Misconceptions About Labor and Delivery




Misconceptions About Pain Management in Labor and Delivery

When planning for the arrival of a new baby, there is much to prepare for. Parents are often focused on equipping the nursery, attending birthing classes and maintaining mom’s health. What many expectant moms may not realize is that they should also be preparing to make important decisions regarding their pain management options during labor and delivery. In order to help expectant mothers prepare for childbirth, the American Society of Anesthesiologists (ASA) wants to set the record straight regarding common misconceptions about obstetric pain management.

Misconception 1: Epidurals slow down the labor process.

There is no credible evidence to show that epidurals (or other pain management procedures) slow labor. Since epidurals are more frequently used in “difficult” labors versus relatively easy labors, some have tried to infer that epidurals, therefore, cause difficult labors. This is not an accurate interpretation of the data. Conversely, there is some evidence that epidurals can actually speed labor for some women, by allowing them to relax.
The best information we have is that pain management procedures have no significant impact on the labor process.   

Misconception 2: Epidurals cause C-sections.

Again, there is no definitive evidence that concludes an epidural will cause a C-section. Women who receive epidural anesthesia report higher pain levels earlier in labor than those who do not.  Such pain itself may be a marker for an unusual labor, which may be longer or more likely to end in a C-section. Women requesting epidurals also tend to be dilating at a slower pace than those who do not; they deliver larger babies; they are more likely to be receiving medication to augment labor, and they are more frequently having their first baby.   

Misconception 3: You can’t get an epidural until a certain level of dilation has occurred.

Women do not have to wait until they are dilated to a certain level before they can ask for, or receive, an epidural. According to the ASA’s current guidelines, “patients in early labor should be offered the option of receiving neuraxial analgesia (spinal or epidural) when the service is available, and it should not be withheld to meet arbitrary standards for cervical dilation.” If a woman is in active, established labor, and is uncomfortable, epidural analgesia is the most effective method of pain relief. There is no medical reason to wait for a specific dilation target.

Misconception 4: Women with lower back tattoos can’t get an epidural.

There is no evidence that lower back tattoos cause harm in this situation. Initiating an epidural through the ink of a lower back tattoo will not cause ink to enter the blood stream or the spinal canal, or cause further complications for the mother or baby.  

Misconception 5:  Having an epidural is extremely painful.

For most patients, the only painful part of the epidural procedure is the numbing of the lower back before the epidural is placed, which does cause a momentary stinging or burning sensation. The insertion of the epidural itself is usually felt as just pressure. In the hours and days following delivery, some women experience discomfort in the lower back where the needle was placed, but this is rarely a significant problem.

Misconception 6: Epidurals can cause permanent medical problems for the mother and/or the newborn.

Serious complications from an epidural procedure are extremely rare. The biggest risk that faces most patients is that the epidural will not work as effectively as desired. The anesthesiologists can administer more medication or make other adjustments in such cases.  

Misconception 7: Epidurals make labor less "fulfilling" for the mother.

What makes a labor meaningful and fulfilling is subjective, but it is important to most women that they remain alert, aware of contractions and participate in the process of childbirth. An epidural does not prohibit any of this from occurring. Eliminating the distraction of labor pain can make the birth process more enjoyable for many women.

Misconception 8: Epidurals depress babies so they can't breast-feed.

Some women worry that the medication they receive via the epidural may somehow reach their baby and make him or her less able to breast-feed. While learning to breast-feed is not always easy, most delivery centers have “lactation specialists” to help new mothers and infants master the skill. Epidural analgesia actually exposes the baby to less medication than many other methods of pain relief.

Misconception 9: The window for receiving an epidural can close.

The primary requirement for receiving an epidural is that the patient can hold still and the baby isn't already in the process of being delivered. Beyond that, there isn’t an arbitrary time when it becomes “too late” to perform the procedure.

Misconception 10: Epidurals are guaranteed to provide optimal relief.

Like all medical procedures, with epidural analgesia, each individual responds differently to medication and sometimes not enough medication is delivered to the right spot. These instances are rare and even when they do occur, an anesthesiologist can make adjustments.


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