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Pros and Cons of an Epidural

cartoon pregnant woman with back pain

Some women choose to have a natural childbirth with no pain medications. Others choose epidural anesthesia to make labor and vaginal delivery less painful. 

The Centers for Disease Control and Prevention (CDC) reports that over 60 percent of women in labor use epidural analgesia in the US. But this does not mean that an epidural is the right choice for everyone.

This article will discuss some of the pros and cons of maternal epidural analgesia, i.e., the use of pain medications during labor and vaginal delivery versus an unmedicated birth.

What is an epidural? How does it work?

An epidural is a type of regional anesthesia in which an anesthetic medication is injected directly into the epidural space in the lower spine. This is a fluid-filled space that surrounds the spinal cord. It contains the nerves that carry pain signals from the lower body to the brain. 

When an analgesic medication is placed in the epidural space, it blocks pain signals from the lower body and effectively numbs the lower half of the body, thus providing significant pain relief during labor and delivery. This significantly decreases the mother's level of pain during labor and delivery while allowing her to stay awake. Epidurals are also used during other medical procedures on the pelvis and legs.

The exact drugs given with an epidural vary, but they usually include a local anesthetic and a corticosteroid. An epidural is not a single injection because the pain relief would not last long enough. Instead, doctors place an epidural catheter in the mother’s lower spine. This is a special needle and tube that stays in place and continuously pumps the medicine into the epidural space throughout labor.

What are the advantages of an epidural during labor pain?

Here are some epidural pros and other benefits:

Labor Pain Relief

Labor pains can be very severe and can last for several hours or even days. The biggest advantage of an epidural for women in labor is pain relief. Besides the physical discomfort after labor starts, the extreme pain can cause stress and anxiety during a natural birth. An epidural can help not only manage labor pains, but also reduce stress and anxiety

Awake and Alert Mother

An epidural block numbs only the lower body. Therefore, an epidural offers reliable pain management while allowing the mother to remain awake and alert while giving birth. 

Lower Risk of Postpartum Depression

Studies have shown that women who receive medical intervention in the form of an epidural during labor and delivery have a decreased risk (in fact, almost half the risk) of experiencing postpartum depression (PPD). Interestingly, other pain management options like nitrous oxide (laughing gas) have not been shown to reduce the risk of PPD.

Emergency C-Section

A vital benefit of having an epidural catheter in place is that it allows doctors to perform an emergency C-section without delay because the mother is already anesthetized. Without an epidural, doctors would need to administer general anesthesia before a cesarean section, which can take longer. In case the baby is in distress, an epidural can help prevent brain damage in the baby due to oxygen deprivation by allowing doctors to do an immediate C-section.

What are the disadvantages of epidural pain medication?

Here are some epidural cons and side effects:

Limited Window of Time

There is a limited window of time to get an epidural to manage pain during labor and delivery. If doctors give the epidural too early (before the cervix is at least 4 cm dilated), it can slow labor progress. If they wait until the cervix is fully dilated, it’s too late for an epidural.

Prolonged Labor

In many women, an epidural can prolong labor because the numbing medicine makes the mother less able to push effectively as she would during a natural delivery. A longer delivery process can put the baby at risk of birth injury.

Headache 

Some women experience a severe headache after an epidural, especially when the needle is first inserted. This occurs because of a leakage of spinal fluid.

Other Side Effects

Potential side effects of an epidural include fever, shivering, itching, nausea, dizziness, back pain, and soreness at the needle insertion site.

Numbness

The effects of the epidural can last for several hours after delivery. This may require the mother to stay in bed, or she may need support to stand and move about until sensation returns in her lower body.

Lowered Blood Pressure

Sometimes, an epidural can cause the mother’s blood pressure to drop, and she may require interventions like oxygen, fluids, and medications to increase her blood pressure.

Urinary Retention

An epidural numbs the lower body. Therefore, the mother may not feel the urge to urinate when her urinary bladder is full. This can lead to urinary retention and may require the placement of a temporary catheter to empty the bladder.

Perineal Tear

Mothers who receive an epidural are at increased risk of perineal tears. The risk is greater in women who have large birth weight babies or women in whom the baby’s head is big. The risk is also higher in women with an episiotomy or labor induction.

Infection or Permanent Nerve Damage

Insertion of an epidural needle can cause potentially life-threatening infection or spinal injury. However, these complications are extremely rare.

Increased Risk of Neonatal Respiratory Distress 

Some studies suggest that babies born to mothers who receive epidurals are at higher risk of developing respiratory distress immediately after birth. However, other studies have found no link between the use of epidural pain medication and the baby’s breathing.

Natural Birth vs. Epidural: Which is better?

There is no single choice that’s right for everyone. Giving birth without pain relief during labor or choosing pain management options like an epidural to reduce pain are both good options. Hopefully, this article has dispelled some epidural myths and educated you about the risk factors so that you can make an informed choice.

Pregnant women and their partners should talk to their doctor about an epidural vs. giving birth naturally. Doctors can help you determine what type of birth plan is best for you. Talk about options such as low-dose epidural and nitrous oxide. Also, keep an open mind and have a Plan B in place if things don’t go as initially planned.


References:

  1. https://www.cdc.gov/nchs/data/nvsr/nvsr59/nvsr59_05.pdf
  2. https://www.asahq.org/madeforthismoment/pain-management/techniques/epidural/
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8242125/#