Epidural Myths, Debunked: What the Evidence Really Says About Pain Relief in Birth
When one of my past clients, Sam, was preparing for birth, she felt overwhelmed by epidural information online.
Some posts she read made epidurals sound like the greatest invention of modern medicine. Others painted them as dangerous or unnatural—something to avoid unless absolutely necessary. Sam wasn’t sure what to believe, but she was sure about one thing: she didn’t want to feel scared of pain relief options during labor.
What helped her most wasn’t someone telling her what to do—it was understanding how epidurals work, based on research, not rumors. By the time she went into labor, she felt confident in her birth plan. She chose to get an epidural—on her terms—and later told me it was one of the best decisions she made for her birth.
Whether you’re planning to use an epidural, avoid one, or keep your options open, you deserve real, evidence-based information. So let’s walk through five of the most common epidural myths—and what the research says.
Myth 1: “You can’t move with an epidural.”
Reality: It depends on the dose—and the person!
This myth probably comes from outdated practices or people sharing their own epidural experiences as a universal truth. But here’s the deal: how much you can move with an epidural depends on the type of epidural and how your body responds to it.
Some people do feel numb or heavy in their legs, which can make walking difficult. But many retain quite a bit of movement, especially with what’s sometimes called a walking epidural. This lower-dose version combines an epidural with other forms of pain relief and allows for more mobility.
Even with a more traditional epidural, you’re not automatically confined to lying flat on your back. Being upright and changing positions during labor can help labor progress and make pushing more effective. Many people with epidurals can move into side-lying, all fours, semi-sitting, or even supported squatting positions. Research shows that birthing people with epidurals can use a variety of positions to support labor and pushing. These positions can help labor progress and may even reduce the need for additional interventions (de Jonge et al., 2009). These positions can help labor progress (Lawrence et al. 2013) and may even reduce the need for additional interventions. Being on your back is not a medical requirement—it’s often just a default. You have options.
Myth 2: “Epidurals cause long-term back pain.”
Reality: There’s no evidence to support this.
This is one of the most persistent epidural myths out there. It makes sense that people want to understand the long-term effects of any medical intervention, especially during a physically intense event like childbirth. But the fear that epidurals cause chronic back pain doesn’t hold up when you look at the evidence. Multiple studies and systematic reviews have found no significant link between epidurals and long-term back pain (Anim-Somuah et al., 2018).
A large Cochrane Review (Anim-Somuah et al., 2018) found no significant increase in long-term back pain among people who received an epidural compared to those who didn’t. In other words, people who have an epidural are no more likely to experience chronic back pain than people who give birth without one.
So, where does the back pain come from? In most cases, it’s not the epidural—it’s pregnancy and postpartum life. Postpartum back pain is very common, but it's more often linked to the physical strain of pregnancy and birth itself—not the epidural (Wang et al. 2004). Think about how your body changes during pregnancy: your center of gravity shifts, your core and pelvic floor are under strain, and you're lifting, feeding, or carrying a new baby around the clock. All of these can affect your back.
There are rare complications from epidurals, like spinal headaches or nerve injury, but these are very uncommon (nerve injury occurs in about 1 in 80,000 cases) (Pan and Bogard 2004). If you're dealing with pain after birth, it's worth checking in with a registered massage therapist, chiropractor, or pelvic floor physiotherapist. You deserve support and relief.
Myth 3: “If you get an epidural, you’ll end up with a c-section.”
Reality: Research shows no increase in c-section risk.
Ah yes, the infamous “cascade of interventions” argument. The fear goes something like this: you get an epidural → which leads to Pitocin → which leads to fetal distress → which leads to a c-section. AKA, the “cascade of interventions.”
There is such a thing as the cascade of interventions, and it’s valid to think critically about how one medical intervention might lead to another. But epidurals on their own don’t increase your risk of cesarean birth (Anim-Somuah et al., 2018), I pinky promise.
Some research suggests people who get an epidural may be more likely to need assistance during birth (like forceps or vacuum) (Lieberman and O'Donoghue 2002), but not because the epidural causes it—more often, it’s because they were already experiencing a longer or more complicated labor (Wong 2009). In these cases, an epidural may be part of a plan that supports your ability to have a vaginal birth.
So why are there so many stories on social media (I see you, Reddit) about people “having to get a c-section” because they got the epidural? Here’s what might be happening: people with more intense or longer labors are more likely to ask for an epidural, and also more likely to need a c-section because of the nature of their labor. In those cases, the epidural didn’t cause the C-section. It was just present during a more complicated birth.
Understanding this nuance matters. Epidurals are an option, not inherently a slippery slope.
Myth 4: “It’s too late to get an epidural.”
Reality: Medically, no. Practically, sometimes. Timing matters.
This is such a common question from clients: “Is there a point when it’s too late to get an epidural?” A lot of people believe that if you're too far along in labor, you’ve missed the epidural window. In part, this myth comes from miscommunication between labouring people and their nurses, who may suggest getting an epidural “while you have the chance.”
The reality is: as long as you're in labor and the anesthesia team is available, an epidural can usually be placed (ACOG Practice Bulletin No. 209 2019). Medically, it’s rarely “too late.”
But there are some practical limitations. For example:
It usually takes 15–20 minutes to place the epidural and another 10–15 minutes to kick in (Leighton and Halpern 2002).
If you’re already in the pushing stage, the epidural might not take effect in time to help much.
Sometimes, the anesthesia team is busy assisting in surgery or another birth, which might delay when they can get to you.
So yes, you can technically get an epidural at nearly any point in labor. But how effective or helpful it will be depends on how far along you are and how fast your labor is progressing. That’s why it’s a good idea to talk with your provider ahead of time about what options are available to you, and when.
