Pros & Cons of Epidurals

(From course manual, email me if you want the study citations:)

As with all drugs, the use of epidural medications carries significant risks and can cause side effects in mother and baby. The severity of these risks varies, depending on which drugs are used, at what stage in the labor the epidural is given, the total dosage of medication accumulated through the labor, the skills of the anesthesiologist, and the woman's individual reactions to the epidural. Generally speaking, the later the epidural is given, and the lower the concentration of the drug, the lower the frequency and severity of side effects will be. Besides the discomfort of administering the epidural and the fact that it may take a half hour to 90 minutes for pain relief to take effect, mothers opting for epidurals risk these side effects:

* a toxic or allergic reaction to the specific drug or drugs
* fever, which becomes increasingly likely after the epidural has been
in for four hours or more
* decrease in maternal blood pressure
* decreased contraction strength and/or frequency and slowed labor
progress (dystocia)
* diminished urge and ability to push
* inability to urinate
* itching and nausea if narcotics such as Sufentanyl, Demerol
(Meperidine), Duramorph (morphine), Fentanyl, and Stadol are used

There is also the remote, though not unprecedented, possibility that the anesthesiologist could insert the needle into a blood vessel or the spinal canal instead of the epidural space. While it is uncommon, this human error has in some cases led to breathing difficulties for the mother, spinal headache, and, in extremely rare cases, meningitis, cardiac arrest, or even death.

An epidural also puts the baby at risk of the following:

 heart rate deceleration and hypoxia (decreased oxygen supply) from a drop in the
mother's blood pressure
 tachycardia (rapid heart rate) and fever (from the mother's fever)
 subtle changes in newborn reflexes and neurobehavior, including in suckling
 more difficulty in self-soothing or being consoled

There may be other, possible long-term effects on the baby, but these have not been studied widely at present.

An additional concern is that intravenous fluids are given in large quantities before and during an epidural in order to expand the woman's blood volume and prevent a drop in blood pressure. This quantity of fluids also can lead to excessive urine production, possible excessive breast engorgement, fluid overload, neonatal tachypnea (rapid breathing), and in rare cases pulmonary edema, as well as other side effects.

Chances are you will not meet the person giving you an epidural until you are in labor and have already decided you want the drugs, not an ideal time to be asking probing questions about risks or this person's qualifications. The list of potential complications is long but when you want those drugs, you want them now and suddenly you don't care so much about the risks. I think it is a good idea to learn about the pros and cons BEFORE you are in labor. 🙂

Some things, like the risk of fever in a mother, don't seem like a big deal - until you learn that having a fever increases the chance of a c-section (they worry about infection, even though fever is a common side effect of the epidural itself) and if mom has a fever, they generally want to treat the baby with antibiotics as well which can mean a NICU stay for a baby that is not even infected. (Cultures take time to come back to verify there wasn't an infection but they preemptively treat with antibiotics to be safe. Which is life saving, if baby has an infection. But what if it was simply a fever in you because of the epidural and baby was fine?)

And it says the risk of spinal headache from a badly placed epidural is remote, but I know too many mothers that did experience a spinal headache (which can be brutal!!) to believe it's truly that rare. If you read up on spinal headaches that alone may heavily influence your decision! And epidurals are by no means a guarantee of pain relief, as numerous women have spotty epidurals that leave hot spots, areas of their body that are not numbed. So they are still paralyzed from the epidural, but in pain and unable to even move to or use other coping techniques like the tub or shower to get relief.

Inability to urinate doesn't sound like a big deal, they just place a catheter to deal with that - but a catheter means risk of a urinary tract infection, requiring antibiotics (which can lead to yeast infection and thrush for you and baby) and a UTI itself is miserable, on top of the healing from a birth?

Side effects for a baby may sound minor, a weak suck for example. But if the baby is unable to latch well and nurse and mom is engorged it can lead to mastitis for mom (imagine a burning pain in your breast combined with the flu, while caring for a newborn) and the baby not gaining weight which can lead to supplementing, having to pump, and overall difficulties establishing a nursing relationship.

Throw into all of this that many of these potential complications increase your risk of a c-section (such as deceleration of baby's heart rate) and you can see an epidural is not a decision to make lightly.

That said, I am not opposed to epidurals. 🙂 I believe every woman must decide for herself and every birth is different. I chose an epidural in my first birth knowing the risks it entailed and I'm fortunate that it was a good epidural (full pain relief, I could still feel contractions enough to push, anesthesiologist stayed in the room to monitor me, no spinal headache, baby handled it fine, and I delivered only a couple hours later.) Some women have wonderful experiences with epidurals, some women have absolutely horrible experiences with epidurals. It's YOUR decision (presuming you get to the hospital in time for one to be placed!) but I think every couple needs to be aware of the benefits and risks of medical procedures.