Epidural Pros + Cons

Everyone’s favorite baby shower topic revolves around the birthing experience, and once the stories start it’s hard to stop! Everyone has a different opinion on what “type” of birth is the best- medicated, unmedicated, scheduled c-section etc.  In all reality the most important thing is delivering a healthy baby right??  But it’s important to be educated on your birthing options so that ultimately you can make the best decision for YOU.  Once you know the facts you can take into consideration your own personal fears, hopes, and ideas of how you’d like your birthing to go and make an informed decision that will be best for you and your baby.

EPIDURAL PROS

  • Relief (or at least reduction) of pain without altering the mother’s mental state.
  • Enables an exhausted mama to sleep during labor and can clam those who are anxious/tense because of the pain.
  • Some prolonged labors (likely those that are slowed because of anxiety) speed up with an epidural.  Anxiety can cause excessive production of the mother’s stress hormones (epinephrine and norepinephrine) which slow contractions- thereby prolonging the labor process.  By allowing the mother to rest without pain, labor progress for an anxious/tense mother may improve.
  • Pain relief while still able to participate in the birth through breathing and pushing (as long as the dose isn’t too high).
  • Epidurals are also very useful for cesarean births, making it possible for the mother to remain involved while free from pain. They also enable the woman to avoid general anesthesia, which carries greater risks.
  • Women can change positions more easily with an epidural than with an anesthetic.

EPIDURAL CONS/ RISKS

-Risks during the labor-

  • May slow labor in some, requiring Pitocin; and has been found to increase the chances of a cesarean delivery in primigravidae (first time mamas) by 2-3 times.  *I know this sounds contradictory to the above mentioned pros to an epidural.  Remember that every labor and every woman is different.  In some labors the administration of an epidural can speed up the process while in other labors it has the opposite effect.  Ahh the mystery of the human body!

-Risks to the Mother-

  • Inadequate pain relief or relief that is unilateral (one-sided).  *Have you ever heard someone say their epidural only took in a certain place?
  • Rise of the mother’s temperature, also known as an “epidural fever”.  This may lead to unnecessary interventions like treatment of the mother AND baby with IV antibiotics for a non-existent infection. (More on the risks to the infant below).
  • Drop in the mother’s blood pressure which can cause nausea and dizziness.  This can be treated with a preventative IV bolus before the epidural administration, through positional changes and oxygen.
  • Urinary retention requiring a bladder catheter.
  • The nurse can no longer assess labor progress by observing the mother and must rely more on the monitor and vaginal exams.  Mother may feel detached from the process and become an observer; others may reduce emotional support.
  • Problems caused by human error or maternal structural anomaly, such as inability to place catheter properly; inadvertent injection of anesthetic into a blood vessel; or too much anesthesia, affecting respiration and swallowing (rates vary with skill of the practitioner and anatomy of the mother).
  • Possible unintentional spinal block and resulting spinal headache-requiring days of bed rest and a blood patch.

-Risks to the infant-

  • Increased likelihood of infant septic workup, and IV antibiotics if the mother develops an “epidural fever” that in turn causes increased respirations or fever in the newborn.  If the mother develops a fever during labor but the infant shows no sign of distress after birth, the likelihood of a newborn septic workup goes down, but ultimately it is up to the pediatrician to decide on a case by case basis.
  • Abnormal heart rate patterns, requiring oxygen to the mother, position changes and possible cesarean delivery.
  • Possible less efficient initial rooting and suckling behavior. Nurses have reported more difficulties in feeding babies whose mothers had an epidural when compared to unmedicated babies. (This is not the case with ALL babies, and should be avoided with proper lactation support).

As you can probably tell, there is almost always a trade-off when medications and interventions are used during labor. Each mama must know and consider the potential benefits and risks- then apply them to her own individual circumstances.  With this education, we can be empowered expecting mamas!

 

References

Dickersin, K. “Pharmacological Control of Pain During Labor.” In: Chalmers, I., Enkin, M., Keirse, M., eds, Effective Care in Pregnancy and Childbirth. New York: Oxford University Press, 1989.

Fusi, L., Maresh, M., Steer, P., and Beard, R. “Maternal Pyrexia Associated With the Use of Epidural Analgesia in Labour.” The Lancet, 1250-1252, June 3, 1989.

MacArthur, C., Lewis, M., Knox, E.G., and Crawford, J.S. “Epidural Anesthesia and Long-Term Backache After Childbirth.” British Medical Journal, 301:9-12, July 7, 1990.

Scott, D.B. and Hibbard, B.M. “Serious Non-Fatal Complications Associated With Epidural Block in Obstetric Practice.” British Journal of Anaesthesia, 64:537-541, 1990.

Lester, B.M., Als, H., Brazelton, T.B. “Regional Obstetric Anesthesia and Newborn Behavior: A Reanalysis Toward Synergistic Effects.” Child Development 53:687-692, 1982.