What Are the Risks and Side Effects of an Epidural During Labor?

Like any procedure, epidurals come with risks and side effects. Learn what they are so you can make an informed decision before you go into labor.

The journey of childbirth, a beautiful and transformative experience, is often accompanied by the anticipation of pain. However, modern medicine offers various pain management options to alleviate discomfort during labor, and one such option is the epidural. This comprehensive guide aims to provide an in-depth understanding of epidurals, including their definition, utilization, and potential side effects and risks.

Understanding Epidurals

An epidural is a medical procedure involving the administration of one or more pain-relieving medications, known as anesthetics, through a small tube or catheter placed in the patient’s back. This catheter opens into the epidural space, an area surrounding the spinal nerves. The introduction of these medications induces a loss of sensation in the lower half of the body. According to a 2018 study published in JAMA Network Open, the prevalence of epidural use during labor varies, ranging from 36.6% to 80.1%, depending on the state in which the delivery occurs.

Dr. Christine Greves, an obstetrician-gynecologist at the Center for Obstetrics and Gynecology at Orlando Health in Florida, emphasizes the safety of epidurals while acknowledging that, like most medical procedures, they entail potential side effects and risks. Being aware of these possibilities can empower individuals to make informed decisions regarding the suitability of an epidural for their specific circumstances.

Epidural Side Effects

1. Itching: Some of the pain medications used in epidurals, particularly opioids, can induce itching. While the exact mechanism behind opioid-induced itching is not fully understood, it may involve the release of histamine—a chemical associated with itching—due to the activation of mast cells, a component of the immune system. Healthcare providers can address itching by adjusting the medication or providing relief through additional drugs.

2. Low Blood Pressure: Epidurals can lead to a temporary decrease in blood pressure, a phenomenon known as hypotension. Research published in Obstetrics and Gynecology in 2017 indicates that up to 30% of individuals who opt for epidurals experience hypotension. The sympathetic nervous system, which regulates various involuntary bodily functions, including blood flow, is affected by epidurals, contributing to this decline in blood pressure. To counteract this, healthcare providers closely monitor blood pressure and may administer fluids or medications through an intravenous (IV) line. Compression devices that provide alternating pressure on the legs have also been effective in reducing hypotension rates.

3. Nausea and Vomiting: A drop in blood pressure during an epidural can lead to feelings of lightheadedness and nausea. Sensitivity to opioids can further exacerbate these symptoms, potentially triggering vomiting. Patients can consult their healthcare providers for remedies to alleviate nausea.

4. Fever: Research published in the Turkish Journal of Anaesthesiology and Reanimation in 2020 suggests that 11-33% of individuals receiving epidurals during labor may develop a fever. The reasons for fever occurrence during labor, particularly in connection with epidurals, remain unclear. One theory posits that epidurals may induce an inflammatory response and disrupt temperature regulation in the body. Prolonged fever during labor may increase the risk of complications, such as surgical vaginal delivery or cesarean (C-section) delivery, as noted in the same study.

5. Difficulty Urinating: Epidurals can temporarily numb the nerves responsible for signaling bladder fullness. In some cases, this may necessitate the insertion of a catheter to empty the bladder. However, normal bladder control typically returns once the effects of the medication wear off.

Potential Risks Associated with Epidurals

1. Severe Headache: Accidental puncturing of the spinal cord’s covering membrane during epidural placement can result in a severe headache. This complication is relatively rare and can often be managed with oral pain relievers and hydration. In some instances, a procedure called a blood patch may be necessary. This involves injecting a small sample of the patient’s blood into the puncture site. As the blood thickens and clots, it seals the puncture, alleviating the headache.

2. Breathing Problems: Opioids used in epidurals can occasionally lead to slow or problematic breathing. Close monitoring by healthcare providers ensures prompt intervention in the event of breathing difficulties.

3. Infection: While there is a general risk of infection whenever the skin is breached, the likelihood of infection resulting from an epidural is low. Healthcare providers maintain strict sterility during the procedure, including sterilizing the needle and cleansing the patient’s skin.

4. Inadequate Pain Relief: Despite its effectiveness, epidurals may not always provide complete pain relief. An estimated 12% failure rate in achieving sufficient pain relief has been reported. In such cases, alternative pain relief methods may be offered.

5. Nerve Damage: Although extremely rare, the epidural needle can potentially strike a nerve, leading to temporary or permanent loss of sensation in the lower body. Nerve damage can also result from bleeding around the spinal cord or the use of incorrect medication in the epidural. Prompt reporting of numbness or tingling after the expected duration of epidural effects is crucial.

Potential Risks to the Baby

Research regarding the impact of epidurals on infants presents varying findings. According to the American College of Obstetricians and Gynecologists (ACOG), the opioids in an epidural may increase the likelihood of the baby experiencing changes in heart rate, breathing difficulties, drowsiness, reduced muscle tone, and challenges with breastfeeding. These effects are typically short-term and depend on numerous factors.

The American Pregnancy Association notes that the use of an epidural during delivery may hinder a baby’s ability to latch onto the breast effectively, potentially causing lethargy in utero and difficulty assuming the proper position for delivery. These factors could contribute to a higher rate of C-section and surgical vaginal delivery among individuals who opt for epidurals.

The decision to utilize an epidural for pain management during labor and delivery should be based on a thorough understanding of its benefits and risks for both the birthing individual and the baby. While epidurals offer effective pain relief, potential side effects and rare complications should be weighed against the anticipated benefits. Open communication with healthcare providers and a personalized approach to pain management can help ensure a positive birthing experience tailored to individual needs and preferences.