An epidural is a common type of regional anesthesia used during labor and delivery to alleviate pain. It involves the administration of medication into a specific area near the spinal cord, creating a band of numbness in the lower body. This procedure allows individuals to remain awake and alert throughout the childbirth process while experiencing reduced pain.
How Epidurals Work
During an epidural procedure, an anesthetist first numbs a small area of the lower back with a local anesthetic. A needle is then used to insert a thin, flexible tube, known as an epidural catheter, into the epidural space, which is located just outside the spinal cord.
Once positioned, the needle is removed, leaving the catheter in place. Pain-relieving medications, often a combination of local anesthetics and opioids, are then delivered through this catheter. These medications block nerve impulses from the lower spinal segments, reducing sensation in the lower half of the body. Pain relief typically begins within 20 to 30 minutes.
Potential Risks and Side Effects
Epidurals are generally safe, but like all medical procedures, they carry potential side effects and, in rare instances, more serious complications. A common side effect is a temporary drop in blood pressure, which can occur in up to half of recipients, sometimes causing nausea or dizziness. This is often managed with intravenous fluids and, if needed, medication to stabilize blood pressure.
Other frequent, usually temporary, side effects include itching (manageable with medication or drug adjustment) and shivering. Difficulty urinating due to numbness may require a temporary catheter to drain the bladder. A low-grade fever can also occur in some women, affecting around 15% of recipients.
More serious complications are rare (approximately 1 in 80,000 to 1 in 320,000 cases). One such complication is a severe “spinal headache,” which can happen if the needle accidentally punctures the dura (the membrane covering the spinal cord), leading to a cerebrospinal fluid leak. This headache occurs in about 1% of procedures and usually improves with time, though a “blood patch” (injecting the patient’s own blood to seal the puncture) can be used for persistent cases.
Nerve damage is also very rare (approximately 1 in 4,000 to 1 in 200,000 individuals). This can result from the needle hitting a nerve, or from bleeding or infection around the spinal cord that puts pressure on nerves. Most nerve damage is temporary, resolving within weeks or months; permanent loss of feeling or movement in the lower body is exceedingly uncommon. Infections or hematomas (blood collections) in the epidural space are also extremely rare but can lead to nerve damage if they compress the spinal cord.
Benefits of Epidurals
Epidurals offer significant advantages for pain management during childbirth. They provide effective pain relief, often described as the most complete relief from contraction pain. This allows the laboring person to rest and recover strength, especially during prolonged labor.
The ability to feel pressure while remaining largely pain-free allows individuals to be awake and actively participate in the birth process, including pushing when it is time to deliver the baby. Epidurals also offer flexibility, as the dosage of pain medication can be adjusted throughout labor. If an emergency cesarean section becomes necessary, the epidural can often provide the required anesthesia without delay.
When Epidurals Are Not Recommended
While epidurals are widely used, there are specific situations and medical conditions where they may not be recommended due to increased risks. Individuals with certain bleeding disorders or those taking specific blood-thinning medications may have a higher risk of bleeding around the spinal cord, which could lead to complications.
Infections, either at or near the injection site or widespread (septicemia), are also contraindications as they increase the risk of introducing bacteria into the epidural space. Very low platelet counts, a condition that impairs blood clotting, can also make an epidural unsuitable. Prior back surgery, particularly involving the lower spine, or anatomical spinal abnormalities might make catheter placement difficult or risky. An epidural may also be avoided in individuals with certain neurological disorders or increased pressure within the skull.