An epidural is a form of regional anesthesia that is the most frequently used method for managing labor pain, with over 50% of people giving birth in hospitals in the United States choosing this option. The procedure involves injecting a local anesthetic, often combined with an opioid, into a specific area of the spine to block pain signals from the lower body. The goal is to provide effective pain relief while allowing the patient to remain awake and alert throughout the birthing process. Epidurals are a safe and effective option for pain relief during labor for most patients when administered correctly by a trained professional.
How the Procedure is Performeda
A trained anesthesiologist or nurse anesthetist performs the epidural procedure in a controlled setting. The patient is positioned either sitting up or lying on their side with the back rounded to maximize the space between the vertebrae. The insertion site in the lower back is first cleaned using an antiseptic solution and then numbed with a small injection of local anesthetic.
The specialist then guides a hollow needle into the epidural space, which is the area just outside the membrane covering the spinal cord. This space surrounds the spinal nerves that transmit pain signals. The correct placement is confirmed using techniques like the loss-of-resistance method, ensuring the needle has not entered the spinal fluid space.
Once the correct location is confirmed, a thin, flexible catheter is threaded through the needle and secured in the epidural space, and the needle is removed. This catheter remains in place for the duration of labor to allow for continuous or intermittent administration of medication, providing sustained pain relief. Continuous monitoring of the patient’s blood pressure, heart rate, and oxygenation is maintained throughout the process. A small “test dose” is often given first to ensure the catheter is correctly positioned.
Potential Maternal Side Effects
The most common side effect experienced by the birthing parent is a temporary drop in blood pressure, known as hypotension, which occurs in about 14% of patients receiving an epidural. This is managed proactively by administering intravenous fluids and, if necessary, with medications to help maintain blood pressure. Other frequent, minor side effects include shivering, itching, and difficulty emptying the bladder, which may require the temporary placement of a urinary catheter. The itching is often a reaction to the opioids used in the anesthetic mixture.
A severe headache, termed a post-dural puncture headache (PDPH), is a less common but recognized complication. This occurs when the epidural needle inadvertently punctures the membrane surrounding the spinal cord, causing a leak of cerebrospinal fluid. This headache is distinct because it worsens when sitting up and improves when lying down. In some cases, a procedure called a blood patch can be performed to seal the leak and provide rapid relief.
More serious complications are exceedingly rare, with the risk of a severe, persistent nerve injury estimated to be about 1 in 240,000 procedures. Temporary nerve symptoms, such as tingling or a small numb area, are more common but typically resolve within weeks to months. Infections at the injection site or the formation of a blood clot (hematoma) around the spine are also extremely infrequent. An epidural may slightly prolong the second stage of labor, potentially increasing the likelihood of an assisted vaginal delivery using vacuum or forceps.
Safety Considerations for the Baby
The anesthetic medications used in an epidural are injected directly into the epidural space. Because the medication is concentrated locally, only a minimal amount enters the birthing parent’s bloodstream and crosses the placenta to the baby. This is a significant difference from systemic pain medications or general anesthesia.
Studies examining the effect of epidurals on immediate newborn health measures, such as the Apgar score, generally show no significant difference compared to births without an epidural. The Apgar score assesses a newborn’s condition based on five measures at one and five minutes after birth. Continuous fetal heart rate monitoring is standard practice during an epidural to promptly identify and address any changes in the baby’s status. The consensus is that epidurals do not pose significant direct risks to the baby.
Conditions That Prevent Administration
There are specific medical circumstances, known as contraindications, that prevent the safe administration of an epidural. A primary concern is a pre-existing or anticipated coagulopathy, such as a severe bleeding disorder or a significantly low platelet count, which greatly increases the risk of a spinal hematoma. Patients receiving therapeutic doses of blood-thinning medications often need their treatment paused and their blood clotting ability confirmed before an epidural can be placed.
An active infection at or near the intended injection site, or a systemic infection, also makes the procedure unsafe due to the possibility of introducing bacteria into the epidural space. Severe, uncorrected maternal hypotension is another reason to defer the procedure until the blood pressure can be stabilized. Neurological conditions or an inability of the patient to cooperate and maintain the necessary positioning can also prevent the epidural from being performed.