The American Pregnancy Association states that the majority of women who give birth in hospitals have epidural analgesia (also known as an epidural block) to relieve pain during labor and delivery. An anesthesiologist injects the medication into the epidural space below the spinal cord. Once the nerves absorb the medication, the patient remains awake and alert, but she is numb in the lower half of her body. Rarely, the injection procedure or the medication itself causes side effects, some of which are serious.
Prolonged Labor
While an epidural allows a laboring woman to cope with the worst pain and to gather her strength for pushing, studies compiled by Drs. Gabbe, Simpson, Neibyl and Galan in "Obstetrics: Normal and Problem Pregnancies" show increased duration of the first two stages of labor following an epidural. An epidural prolongs the first stage of labor (from the first contraction until complete dilation and thinning of the cervix) for approximately 30 to 90 additional minutes, which is a statistically significant increase. However, this may be negligible to a laboring woman who typically endures 10 to 14 hours in this stage. The pushing stage, typically an hour to two hours, can last approximately 20 extra minutes in women given an epidural.
Spinal Headache
Spinal headache occurs when the epidural needle nicks the covering of the spinal cord (the dura), allowing some spinal fluid to leak out. Dr. Gabbe et al note statistics about this complication. The likelihood of nicking the spinal cord correlates with the level of experience of the anesthesiologist, varying from 1 to 3 percent. In the rare event that the anesthesiologist nicks the dura, a spinal headache develops in up to 70 percent of cases. A spinal headache can be severe and can last for up to several days.
Low Blood Pressure
The medication in an epidural can relax and dilate nearby blood vessels, and it can also decrease the output of maternal chemical messengers called catecholamines. Together, these two factors can cause a steep drop in maternal blood pressure, presenting a danger to the baby if less blood reaches the placenta. To avoid this complication, prior to injection of the epidural, laboring women usually have intravenous (IV) lines in place to administer fluids or medications to increase blood pressure if needed. Hypotension (low blood pressure) occurs in 10 to 30 percent of women given an epidural, say Dr. Gabbe et al, but, if recognized and treated quickly, no harm is done to the mother or baby.
Other
Other rare complications of epidural anesthesia include shivering, nausea, difficulty urinating and difficulty walking for a few hours after delivery due to numb legs. Very rarely, in 0.02 percent of cases, state Dr. Gabbe et al, placement of the catheter causes permanent damage to spinal nerves.
References
- American Pregnancy Association: Epidural Anesthesia
- "Obstetrics: Normal and Problem Pregnancies"; Steven G. Gabbe, M.D., Joe Leigh Simpson, M.D., Jennifer R. Niebyl, M.D. and Henry Galan, M.D.; 2007
- The American Congress of Obstetricians and Gynecologists: Pain Relief During Labor and Delivery
