Epidural

What you need to know

Prepare for the unexpected

Epidural Risks and Realities

There is a myth in our culture that an epidural is a panacea, that it will give the laboring mother rest. While this does occur for some mothers it does not tell the whole story. Some women will have an ineffective epidural that leaves a window of sensation. The mother will continue to feel partial or complete contractions, but she is restrained to the bed and can not access her comfort measures in an upright position or have the benefit of gravity. 

 

10%-15% of women will experience inadequate pain relief 

The drugs and the restriction of movement can cause labor to stall or it may elongate the process. Since the labor may stop or slow down, pitocin is often added. Pitocin carries it's own risks. Even if the mother does have adequate relief, the baby maintains full sensation. Pitocin often creates more intense, longer and closer together contractions than natural labor and they do not fluctuate as much to flow with the mother and baby's needs. There is no feedback system, so the baby may go into distress. This may lead to cesarean.

Epidural may increases the risk of cesarean by 2.4 times

"Among first-time mothers, women having epidurals were 2.4 times more likely to have a cesarean."

Being completely numb, the mother looses touch with the sensations of the baby moving through her body and may have TRIPLE THE RISK OF A PERINEAL TEAR. Since the mother is numbed in an unnatural way, the baby may be more likely to slip into a PERSISTENTLY POSTERIOR position among other unfavorable positions. Epidural also increases the chance of COMPLICATIONS FROM INSTRUMENTAL DELIVERY, which can increase the short-term risks of bruising, facial injuries, displacement of skull bones and blood clots in the scalp for babies, and of episiotomy and tears to the vagina and perineum in mothers. Epidural also increases the RISK OF PELVIC FLOOR PROBLEMS (urinary, anal and sexual disorders) in mothers after birth.

Risks to the Baby and Mother

Remove the Fear with Information

For the baby, epidural medication is present at equal and sometimes at even higher levels than the mother, possibly remaining for days.

 

Epidural may affect the baby's fetal heart rate, and may compromise blood and oxygen flow.

The medication of an epidural can leave the baby feeling sluggish. It has fentanyl in it, which is a narcotic. This is one reason epidurals may interfere with breastfeeding, bonding, result in lower APGAR scores and decrease alertness in the baby. The medication and change to being confined to the bed may decrease the mother's natural hormones, which helps explain the stall or total stop to the labor. This drop in hormones also impacts the mother postpartum. In a natural delivery, the mother has a surge of endorphins and oxytocin that prime her body for euphoria. Many mother's describe themselves as feeling flat after having an epidural. The hormones of labor help us to bond, but they may not be there in the same capacity with an epidural in the mix. We can overcome that to some degree, by having lots of skin to skin postpartum with our baby and avoiding mother baby separation whenever possible. This is important, not just for bonding, but also for preventing postpartum depression (PPD) and postpartum anxiety (PPA). Pitocin was studied for it's impact on postpartum mothers and it was found to be an independent risk factor for postpartum depression. 

The researchers found that exposure to peripartum oxytocin increased the risk of depression or anxiety in the first postpartum year by about 32% in women with no history of pre-pregnancy depression or anxiety. In women with a history of pre-pregnancy depressive or anxiety disorder, exposure to the peripartum oxytocin increased the risk of depression or anxiety by 36%.

Epidurals also carry with them some unpleasant surprises and reducing the element of surprise can help make the labor process easier and less stressful. Less stress is better overall. Do not be taken off guard if the laboring mom has a DROP IN BLOOD PRESSURE. It is very common and the staff should be looking for it and respond quickly. Most likely, they will give a bag of fluid preventatively, as the increase in fluid is what fixes the issue. 

1 IN 5 WOMEN WILL DEVELOP A FEVER. They do not know if the fever is from the epidural or if it is a brewing infection. This scenario logically leads to surgery for most providers as they have no way of knowing where the fever is coming from. This is another clear reason that epidurals may increase cesarean rates.

A mother with an epidural is TWICE AS LIKELY TO EXPERIENCE POSTPARTUM HEMORRHAGE and this makes sense, because the pushing may be longer due to the unnatural numbing and the increased chance of having an instrumental delivery.

Up to TWO-THIRDS OF WOMEN WILL ITCH all over. This is likely due to the narcotic and can be corrected with ant-itch drugs. It adds one more drug to the mix.

Most women will need a catheter in place. This is because the numbness leads to DIFFICULTY URINATING. The catheter may be uncomfortable and sometimes leads to infection.

BREATHING PROBLEMS are also possible as the numbing effect may go too high in the body. This can feel scary if it were to take a mom by surprise, but if she knows that it is possible, she can remove the fear and notify the staff, get the problem corrected and advocate for herself.

TINNITUS is also a possibility. It is less common, but can last for months or longer. It may be very unpleasant for a new mom to have ringing in her ears and even worse to have unexplained ringing.

1 IN 3 MOMS WILL SHIVER. Cover her with warm blankets. Wrap the rebozo around her body and hold her to reduce the sensations. Firm massage down her legs and arms will also potentially relieve the shaking.

BACKACHE, HEADACHE, SORENESS where the needle was inserted are also common and vary in the degree of severity. It is possible to have a very rare, but very severe headache from an epidural.

1 IN 20 WILL EXPERIENCE NAUSEA. This is common in labor to begin with, but an epidural increases the chance. An anti-nausea medication may be provided.

Informed Consent

With this information you can have true informed consent. 

"You are monitored closely when receiving epidural or spinal anesthesia. That's because the anesthetics can affect the central nervous system, cardiovascular system, and respiratory system. Both spinal and epidural anesthesia may affect blood pressure, breathing, heartbeat and other vital functions." - WebMD

 

As Dr. Sarah Buckley explains -

"A woman laboring with an epidural therefore misses out on the final powerful contractions of labor and must use her own effort, often against gravity, to compensate for this loss. This explains the increased length of the second stage of labor and the increased need for forceps when an epidural is used."

Spinal placement is very similar to epidural, but it is often faster to take effect and faster to wear off.

Epidural Placement

Epidurals an epidural is placed, it is common for most or all of the birth team to leave the room. Sometimes one person may stay to support the mom. The decision is completely at the discretion of the anesthesiologist. The mother will be asked to sit on the edge of the bed and curl around. A pillow may be helpful for this, to give her something to lean on. She will need to be completely still, so that the placement is safe and accurate. This may not be easy in labor, so it is something to keep in mind beforehand to consider. The long needle is used to place a tube that will remain. The tube administers the medication. It will be taped on the mother's back and she will be given a device with a boost button that will deliver an extra dose if she desires. This extra dose is only given once in a set interval. 

Epidural Variations

Some people inquire about walking epidurals. It is not common, but sometimes a low dose epidural can be administered and monitored by an anesthesiologist. More common, but also rare is when a mother can remain mobile within the bed. If she has some feeling, the baby has a stable heart rate, and the support team helps keep her safe, she may be able to explore some different options if she wants.

TEL: 202-441-6771 chava@birthingwithjoy.com