Epidural: Procedure, Benefits, and Potential Risks

The most common form of pain medication used in childbirth in the United States is the epidural block. Despite its widespread use, I strongly feel that the majority of pregnant women in the United States are not properly educated about the use of an epidural block. Here is some information that every woman should consider when deciding whether or not she will choose an epidural in labor.

How an epidural is done:

• The drugs used in an epidural are usually a combination of an anesthetic (like bupivacaine) and a narcotic or opioid (like fentanyl). Dosage depends on the anesthesiologist performing the epidural.
  
• The mother must have an IV line to ensure adequate fluids.
• Constant monitoring of the mother's blood pressure and baby's heart rate is needed.
  
• The mother is placed on her side or sits up and leans forward to receive the epidural.
• The anesthesiologist cleans the lower back area.
• A local anesthetic is given and then a hollow epidural needle is inserted between two vertebrae into the epidural space, just before the membrane that covers the spinal cord.
• The mother usually feels pressure.
• A test dose of the medication is usually given to ensure proper placement and effectiveness of the epidural.
  
• A thin, plastic tube called an epidural catheter is threaded through the hollow needle into the epidural space and the needle is removed.
• The catheter is taped to the mother's back.
• Generally each contraction will get easier, and the mother will begin to feel pain relief in about 10 to 20 minutes. Her legs may feel warm or tingly and may feel heavy.
• The lighter the epidural dose, the more control the woman will have to move her legs and the easier it will be to change positions.

Advantages to using an epidural:

• Allows the mother to stay alert throughout labor and delivery.
• The baby is less medicated compared to if an IV narcotic is used.
• The mother can rest during a long labor.
• Can provide pain relief, particularly when labor is induced with pitocin.

Potential side-effects of an epidural:

• The woman's ability to move around or change positions may be limited. She is generally restricted to the bed.
  
• The medication may cause an erratic fetal heart rate. Local anesthetics cross through the placenta.
• Drugs can cause various degrees of maternal, fetal, and neonatal toxicity.
• May slow down labor (particularly if given before 4-5 cm dilation).
• May increase the possibility for use of pitocin.
• May make it hard for the mother to push the baby down. Some women don't feel the urge to push at all when they have an epidural. This is generally related to how strong the epidural is.
• May increase the likelihood of the use of forceps or vacuum extraction.
• May cause a fever in the mother when used for long hours.
• May make it more likely the newborn will be screened and treated for infection.
• Some mothers experience nausea, vomiting or itching when epidural narcotics are used.
• May cause short-term urinary incontinence, and a bladder catheter may be inserted into the mother. A full bladder will generally slow the progress of labor.
  
• Delayed fetal rotation and descent.
  
• Spinal headache if the epidural needle goes in too far (if it punctures the spinal space). This is usually a severe, debilitating headache that can last for a couple of weeks. A blood patch can be done to help repair the damage and alleviate the headache.
• Postpartum backache.
• Possible long-term paralysis. This is more rare than other side effects, but it can happen. I have a friend who experienced a numb spot in her leg for several months after having the epidural.
  

Click here to see photos of the epidural procedure by Patti Ramos

This information was paraphrased and compiled from An Epidural for Pain Relief: Making an Informed Choice by Nicette Jukelevics, MA, ICCE and Pregnancy, Childbirth and the Newborn by Penny Simkin, PT, CD(DONA). For more in-depth information about the risks and benefits of epidurals, please also see The Thinking Woman's Guide to a Better Birth by Henci Goer.