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An epidural is the most common form of anesthesia used during labor and delivery. Epidurals provide the best pain relief of all sedation options available for labor, while posing minimal risk to mom and baby. About 60% of women delivering vaginally use an epidural while 95% of women having a cesarean delivery receive epidural or spinal anesthesia. Just like each person is unique, every epidural is different and the outcomes can vary.
What is an epidural?
An epidural is a form of regional anesthesia given through a catheter into the epidural space, just outside the spinal cord membrane. It is administered and monitored by an anesthesiologist and can be given at any point during the course of delivery, as long as the patient can sit still to receive it. Epidurals target the nerves that carry sensation signals, blocking the ability to feel pain while maintaining muscle control, and varying levels of pressure sensation. It is similar to a spinal block, but administered into a different space around the spinal cord. Unlike IV pain medication, it does not cross the placenta, and therefore doesn’t pose a direct threat to your baby’s heart rate or respiratory function.
What are the risks and side effects?
The most common side effect of an epidural is a reduction in mom’s blood pressure. When mom’s blood pressure goes down, it can cause changes in the baby’s heart rate. This risk is routinely averted, however, by giving mom additional fluids prior to receiving an epidural. If mom’s blood pressure does drop, it is usually quickly corrected with medication. Other minor side effects include itchy skin, nausea and vomiting, and a slight increase in temperature. All of these are easily treated and should resolve.
There are other risks, but they are very rare. If the medicine leaks outside the epidural space, it may cause headaches when changing positions. Usually, the headaches are worse when sitting compared to laying down. These typically resolve on their own, but if they persist, they can be treated with a blood patch or caffeine. Other rare risks include the development of a hematoma, or a bruise, around the spinal cord, infection, or abscess.
Not everyone is a candidate
Women who have bleeding disorders should not have epidurals, due to the risk of hematoma. This includes clotting, platelet or other blood-related issues. Some blood thinning medications may also interfere, depending on when the last dose was taken. In the rare case of a woman with a brain lesion, epidurals are not recommended due to the possible increase in intracranial pressure. And, women who had scoliosis surgery may not be good candidates. If there’s a concern about epidural eligibility, an anesthesia consult during pregnancy can be arranged.
It really is the best, safest option for pain relief
Just like every person is unique, so is every pregnancy. Each person tolerates pain differently. Some women give birth with very little pain, while others experience much more pain. During labor and delivery, it is important to manage pain, and remain calm. An epidural is by far the most common, effective and safe method for pain management during childbirth. Although results can vary, epidurals make labor and delivery more pleasant and safe for mom and baby alike.
Follow along this week as I debunk 8 myths about epidurals in my next blog.