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One of the most frequently asked questions the doctors at Chouchani, Sayegh and Bagnarello receive from our pregnant patients is if they should or should not get an epidural. While many women are entering the delivery room demanding that they be given an epidural, other women are staunchly opposed to this form of pain management. Each expectant mother should have a thorough understanding of the pros, cons, and risks involved before she makes a determination as to whether or not she will accept an epidural during delivery.

The Procedure

To perform the epidural, an anesthesiologist will insert a needle between two spinal vertebrae in the lower back. A fine catheter is threaded through the needle, and then removed, so that a mixture of a local freezing agent and a pain medication can be administered into the injection site. As a result, the mother will experience numbness below the waist.

The Pros

Epidurals can provide effective pain relief in many cases, especially in the case of a long, or difficult labor. Additional pros of epidurals include:

• Mitigating exhaustion: When the pain of contractions keeps you awake, an epidural can ease the pain enough to allow for rest or even a nap.
• Calming anxiety and speeding labor: For women who are exceptionally nervous or anxious during birth, an epidural can ease pain, allowing a woman to become more calm and less tense, ultimately helping to speed delivery.
• Easier delivery for “sunny-side up” babies: If the cervix is fully dilated, but your baby is facing your belly button instead of your spine, an epidural can relax the muscles of your vagina and perineum, helping the baby to properly reposition for delivery.
• Controlling high blood pressure: For women who experience a spike in blood pressure during labor, an epidural can help lower blood pressure to safer levels.
• Enabling consciousness: For women in need of a non-emergency C-section, epidurals can allow you to remain awake through the final stages of birth.

The Cons

Undesired side effects of epidurals tend to increase with larger doses of medication, longer deliveries, or fetal distress. Cons of receiving an epidural may include:

• Partial relief: In approximately five to 10 percent of cases, an epidural only provides partial relief, which is improved when additional medication is administered, but only in 75 percent of cases.
• Less effective labor: Numbness may make it more difficult for you to push through contractions, which can prolong labor, resulting in the need for a forceps or vacuum delivery in approximately 38 percent of cases. In other instances, oxytocin is used to speed stalled delivery, a medication that poses its own risks. In other cases of stalled labor, Pitocin must be administered, increasing the chances of a C-section by two or three times for first time mothers.
• Perineal injury: Tears and other injuries are more common in women who use epidurals because of the increased need for a vacuum or forceps delivery.
• Respiratory complications: In some cases, the sensation of numbness extends too far up a woman’s body, which can make breathing and swallowing difficult.
• Difficulty urinating: Lower body numbness often requires the insertion of a catheter to empty your bladder.
• Limited mobility: Once an epidural is administered, you will be rendered mostly immobile, keeping you from walking the halls or moving around.
• Spinal headache: Approximately one percent of women who receive an epidural develop an often severe headache during or after labor, which may linger for days or even weeks in rare cases.
• Postpartum backache: An epidural can result in bruising at the injection site, or ligament strain from prolonged time spent in the labor position. Either of these complications can cause short or long-term postpartum backache. Long-term backaches are almost twice as likely to occur with an epidural than without.
• Dropping blood pressure: When an epidural causes too much of a drop in blood pressure, it can cause the baby’s heart to slow. Since a slowed heart rate could indicate a sign of stress in the baby, medications may be administered and if ineffective, a C-section may be necessary.
• Fever: Epidurals significantly increase the likelihood of developing a fever during labor. In case the fever signals infection, you and your baby may be unnecessarily treated with antibiotics. In some cases, your baby may be admitted to the neonatal intensive care unit (NICU) after delivery to rule out complications.
• Emotional detachment: With a loss of physical sensations, some mothers feel an emotional detachment from the labor process, which can also make it more difficult for nurses to assess the progress of the labor.
• Residual complications: In rare cases, further complications can include residual numbness, weakness caused by injury to nerves at the injection site, and most severely, brain damage or death.
• Undesired effects on the newborn: In some cases, epidural complications may cause side effects for the newborn including short-term neurobehavioral complications such as irritability, inconsolability, decreased ability for visual tracking, less efficient initial suckling behavior, and decreased responsiveness.

Of course deciding whether or not to get an epidural should be based on a conversation that you have with your doctor — on a case by case basis. Remember to talk to your doctor about your questions and concerns regarding the epidural procedure before your delivery, and be prepared to know the risks involved before you make your decision during labor.