Myth 5: “My epidural stopped working when I started pushing.”
Reality: It didn’t stop—you’re just feeling something different. Intense pressure is expected.
This one trips a lot of people up. They’re deep into labor, the epidural is working great… and then suddenly, they’re pushing and feeling a lot. What gives?
The truth is that epidurals are very effective at relieving contraction pain, but they’re not designed to fully block the pressure and stretching sensations that come during the pushing phase.
Why? Because those sensations come from a different set of nerves, especially the pudendal nerve, which runs through your pelvis and isn’t fully numbed by a standard epidural. So when you feel pressure in your rectum or the intense “ring of fire” during crowning, that’s normal—even with an epidural.
This doesn’t mean your epidural failed. It means your body is doing exactly what it needs to do to birth your baby. And yes, that might still be intense—but understanding what’s happening can make it a lot less frightening.
In the end, Sam chose to get the epidural.
After hours of intense back labor and trying every position and coping strategy we’d talked about, she turned to me and said, “I think I’m ready.” Not because she was pressured. Not because she’d failed. But because, in that moment, it felt like the right decision for her.
And it was.
Later, Sam told me that what made the difference wasn’t just the pain relief—it was knowing that she chose for herself, with real information and support, not fear.
Whether you’re leaning toward an epidural, planning to skip it, or still undecided, here’s what I want you to remember:
You have options. Pain management is not one-size-fits-all.
You can change your mind. What feels right now might shift during labor, and that’s okay.
You’re allowed to use tools that help you feel safe and supported. Whether that’s an epidural, breathing techniques, or both.
Epidurals aren’t magical, and they’re not evil. They’re just one of many tools available to you during birth. When you understand the evidence, you get to make choices rooted in your values, not someone else’s fears.
TL;DR: 5 Things to Know About Epidural Myths
You can move with an epidural. Many people can change positions or even walk, especially with a low-dose or “walking” epidural.
Epidurals don’t cause long-term back pain. Research shows no increased risk compared to those who don’t get one (Anim-Somuah et al., 2018).
Getting an epidural doesn’t mean you’ll end up with a c-section. High-quality studies have found no connection between epidural use and higher cesarean rates.
It’s rarely “too late” to get one, but timing matters. Medically, you can usually get one at any stage of labor, but how fast things are moving (and an anesthesiologist's availability) can be a factor.
If you feel pressure during pushing, that’s normal. Epidurals often don’t block the nerve pathways responsible for stretching or crowning sensations.
Want to know how an epidural is placed? Looking for more research and evidence on epidurals?
My friend Ashley Cooley and I chatted all about epidurals on the Bringing Up Baby podcast!
References:
Simmons, S. W., Taghizadeh, N., Dennis, A. T., Hughes, D., & Cyna, A. M. (2012). Combined spinal-epidural versus epidural analgesia in labour. Cochrane Database of Systematic Reviews, (10), CD003401. https://doi.org/10.1002/14651858.CD003401.pub3
de Jonge, A., van der Goes, B. Y., Ravelli, A. C., Amelink-Verburg, M. P., Mol, B. W., Nijhuis, J. G., & Buitendijk, S. E. (2009). Perinatal mortality and morbidity in a nationwide cohort of 529,688 low-risk planned home and hospital births. BJOG: An International Journal of Obstetrics & Gynaecology, 116(9), 1177–1184. https://doi.org/10.1111/j.1471-0528.2009.02175.x
Lawrence, A., Lewis, L., Hofmeyr, G. J., Dowswell, T., & Styles, C. (2013). Maternal positions and mobility during first stage labour. Cochrane Database of Systematic Reviews, (10), CD003934. https://doi.org/10.1002/14651858.CD003934.pub4
Anim-Somuah, M., Smyth, R. M., & Cyna, A. M. (2018). Epidural versus non-epidural or no analgesia for pain management in labour. Cochrane Database of Systematic Reviews, (5), CD000331. https://doi.org/10.1002/14651858.CD000331.pub4
Wang, S. M., Dezinno, P., Maranets, I., Berman, M. R., Caldwell-Andrews, A. A., & Kain, Z. N. (2004). Low back pain during pregnancy: prevalence, risk factors, and outcomes. Obstetrics & Gynecology, 104(1), 65–70. https://doi.org/10.1097/01.AOG.0000129403.54061.0e
Pan, P. H., & Bogard, T. D. (2004). Nerve injury after neuraxial anesthesia and analgesia in obstetrics. Anesthesia & Analgesia, 99(2), 538–544. https://doi.org/10.1213/01.ANE.0000131970.20057.34
Lieberman, E., & O'Donoghue, C. (2002). Unintended effects of epidural analgesia during labor: a systematic review. American Journal of Obstetrics and Gynecology, 186(5), S31–S68. https://doi.org/10.1067/mob.2002.121390
Wong, C. A. (2009). Epidural and spinal analgesia/anesthesia for labor and vaginal delivery. In: Chestnut's Obstetric Anesthesia. 4th ed. Elsevier.
ACOG Practice Bulletin No. 209 (2019). Obstetric Analgesia and Anesthesia. Obstetrics & Gynecology, 133(3), e208–e225. https://doi.org/10.1097/AOG.0000000000003132
Leighton, B. L., & Halpern, S. H. (2002). Epidural analgesia: effects on labor progress and maternal and neonatal outcome. Seminars in Perinatology, 26(2), 122–135. https://doi.org/10.1053/sper.2002.29872
Bucklin, B. A., Hawkins, J. L., Anderson, J. R., & Ullrich, F. A. (2005). Obstetric anesthesia workforce survey: twenty-year update. Anesthesiology, 103(3), 645–653. https://doi.org/10.1097/00000542-200509000-00024