Thank you for this piece. I wanted to add an additional perspective to the line about accidental dural puncture causing "a severe headache" that is then described as being treated via an epidural blood patch. Unfortunately, an epidural blood patch is not always curative and for a subset of patients, the dural puncture turns into a chronic, post-puncture spinal cerebrospinal fluid (CSF) leak.
While my own spinal CSF leak was sustained via lumbar puncture (LP), not epidural, the reality for all of us is far more than the temporary headache I was warned about. Spinal CSF leak is a debilitating neurological condition that affects many systems in the body, not a passing headache.
Following my LP, I had four blood patches with blood and fibrin glue, none of which provided lasting relief. Unfortunately, some epidural patients suffer the same trajectory.
None of this is an argument against epidurals, of course! I'm glad they exist and that they help women through childbirth. I wanted to comment on the brief mention of risks, however, because there are profound barriers to care in seeking treatment for spinal CSF leak, even when a known puncture occurred. (For more on these barriers, we recently published a paper on the fractured and lengthy path to care with spinal CSF leak: https://www.ajnr.org/content/early/2026/06/08/ajnr.A9459) New mothers are sometimes told it's hormones, it's anxiety, or it's post-partum adjustment, when in reality their symptoms are caused by a spinal CSF leak.
I appreciate this article, and wanted to make mention of the full range of outcomes, including the underdiagnosed one I'm still living with, so that patients who don't recover quickly are believed and diagnosed quickly rather than dismissed.
Fascinating article! Amazing to me that all the Scandinavian countries with their focus on nature and so on are way above the UK with epidural take up - is this because of all the talk about natural birth and so on?
I had four children and had an epidural with the first - it was manna from heaven after a 55 hour labour with endless contractions going nowhere and lack of sleep
When I had my three boys subsequently I went for gas and air which was fantastic for me and enabled me to be much more active (no lying on the bed which was excruciating and I hated, and it probably helped labour go faster too). But you also know nothing with your first.
On the other hand my daughter had her first baby at home with just a birthpool, that did make me feel a little wistful, but I had ended up in hospital after midwives said baby's heartrate was showing distress so you don't have any choice under those circs
very hard to disentangle all these things connecting pregnancy, birth and childrearing from all the other factors that influence a woman's decision to have a child or not.
In my 7 weeks of obstetrics rotation I did not even see a single patient getting an epidural for labor. In government hospitals here in India the doctors don't even offer it. Every time I worked in the labor room I felt really bad for those patients screaming during childbirth. I wish the awareness and acceptance increases in this part of the world. Great article though!
I know nothing of pregnancy but spinal epidurals are also GREAT for lumbar back pain! I get 2-3 yearly. Keeps me going through 10 mile hike/jogs, regular workouts and gardening.
The premise is good in theory. However, the clinical outcome depends critically on the care setting. There are epidural patients where the catheter is not positioned correctly or the dose is not correct. This requires attention by the anesthesiologist and regular follow up by the nurses. As we know, staffing shortages leads to inattention and inadequate training, which increases the risk that epidurals are not administered effectively. Speaking from experience, this is not uncommon, which leads to patient suffering.
Any drug given to the mother to sedate or numb pain also reaches the fetus, which is undergoing a life-and-death ordeal to emerge alive. The fetus requires all of his/her capacities, and as such, there needs to be alternative means of supporting the mother and helping assuage her pain than heavy duty medications that actually counter the challenges of, if not endanger, the fetus.
In addition, babies that are born under the influence of drugs may be predisposed later in life to self-medicate with drugs, alcohol, food, and process addictions of all kinds.
Absolutely wonderful tool for anyone giving birth. Amazing technology developed by science and medicine. But "miraculous" is not accurate. No laws of physics or nature are broken or suspended. It's the body reacting to a chemical in a tested and predictable manner.
Which is why miracles don't happen. You said medicine can "radically alter what's possible" but that's not really true. Something doesn't "become possible" just because medicine discovers a new treatment. We just learn new things. That doesn't make them miracles.
Maybe just semantics, but it's an interesting discussion.
Thank you for this piece. I wanted to add an additional perspective to the line about accidental dural puncture causing "a severe headache" that is then described as being treated via an epidural blood patch. Unfortunately, an epidural blood patch is not always curative and for a subset of patients, the dural puncture turns into a chronic, post-puncture spinal cerebrospinal fluid (CSF) leak.
