The Childbirth Pain No One Warns You About

My daughter was just a week old as she lay in her bright blue plastic bathtub, screaming. I watched as my husband held her squirming, skinny body, my in-laws gently dumping warm water on her writhing legs. "Can you see this?" my husband asked. "Yes," I muttered, my voice weak. I had expected to be able to give my daughter her first bath, one of those basic tasks that become monumental when it's your own kid. Instead I watched it unfold via FaceTime, through eyes that hurt to blink. I was trapped in my bed, lying flat on the cold sheets. Any attempt to lift my head resulted in the sensation of an MLB pitcher lobbing fastballs at my body at full speed. I had to crawl on all fours to the bathroom if I needed to pee, because even just lifting my head upright caused it to throb so much I yelped in pain.

I had what's called a spinal headache, a rare complication from the spinal tap I received on the operating table right before my emergency C-section. That week, I'd endured contractions that felt like an ax splitting my body open, and major abdominal surgery. (And my phone and wallet were stolen from the waiting room while I gave birth.) Yet the pain from the spinal headache was worse than all of that, like if a migraine on steroids had a threesome with car accident whiplash and the flu.

Less than 24 hours after giving birth, I was overcome with what I thought was a basic migraine. I had been through a challenging labor followed by a C-section and hadn't been allowed to eat anything until my catheter was removed and I could pee on my own, a task that's much harder than it sounds. So I chalked my head pain up to being hungry and exhausted, and, you know, the fact that I had just given birth. But the dull throbbing turned into hot, raging pain that coursed from my head into my shoulders and back. And nothing the nurses brought me was helping; they turned off all my lights and dosed me with Motrin, to no avail.

If you had no idea what a spinal headache was until this very moment, you're in good company! I had taken an eight-week birth class, religiously attended prenatal yoga, and created profiles on every pregnancy message board the internet has to offer. But I never once heard or saw the words "spinal headache" until the doctor uttered it the day after my daughter's birth, after I explained through tears that my head and neck were crippled by blinding pain every time I sat up in my hospital bed.

Kelly, a certified registered nurse anesthetist who works in Labor and Delivery, explained it to me like this: "A spinal headache is caused by the hole made in the 'sack' that holds spinal fluid and your spinal cord. During an epidural, the 'sack' called the dura should not be punctured. However, if the epidural needle goes a few millimeters too deep, it is punctured and fluid leaks out. The cause of the headache is because you lost some spinal fluid, which keeps your brain floating. The headache is caused by traction on your brain." (Kelly and I are in the same parenting Facebook group, and she asked that I use her first name only because she did not request permission from her employer to speak to a reporter.)

Like contractions during labor, the pain of a spinal headache is so severe it's almost indescribable. Yes, my head throbbed, but it was not a manageable pounding, and my body rippled with nausea. But spinal headaches are also tricksters — your symptoms all but disappear when you lie down. One second, you're lying flat in bed feeling almost totally fine. Then you lift your head an inch and it feels like a train is plowing into your body at full blast.

So why aren't spinal headaches detailed in birthing classes or in the pages of pregnancy books? According to Dr. Alexandra Bullough, a Loyola Medicine anesthesiologist who specializes in obstetric anesthesiology, when a spinal tap is performed by an experienced provider, your risk of getting a spinal headache is 1 out of 100. "A spinal headache from spinal anesthesia is rare due to the current design of the needle and use of smaller gauged needles," says Dr. Bullough, who calls epidurals the "gold standard" for analgesia during childbirth. This is reassuring news, and in my humble opinion, the risk of a spinal headache should not turn anyone off from considering epidurals during childbirth (though to be fair, I did not have one with my second birth, a VBAC, because I didn't want to risk going through a spinal headache again). And yet they aren't so rare; search for "spinal headaches" on any mom message board and you'll find posts from women who've just given birth, complaining about their debilitating spinal headache symptoms, seeking advice on treatment, and asking if anyone else out there has experienced the same thing. Still, my midwives never mentioned them before I gave birth.

"I always consent my patients and discuss the risk of the headache prior to inserting an epidural," Kelly told me, "However most people are in so much pain they don't care about the risks and they aren't really paying attention. But it is my obligation to get their verbal consent prior to performing the epidural."

This was my experience. I was in so much pain as I sat on the operating table that I barely remember anything my anesthesiologist said other than "try to sit still."

Some spinal headaches go away on their own but they're also treatable. "Alternative treatments may be tried first, e.g. hydration, caffeine, abdominal binder, oral pain medication," Dr. Bullough wrote in an email. "However if these treatments don't work and a woman is unable to carry out daily activities post-delivery a blood patch may be required." A blood patch is a procedure in which an anesthesiologist draws your blood and then gives you an epidural with that blood to block the spot where fluid is leaking. If it works, your headache will be gone when you sit up.

Doctors don't offer it as a first option because there's a very small risk of infection with a blood patch, Kelly told me. "If you were a difficult epidural placement, it could be difficult to perform the blood patch. We try to do the least invasive treatment first always. Also, sometimes we aren't convinced that the headache is actually a spinal headache so we would hate to perform a procedure that won't help the problem."

And indeed, when my doctors first identified my spinal headache, they gave me traditional pain medications and encouraged me to drink caffeine, sending my husband out to Starbucks for espresso shots. As the days went on, even just the faintest hint of light made me lurch or vomit. I could not sit up to nurse my daughter or stand to change her diaper. And to top it all off, I was recovering from my C-section too.

So a week after I gave birth, I returned to the hospital for the blood patch. I went into the hospital in severe pain and left a couple hours later feeling exhausted but otherwise fine. Recently, I spoke with three other women who experienced spinal headaches after childbirth (none had heard of the ailment until during or after childbirth either), and two were advised — by doctors and nurses! — to chug Mountain Dew for the caffeine if the spinal headache returned. "I pounded the Dew and felt much better," said one woman.

"Most of the women I've told about this experience have been floored to hear about it," one woman told me. Another was shocked to learn she wasn't alone: "I can't believe how many women have told me they had it after I said I'd had it. So many of them said they were dismissed."

Dr. Bullough says hospital staff "routinely assess any patient who receives a labor epidural prior to the patient leaving the hospital." And it's true I was monitored constantly by doctors, nurses, midwives, and anesthesiologists working to remedy the situation. Still, not being informed about spinal headaches until I was bedridden by one limited my agency in the situation. Had I known what I was in for, I would have pushed harder to receive the blood patch before I left the hospital.

So much can happen in childbirth, and so often information is thrown at us with little time to process it. If you think you're experiencing a spinal headache — or any sort of medical complication after giving birth — it's important to speak up and seek the support of your partner or other caregivers to back you up. Because lacking power over your own care while caring for a newborn is just one more headache you don't want.

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