Epidural

Cascade Christian Childbirth Association

he epidural is regional anesthesia given via catheter inserted into the

epidural space in the spinal column. If given properly, sensation below

the injection site will be blocked, thus providing total pain relief.

THE BENEFITS

~ Does not alter the mother’s consciousness

~ May provide a total block of all sensations below site

~ Can relax a mother with extreme anxiety

~ Can help lower blood pressure of a PIH patient

(if blood platelets are high enough)

THE PROBLEMS

~ Completely immobilizes patient6

~ May have side effects

~ Patient no longer has an active role in the delivery of the baby6

~ Makes second stage longer and more difficult to push7

~ Increases the risk of vacuum or forceps assistance

~ Requires continuous electronic fetal monitoring

~ Requires an IV

~ Requires a urinary catheter

~ Requires a blood pressure cuff

~ Tubes, wires, and lines to strap you down in the bed

~ Risks of decreased blood pressure

~ May affect the baby's oxygen supply and affect his/her heart rate

~ Risks of causing more interventions especially if done too early

~ Risks of slowing down labor requiring pitocin3

~ Hypotension (drop in blood pressure)1

~ Inability to get a mal-positioned baby into place

~ Increased likelihood of the risk of vacuum extraction

~ Human error or abnormal spinal structure of the mother, such as

inability to place catheter properly; inadvertent injection of anesthetic

into a blood vessel; or too much anesthesia, affecting breathing and

swallowing (Each anesthesiologist’s skill level varies)

~ Increased likelihood of the need for an episiotomy

~ Fetal distress

~ Postpartum backache4

~ Urinary retention and postpartum urinary dysfunction5

~ Itching in the face, neck, and throat

~ Nausea and vomiting

~ Spinal Headache – when there is a puncture in the spinal cord, and

spinal fluid leaks back out, a thunderclap headache develops and you

will not be able to sit up until it heals. Oftentimes, this requires yet

another puncture to insert your own blood to “patch” the hole.

~ Uncontrollable shivering

Uneven, incomplete or failed pain relief1

~ Postpartum feelings of regret

~ Immobility that requires others to birth your baby for you

~ Inability to push your baby out due to loss of perineal sensation, often

requiring a cesarean section

Rare but Very Real and Serious Risks – They DO happen

~ Convulsions

~ Spinal cord damage, leading to paralysis

~ Cardiac arrest

~ Allergic shock

~ Epidural abscess

~ Respiratory arrest due to the epidural “going too high”

~ Maternal and/or fetal death

~ Possibility of low-grade fever - If membranes have been ruptured, the

fever will have to be assumed to be caused by infection rather than

epidural. Most care providers err on the side of caution - causing the

baby to have to have a "septic work-up" for infection even though

he/she is not infected

~ Can accidentally become a spinal if medication enters the dura space

~ May lead to the use of a urinary catheter, due to the fact the mom

cannot get up to go to the bathroom.

~ Subtle short-term neurobehavioral effects up to six weeks of age, such

as irritability and inconsolability and decreased ability to track an object

visually or to shut out bright light and noise. There are no data on

potential long-term effects.1

~ Possible difficulty with initial rooting and suckling behavior. Nurses

have reported more difficulties in feeding medicated babies than

unmedicated babies.

~ Interrupted mother-baby bonding time, due to reduced infant

responsiveness. This may lead to long-term relationship difficulties.

ALTERNATIVES

~ Prayer

~ Hydrotherapy (water tubs, showers, warm foot soaks)

~ Bring a doula

~ Upright positions/out of bed

~ Massage

~ Birth room atmosphere

~ Supportive staff

~ Deep relaxation / Music therapy

~ Determination / Confident mindset

~ Counteract fear-tension-pain

~ Avoid unnecessary inductions and interventions

~ Maintain activity

~ Prenatal preparation (nutrition, exercise, education, practice)

~ Support from friends, family, and birth team

~ Faith in the body’s ability to deliver a baby naturally

1. Avard, D.M., and Nimroof, C.M. "Risks and Benefits of Obstetrical Epidural
Analgesia: A Review." Birth 12(4):215-225, Winter, 1985.

2. 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

3. Thorp, J.A., Parisi, V.M., Boylan, P.C., Johnston, D.A. "The Effect of Continuous
Epidural Analgesia on Cesarean Section for Dystocia in Nulliparous Women." American
Journal of Obstetrics and Gynecology 161(3):670-675, September 1989.

4. 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.

5. 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.

6. McKay, S., and Roberts, J. "Obstetrics by Ear," American
Journal of Midwifery 35(5):266-273, Sept/Oct 1990.

7. Maresh, M., Choong, K.H., and Beard, R.W. "Delayed Pushing with Lumbar Epidural Analgesia in
Labour." British Journal Obstetrics and Gynaecology 90(7):623-627, July 1983.

EPIDURAL