While my own spinal CSF leak was sustained via lumbar puncture (LP), not epidural, the reality for all of us is far more than the temporary headache I was warned about. Spinal CSF leak is a debilitating neurological condition that affects many systems in the body, not a passing headache.
Following my LP, I had four blood patches with blood and fibrin glue, none of which provided lasting relief. Unfortunately, some epidural patients suffer the same trajectory.
None of this is an argument against epidurals, of course! I'm glad they exist and that they help women through childbirth. I wanted to comment on the brief mention of risks, however, because there are profound barriers to care in seeking treatment for spinal CSF leak, even when a known puncture occurred. (For more on these barriers, we recently published a paper on the fractured and lengthy path to care with spinal CSF leak: https://www.ajnr.org/content/early/2026/06/08/ajnr.A9459) New mothers are sometimes told it's hormones, it's anxiety, or it's post-partum adjustment, when in reality their symptoms are caused by a spinal CSF leak.
I appreciate this article, and wanted to make mention of the full range of outcomes, including the underdiagnosed one I'm still living with, so that patients who don't recover quickly are believed and diagnosed quickly rather than dismissed.
Great essay
Fascinating article! Amazing to me that all the Scandinavian countries with their focus on nature and so on are way above the UK with epidural take up - is this because of all the talk about natural birth and so on?
I had four children and had an epidural with the first - it was manna from heaven after a 55 hour labour with endless contractions going nowhere and lack of sleep
When I had my three boys subsequently I went for gas and air which was fantastic for me and enabled me to be much more active (no lying on the bed which was excruciating and I hated, and it probably helped labour go faster too). But you also know nothing with your first.
On the other hand my daughter had her first baby at home with just a birthpool, that did make me feel a little wistful, but I had ended up in hospital after midwives said baby's heartrate was showing distress so you don't have any choice under those circs
very hard to disentangle all these things connecting pregnancy, birth and childrearing from all the other factors that influence a woman's decision to have a child or not.
In my 7 weeks of obstetrics rotation I did not even see a single patient getting an epidural for labor. In government hospitals here in India the doctors don't even offer it. Every time I worked in the labor room I felt really bad for those patients screaming during childbirth. I wish the awareness and acceptance increases in this part of the world. Great article though!
I know nothing of pregnancy but spinal epidurals are also GREAT for lumbar back pain! I get 2-3 yearly. Keeps me going through 10 mile hike/jogs, regular workouts and gardening.
The premise is good in theory. However, the clinical outcome depends critically on the care setting. There are epidural patients where the catheter is not positioned correctly or the dose is not correct. This requires attention by the anesthesiologist and regular follow up by the nurses. As we know, staffing shortages leads to inattention and inadequate training, which increases the risk that epidurals are not administered effectively. Speaking from experience, this is not uncommon, which leads to patient suffering.
Any drug given to the mother to sedate or numb pain also reaches the fetus, which is undergoing a life-and-death ordeal to emerge alive. The fetus requires all of his/her capacities, and as such, there needs to be alternative means of supporting the mother and helping assuage her pain than heavy duty medications that actually counter the challenges of, if not endanger, the fetus.
In addition, babies that are born under the influence of drugs may be predisposed later in life to self-medicate with drugs, alcohol, food, and process addictions of all kinds.
Absolutely wonderful tool for anyone giving birth. Amazing technology developed by science and medicine. But "miraculous" is not accurate. No laws of physics or nature are broken or suspended. It's the body reacting to a chemical in a tested and predictable manner.
Medicine that radically alters what’s possible is a miracle, I don’t think the term needs to be reserved for the supernatural
It's a slippery slope in terms of linguistics. What then do you call something that supercedes what is physically possible?
We used to have easily broken bones - calcium is a miracle.
We used to die from an infection - antibiotics are a miracle.
We used to have teeth fall out - flossing is a miracle.
We used to get skin cancer - sunscreen is a miracle.
These are all just laws of nature and biology that someone eventually discovered. If everything "amazing" is a miracle, then nothing is a miracle.
“What do you call something that supersedes what is physically possible”
How about impossible?
Which is why miracles don't happen. You said medicine can "radically alter what's possible" but that's not really true. Something doesn't "become possible" just because medicine discovers a new treatment. We just learn new things. That doesn't make them miracles.
Maybe just semantics, but it's an interesting discussion.
Very important, thanks. Prob the worst decision my wife and I made was to go with "natural" childbirth. :-(