The Doctor Is In: The truth about epidurals

The Doctor Is In is an occasional series where JHU Press authors discuss the latest developments and news in health and medicine.

Guest post by Richard Siegenfeld, M.D.

Have you ever wondered why there is still so much angst over epidurals for childbirth, even with all the medical information at a person’s fingertips? One reason is just that–there’s so much information; information that is unfortunately entwined with so much misinformation and a few exaggerated partial truths, too! Anybody who watched the recent presidential debates, with the accompanying “truth meters” at the end, can attest to how much spin can be strategically placed on just about any topic.

A quick web search under “epidural” yields first-page results that show what the average expectant mother must deal with when researching labor and delivery. One popular parenthood website states that “The mother must remain completely still for insertion, even through severe contractions.” This statement is not only misleading, but it evokes overwhelming apprehension in the person who is considering a labor epidural.

In reality, placing an epidural is not an extremely delicate process. Women who make small to moderate movement during the procedure may slow us anesthesiologists down and, in extreme cases, increase their chances of getting a headache afterward. But almost everyone can stay still enough, even while experiencing contractions every two minutes.

This misstatement about the process of receiving an epidural also feeds the common misperception that the epidural needle or the epidural medication is placed into a nerve or into the spinal cord. Nothing could be further from the truth. The needle and the medication go into the compartment that nerves pass through. Medication reaches nerves as it spreads within the compartment.

Expectant mothers are usually both surprised and relieved with this knowledge. Unfortunately, they often don’t learn about the method of insertion until labor, only minutes before the use of a labor epidural.

The anesthetic options for childbirth, like a labor epidural for a vaginal delivery or a spinal epidural for a C-section, have numerous advantages and disadvantages. Will it cause chronic back pain, increase the chance for a C-section, or hurt the baby? How well does it work, and for how long? What conditions can affect my choices? Reliable answers to these questions and many others can be found in both reputable websites and publications by experts in obstetrics and anesthesiology.

seigenfeldRichard Siegenfeld, M.D., is author of The Epidural Book: A Woman’s Guide to Anesthesia for Childbirth, an assistant professor of anesthesiology at Hofstra University School of Medicine, and an attending anesthesiologist at Long Island Jewish Medical Center.