The Safety of Epidurals in Pregnancy

One of the first things an expectant mother will ask for when coming into the hospital in labor is an epidural. The cramping and pain of contractions during labor can be so intense that some women choose to "numb" this pain and relieve some of their suffering. Epidurals are not only used during pregnancy however. Those patients have abdominal or back surgery will often be offered an epidural by their surgeon prior to the operation. In this case the epidural is administered immediately after surgery but before the patient regains consciousness.

What is an Epidural?

An epidural is used during childbirth to block pain signals that are transmitted to the brain. It is a procedure by which anesthesia is injected into a part of the spine, known as the epidural space, to produce a numbing effect. It is given through an epidural catheter (thin tube) and is believed to be the most effective pain medication for childbirth pain. It can be used to fully or partially numb the lower body and is used in adjusted doses that will accommodate Caesarean sections and the ability to walk after an epidural is administered. An epidural does not travel through the blood to your brain or central nervous system and therefore allows a patient to remain alert.

How Safe Are Epidurals For a Baby?

Parents are most concerned that an epidural may not be safe for their baby. Again, because the medication in an epidural does not travel through the blood it is not likely to affect the baby. It does not cross the placental barrier and thus has no negative consequences on the baby's health.

What Are the Side Effects of an Epidural?

As with any other anesthetic there are side effects and adverse reactions that can occur with the use of an epidural. The three main side effects to a mother are a loss of sensation in parts of the body other than where the epidural is intended for, being the lower section of the body, a loss of use in the muscles, and a loss of function in the sympathetic nervous system. A loss of function in the sympathetic nervous system can cause problems with blood pressure and affect the heart rate.

Other safety risks of epidurals include a failure of the epidural to block the pain signals transmitted to the brain, which occurs in about 10% of all cases, an accidental puncture of the dural space, which can cause prolonged headaches, damage to the nervous system, the forming of an abscess around the site where the injection is given, paralysis due to damaging another part of the spine, and in very rare instances, death. Death is a very rare occurrence with epidurals and only occurs in 1 of every 100,000 cases.

Sources:

Wong, Cynthia A. Spinal and Epidural Anesthesia. Columbus, OH: McGraw-Hill Professional; 1 Edition, 2006.

Covino, Benjamin G. Handbook of Epidural Anesthesia and Analgesia. New York, NY: Grune & Stratton, 1985.

Lewis Mehl-Madrona, M.D., Ph.D. and Morgaine Mehl-Madrona
"Medical Risks of Epidural Anesthesia During Childbirth"
The Healing Arts Center Online. Web. Accessed 08/27/10.

Dr. Judith Reichman
"Does An Epidural Put Me or My Baby At Risk?"
Guide for Working Moms on Today. 02/22/06. Web. Accessed 08/27/10.