Are Epidurals Safe During Labor?

I recently had a friend who gave birth to her first child. Throughout her pregnancy she had envisioned a childbirth without medications so that she would have the opportunity to get breastfeeding off to the best start possible. However, as she entered the hospital in labor, she was immediately asked if she would like an epidural. She declined. She then declined again, and again, and again. Hospital personnel were constantly asking her if she had changed her mind or wanted one yet? Finally, when she reached 7 centimeters the nurses became so persistent that she needed an epidural that her confidence was destroyed, and she consented to have one. By the time the epidural was administered, she was 9 centimeters dilated. The result? The baby's heart rate dropped dramatically and she had an emergency Cesarean delivery. Her hopes for a natural childbirth and immediate breastfeeding? Shattered.

My friend's story prompted me to look more deeply into the risks accompanying epidurals during labor. I admit up front that I have a strong bias toward natural childbirth if it is possible. However, the information I have gathered on the negative side effects of this method of pain relief is the result of scientific research.

23% of women who receive an epidural will experience complications. These complications may be mild, moderate or severe, often depending upon the timing with which the epidural was given. When epidurals are given too close to delivery, or at a time in which the woman's body is progressing well on her own, epidurals can result in fetal distress or the cessation of labor altogether. Here is a breakdown of the categories of risk.

Risks to the Mother
Hypotension, or a drop in blood pressure, occurs in 30-35% of women who receive an epidural.

Because women who receive epidurals also need a catheter, 25-34% of women will experience some type of bladder dysfunction after childbirth. Lack of bladder control may continue for days, weeks, or even months.

Frequently, mothers will experience uncontrollable shivering after receiving an epidural.

Some mothers will experience nausea, vomiting, or itching of the face or neck (due to narcotics used in some epidural formulas).

10-22% will experience postpartum back pain.

15% of mothers will experience a fever, which may affect the heart rate of the baby and lead to a C-section or infection in the baby.

1-10% will experience a spinal headache for days or weeks after delivery.

10% will experience inconsistent, or partial pain relief.

100% will not be able to move about freely for the rest of labor and for some time afterward.

Some mothers may also feel detached from their deliveries as they think they were no longer part of the delivery process after receiving an epidural. This depends on the mother, but in severe cases this disappointment can affect mother-baby bonding.

Risks to the Labor
Commonly, an epidural received before the mother has reached 5 centimeters will cause a prolonged first stage of labor. When an epidural is administered, the muscles below the injection site can be weakened. The result will be weaker uterine contractions and a longer labor. An epidural also puts you at a greater risk for a prolonged second stage of labor.

20-26% will present a baby in an inappropriate position due to the relaxation of pelvic muscles. The pelvic muscles are meant to guide a baby into the correct birthing position, but may be unable to do so after a woman has received an epidural.

Epidurals almost always increase the chances a mother will receive Pitocin to speed up labor. Pitocin comes many negative side effects, such as causing an abnormal fetal heart rate which can mean an emergency C-section.

Decreasing ability to push effectively, as the woman cannot feel the natural urge to push when she has completely dilated and the baby's head puts pressure on the perineum.

Increased risk for needing an episiotomy, or a vacuum extraction or forceps delivery.

Cesarean rates rise dramatically depending upon when a mother receives an epidural. For a mother who gets her epidural at 2 centimeters, her C-section risk just jumped to 50%, 3 centimeters, 33%, and 4 centimeters, 26%.

Risks to the Baby
Fetal distress (inconsistent or dropping heart rate) is most likely caused by hypotension (low blood pressure) in the mother. This includes the likelihood of needing a vacuum extraction, forceps, or Cesarean delivery.

Drowsiness and a poor sucking reflex in the baby. This interferes with mother-baby bonding and can also destroy the breastfeeding relationship before it starts.

Poor muscle strength and tone in the baby for the first few hours as a result of the drugs which made it into the baby's system. This may mean the baby has to spend more time away from mom under observation or in order to receive oxygen.

If a medical situation arises in which an epidural is necessary for the safe delivery of a baby or for the health of the mother, then I support its use. However, when epidural use is based on a nurse's or doctor's convenience over a mother's preference, I am strictly opposed. The best tool an expectant mother has before heading into labor is her knowledge. Educate yourself about all aspects of labor so that you can make sound, confident decisions that will enable you to have the labor you envision for yourself and your baby.