Being in Labor: Get the Facts About Epidurals

Let’s jump right into the questions that many women have about labor epidurals.

Will an epidural slow the progress of my labor?

As of this writing, much of the evidence does not find this to be true. Epidurals have not been found to slow the progress of the first stage of labor. This is defined as the period of regular contractions and cervical dilation, that ends when the cervix is fully dilated. The second stage of labor has been found to be about 15 minutes longer in women with epidurals. This is the “pushing” stage that begins with full cervical dilation and ends with the delivery of the baby.

Will an epidural increase the chances of a forceps delivery or make me more likely to have to deliver via C/S?

The literature has also NOT found this to be true.

Epidurals have also been found to be the most effective method for pain relief during labor. This view is shared by the American College of Obstetricians and Gynecologists. With an epidural in place, the mother requires significantly less, or no, IV pain medicine. Babies tend to be born less drowsy in these cases.

How about any adverse effects?

Epidurals are associated with a slight temperature increase for the mother. It’s important to note that they are NOT associated with increased rates of infection, for the mom or the baby. There are several reasons why this temperature increase happens with an epidural, but this is not an infection.

Epidurals cause a sympathectomy, which can result in a drop in blood pressure. Your blood pressure will be monitored regularly once an epidural is placed, and your anesthesiologist will treat any unsafe decrease.

Epidurals can be associated with a specific kind of headache, called a post dural puncture headache. This occurs about 1% of the time. The headache worsens on standing and gets more tolerable when lying flat. Treatment includes hydration, caffeine, and an epidural blood patch.

Another great fear is that of nerve damage. Many women are afraid of becoming permanently paralyzed from the epidural. Data tells us that nerve injuries related to epidurals occur somewhere between 0.08% and 0.92% of the time. The symptoms usually last less than two months and there is complete recovery in almost all cases. While you can never say the risk is zero, it is extremely rare to have any permanent nerve damage from epidurals.

There is, unfortunately, also a chance that the epidural may not work as well as we’d like. Your anesthesiologist will troubleshoot the epidural and may offer to replace it. Some things that make epidural placement more difficult include: scoliosis, a history of lower back surgery, and obesity.

Hopefully, this information has given you a better understanding of labor epidurals. Your anesthesiologist will review your medical history and, if you are a candidate for an epidural, will talk to you about the risks, benefits, and alternatives.

Armed with this information, you will be able to have a more informed conversation with him/her, and make the decision that is right for you.