The truth about epidurals
TikTok and Facebook have *a lot* of opinions about them...
The pressure to ‘do’ everything right as a parent starts looong before your baby arrives. I have seen countless questions and incorrect opinions on A LOT related to birthing, and the topic of epidurals is one that comes up over and over again. So save this if you think you might want an epidural so when friends, family members, neighbors, and strangers on the street try to tell how horrible they are—you can reference this and help your blood pressure normalize again. Happy reading! -Dr. Jen
Epidurals: so much misinformation!
If you're considering an epidural for labor pain relief, you’ve probably heard many stories about them—whether you wanted to or not. One of the topics I see most hotly debated on social media is this tool in our toolbox, and I worry that folks who may want one may feel scared or shamed out of getting one.
Let me be clear: We have many ways to manage labor pain, and an epidural is but one of them. But with 36-80 percent of people birthing in hospitals opting for them (with a huge range depending on the state in which you live), it’s important to be able to separate fact from fiction. Let’s do just that…
Myth 1: “Epidurals make labor longer.”
You might push for about 15–20 minutes longer with an epidural on average—but since you're more comfortable, you might not mind.
Myth 2: “Epidurals increase your chance of needing forceps or a vacuum.”
They don’t. Older studies said yes, but newer data shows no increased risk. This is likely because we now use lower doses of the medicine in the epidural.
Myth 3: “Epidurals increase your risk of a C-section.”
Nope! I hear this one a lot, but some of us actually think that by helping your body relax, an epidural might even lower your C-section risk (we just don’t have hard data to prove that yet). The key: once you have an epidural, keep moving! This helps your baby rotate into an optimal position for birth. Your nurse and/or doula can help with this using peanut balls and different position tricks to achieve this movement even when your legs are partially or totally numb.
Myth 4: “You can’t push effectively with an epidural.”
If you're too numb, pushing can be tough—but we can adjust the dose to give you more sensation and better control.
Myth 5: “Epidurals cause long-term back pain.”
They don’t. Postpartum back pain is common, but it’s more often from pushing, posture changes, and pelvic floor strain—not the epidural itself. You might feel sore at the insertion site in the short-term, but there’s no link to chronic pain.
Myth 6: “Epidurals make breastfeeding harder.”
Studies vary, but with typical epidural doses and by avoiding overdoing IV fluids (which can cause breast swelling), there’s likely little to no impact to breastfeeding.
Myth 7: “Epidurals cause autism.”
This myth took off after a 2020 study, but follow-up research has not shown any connection. There’s no known biological mechanism for an epidural to cause autism, so please don’t let folks shouting about this on the internet stress you out.
Q&A: Is it too late?!
I got SO many good questions when I posted a question box on my Instagram this week, so stay tuned for answers to them in coming newsletters.
First up, these two, which inspired the content of this week’s newsletter:
A: It’s really never too late to ask—even when you’re completely dilated and starting to push! But it doesn’t mean it’s always possible.
As a new OBGYN intern (aka, I was in my first year of training after graduating medical school), I had a mom ask for an epidural when she was 9 centimeters dilated. I regretfully told her no because I thought it was too late. The anesthesia resident thankfully overheard me and said, “Of course we can try!” He snuck it in in time and our patient was so thankful. And I was *very* happy to have been wrong and to have learned from this.
Usually, it’s not too late until the baby is almost out. If you’re near the end of labor—even if you’re about to start pushing— and you’re able to still for the placement, you can likely still get one. That said, it takes about 10–15 minutes to place and start working—so if delivery feels very close, we might suggest other comfort options instead. We also find when they’re placed as late as I am describing here that they might not work as well, but if it’s something you really want to try, we can give it a go.
If it’s not your first baby, though, you may well be able to push out your baby much more quickly than we can place an epidural, so we may also discuss that with you. It’s not one-size-fits-all!
Want to get your question answered in the BBC newsletter? Send me a message and I’ll incorporate them into future newsletters! *no personalized medical advice*
POV: Getting an epidural
What better way to know what having an epidural placed looks like than to see a unicorn get one? Watch the video and you’ll see what I mean ;). I do love nurse anesthetist Olivia Reeves’ content, and her walking us through a labor epidural placement is *chef’s kiss*:
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I hope this newsletter helped you feel a little more relaxed if you might be going the epidural route. And if you found this content useful, please consider upgrading to being a paid subscriber. I will never keep any educational content behind a paywall, but your support—if you’re able—means the world to me so I can continue this work!
Dr. Jen