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Are Epidurals Really Risk Free?

There is a lot of misinformation out there regarding epidurals, so I thought  I would dig up some information as I am currently researching myself for my upcoming c-section delivery in May.

I have had 2 epidurals thus far, one with each delivery although I never planned on having any. Like a trooper I thought I could go through an induction with pitocin and no epidural with my oldest son, about 3 hours into it, I was begging for someone to knock me out completely. I did regret it after the fact because I had horrible back problems from that day forward, when I never had as much as a back ache before that.

With my second son, I labored for what seemed like a lifetime, although it was only about 20 hours before I opted for an epidural to help get some sleep. I had been up at that point for about 30 hours. But this time, my best option is a spinal and I am not sure if I want it.

I often hear women being told there are no risks to epidural. Whether their provider has given them bad information, because yes I have heard OB/GYN’s and other providers tell women there are no risks to epidurals, or their best girlfriend just gave them some bad information. I am all about women being educated and really knowing about the typical procedures, and options for labor.

I started my research with the American Pregnancy Association. The website gives great information on epidurals. How they are done, what different kinds are offered, and of course the benefits and risks which they detail as:
What are the benefits of epidural anesthesia?

  • Allows you to rest if your labor is prolonged
  • Relieving the discomfort of childbirth can help some woman have a more positive birth experience
  • Most of the time an epidural will allow you to remain alert and be an active participant in your birth
  • If you deliver by cesarean, an epidural anesthesia will allow you to stay awake and also provide effective pain relief during recovery
  • When other types of coping mechanisms are not helping any longer, an epidural may be what you need to move through exhaustion, irritability, and fatigue. An epidural may allow you to rest, relax, get focused and give you the strength to move forward as an active participant in your birth experience.
  • The use of epidural anesthesia during childbirth is continually being perfected and much of its success depends on the care in which it is administered.

What are the Disadvantages of epidural anesthesia?

  • Epidurals may cause your blood pressure to suddenly drop. For this reason your blood pressure will be routinely checked to make sure there is adequate blood flow to your baby. If this happens you may need to be treated with IV fluids, medications, and oxygen
  • You may experience a severe headache caused by leakage of spinal fluid. Less than 1% of women experience this side effect from epidural use. If symptoms persist, a special procedure called a “blood patch”, an injection of your blood into the epidural space, can be done to relieve the headache
  • After your epidural is placed, you will need to alternate from lying on one side to the other in bed and have continuous monitoring for changes in fetal heart rate. Lying in one position can sometimes cause labor to slow down or stop
  • You may experience the following side effects: shivering, ringing of the ears, backache, soreness where the needle is inserted, nausea, or difficulty urinating
  • You may find that your epidural makes pushing more difficult and additional interventions such as Pitocin, forceps, vacuum extraction or cesarean may become necessary
  • For a few hours after birth the lower half of your body may feel numb which will require you to walk with assistance
  • In rare instances, permanent nerve damage may result in the area where the catheter was inserted.
  • Though research is somewhat ambiguous, most studies suggest some babies will have trouble “latching on” which can lead to breastfeeding difficulties. Other studies suggest that the baby may experience respiratory depression, fetal malpositioning; and an increase in fetal heart rate variability, which may increase the need for forceps, vacuum, cesarean deliveries and episiotomies.

All great information that mothers should fully be aware of before consenting, or even considering an epidural during their labor experience. Those saying that epidurals are risk free certainly are doing a great disservice to the women they are working to educate.

Then I had the pleasure of reading an amazing post on epidurals on the Science and Sensibility blog. Not only does Dr. Michael Klein give information on the history of epidurals, he includes some awesome information about if an epidural really is the best way to relieve pain during labor. What I liked most was what he said here:

Is epidural analgesia the best form of pain relief?
Epidural analgesia is a very effective form of pain relief, meaning that compared to a variety of other pharmacological and non-pharmacological methods, it provides generally consistent pain reduction. If there were no problems associated with epidural analgesia, almost everybody would want it. Unfortunately, though, associated with its use there are various undesieable effects, including:

  • longer first stage labours
  • longer second stage labours
  • increased incidence of maternal fever directly caused by the epidural, which often leads to the use of antibiotics in both the labouring woman and her newborn
  • increased rates of operative vaginal delivery (forceps and vacuum)
  • increased perineal trauma with and without instrumental births including severe tears into the rectum (3rd and 4th degree tears).
  • a variety of complications such as a placement of an epidural too high on the spine (leading to breathing problems).
  • failure of the epidural to provide any pain relief, or insufficient pain relief—requiring the continued use of other methods of pain relief
  • increased need for a bladder catheter
  • maternal hypotension leading to worrying fetal heart rate changes
  • an increase in the likelihood of the need for a cesarean section this last complication being the subject of great debate, which will be discussed further

Of course, some of these problems may occur whether the epidural was or was not truly needed. And when an epidural is truly needed for pain relief or to solve a specific problem, it can dramatically change a situation for the better and can improve outcome. It is only when epidurals are used routinely, and especially very early in labour that these complications are more likely to occur.

He plans on writing another part to the post, which I am eagerly awaiting over the next couple weeks. I find this information fascinating, and incredibly helpful given the circumstances surrounding my delivery coming up in May. I also hope that all the mothers out there, whether you are a first time mother, or just someone considering an epidural with your next child, find this helpful!

photo: flickr.com/archibaldjude

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