunderstood this procedure is. For starters, even doctors use the word “epidural” generically, to encompass three similar yet distinct procedures: epidurals, spinals and the combined spinal-epidural (CSE), or “walking” epidural. Since deciding whether or not to have an epidural means becoming informed about the benefits and risks well before labour begins, here are the facts to help you make sense of some common misconceptions.
Perception An epidural and a spinal are the same procedure.
Reality - An epidural involves injecting pain-blocking medication into a space between the vertebrae and the spinal fluid; it usually takes about 15 minutes to work. A spinal is an injection directly into the spinal fluid; it is given as part of the CSE technique, usually before a Caesarean section, and takes effect in five minutes. With either an epidural or CSE, the catheter that delivers the drug is left in the epidural space until the baby is born so the medication can be administered continuously. An increasingly popular option is patient-controlled epidural analgesia (PCEA), which allows the labouring woman to control the amount of pain relief she gets without the risk of overdosing.
What medication is given, how much and for how long all vary depending on the individual and the hospital; some routinely combine epidurals with spinals and some do not. Being educated about the procedures used where you will deliver can help you make a decision that is right for you.
Perception The needle used for both procedures is gigantic, and it hurts when inserted.
Reality - The epidural needle is left in place for only a minute or two, just long enough to insert a catheter the size of a pencil lead into the epidural space. The spinal needle is smaller — the width of a thick piece of hair. Before this happens, the injection site is numbed with a local anaesthetic, at which point you’ll feel a pinch and sting for about 10 seconds. You’ll feel pressure, but not pain.
Perception You can’t get an epidural early in labour.
Reality - Research published in The New England Journal of Medicine found that women who received low-dose CSE when their cervix was less than four centimeters dilated had labours that were on average 80 minutes shorter than women who received a narcotic injection early in labour, followed by an epidural when the cervix was at four centimeters. Caesarean section rates were about the same.
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. 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 labour if she has a “walking” epidural.
Reality - Most women do not walk with one. Continuous foetal 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. 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.
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. 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.
A much rarer complication is a severe headache. This occurs in less than one percent of patients but it can last for several days and be very uncomfortable. 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, experts say, “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 Caesarean 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 labours that may have required a C-section anyway. However, no studies have compared labours with epidurals or other pain relief to labours with no pain medication (such studies are difficult, if not impossible, to conduct). Further research is needed.