Epidural or no? It’s a hard question for moms-to-be to grapple with, especially when they have no idea what the labor experience or contractions may feel like. But let’s get one thing straight: There is no shame in getting an epidural, which can help numb the pain of contractions and delivery.
And contrary to popular belief, there's no needle in your spine with an epidural, explains Chase White, MD, an ob-gyn at Einstein Medical Center Philadelphia. “The pain-relieving medication is provided through a flexible catheter that rests in the space between the ligaments of the back and the fluid-filled sack that contains the spinal cord and nerves,” he says. What you end up experiencing, after it’s administered, is a “decreased sensation in the lower half of the body,” says Jennifer Gattuso, DO, an ob-gyn with University of Maryland Upper Chesapeake Women’s Care in Bel Air, Maryland.
While epidurals are safe—complications related to epidurals are just under 3 percent, according to a 2014 study—there are a lot of myths about their side effects for mom and baby. It’s helpful to know what epidural risks are real and what are false, so you can discuss them with your doctor, and, when the time comes, be able to decide whether it’s right for you.
Epidural Side Effects for Mom
Delivering a baby—no matter how you do it—isn’t easy, and some moms assume the pain they experienced were caused by an epidural. In fact, those aches are really just part of the birth process. For instance, [epidurals are] often incorrectly blamed for back pain,” says Kara Manglani, a certified nurse-midwife in New York City and creator of The Fertile Times, a guide to getting pregnant. The truth is back pain can occur because the pelvis changes positions during labor.
Paralysis is another common myth as far as epidural side effects go. “One of the biggest fears mothers tell me is that an epidural will leave them paralyzed,” says David Jaspan, DO, chair of the department of obstetrics and gynecology at Einstein Medical Center. “While spinal cord paralysis or permanent neurologic injury are possible, they are very, very unlikely – on the order of 1 per 100,000.” The epidural is actually placed below where the relatively solid structure of the spinal cord ends, he explains.
Finally, some moms forego the epidural because they think it will cause a longer labor. But while that was once the thinking, more recent research suggests that this isn’t necessarily the case. Lower-dose epidurals allow women to change positions as they need to for labor to progress. Kevin Chen, MD, chief anesthesiologist at Northwest Community Hospital in Arlington Heights, Illinois, also adds that, with the advent of Pitocin, a drug used to maintain active labor progression, stalled labor is even less of a problem.
Still, as is the case with all medications, there can be risks. Fortunately, few, if any, can be considered long-term side effects of epidurals, and most are rare and can be treated quickly and effectively.
• Low blood pressure. “One of the short-term risks of an epidural is low blood pressure, which can make a woman feel faint,” Manglani says. This is one of the many reasons your OB is carefully monitoring your blood pressure during the labor process—if she sees it dip, or if you feel faint or dizzy, additional medications may help.
• Itching. As is the case with many pain medications, you might feel some minor itching almost anywhere on the body. But says, Numair Mohammed, MD, chief of ob-gyn, who works closely with Chen at Northwest Community Hospital, “it can easily be treated with Benadryl and doesn't affect the baby in any way.”
• Fever. “Anytime a foreign object, such as an epidural catheter, is placed in the body, there is a chance of developing an infection and then a fever,” says Mohammed. But, he says, this is very rare with epidurals, since strict infection prevention precautions are taken.
• Breathing difficulties. In very rare instances, the medication can drift higher along the spinal cord, and cause difficulty breathing. It can be treated but “as a safety precaution women who have an epidural have their oxygen level monitored throughout their labor,” Jaspan notes.
• Severe headache. Although rare, an epidural can cause a severe headache known as a post dural puncture (or spinal) headache, Chen says. Usually occurring within 48 hours of an epidural, it’s the result of spinal fluid leaking through the puncture site and reducing the pressure in the fluid around the brain. If you experience a severe headache, especially while sitting upright, consult your doctor immediately. She’ll treat you with something called a “ blood patch,” Holtz says. This involves injecting a tiny amount of mom’s blood into the epidural space to clot the hole and stop the leak.
• Ambivalence about the birthing experience. A small 2012 study found that women who had planned on a natural birth but had a last-minute epidural were sad or ambivalent post-delivery, and many felt they hadn’t accomplished birth the way they wanted to. If you’re experiencing similar emotions, talk with your partner or a counselor to help work through these feelings.
Epidural Side Effects for Baby
Epidural medication—often a combo of a local anesthetic (a numbing drug) and a narcotic (a pain reliever)—primarily stays in the epidural space. “The amount absorbed by the bloodstream is minimal,” Chen says. That means you shouldn’t worry too much about short or long term side effects of epidurals as far as baby is concerned.
In rare instances, a severe drop in mom’s blood pressure (see “Epidural Side Effects for Mom) can, in turn, decrease blood flow to baby, which would then cause a drop in baby’s heart rate. Fortunately, this isn’t typically something to be concerned about either. “It can be easily treated with IV fluids, medications, or changing the mom’s position,” says Mohammed. Only in very few cases would this require a c-section, he adds.
Minimizing Epidural Risks
Even if you don’t think of an epidural as a part of your “plan,” considering the possibility can help you avoid any surprises or panic, and it keeps you informed too. Doing the following will help you avoid a negative experience:
• Be clear about your medical history with your doctor. Some moms-to-be may not qualify for an epidural, including women on blood thinners and antiplatelet drugs or women with medical conditions that lead to bleeding disorders or platelet dysfunction, Chen says. Sharing your medical issues—including any previous bad epidural experience—can help your doctor choose the best course of care.
• Practice anxiety relief. We get it—the idea of a large needle near your spine is stressful. OK, terrifying. Learning visualization techniques or breathing exercises can help you zen out when the epidural is administered.
• Speak up. Yes, the insertion may feel momentarily uncomfortable, but an epidural should not hurt. If you feel pain, discomfort or otherwise feel weird, let your doctor or anesthesiologist know ASAP.
• Ask what’s happening. Empower yourself by asking which medications you’re receiving during labor. It will help you troubleshoot any symptoms later.
Published November 2017