Epidural Safety

Epidurals have become so common place that I think many folks feel they must have no risks at all. So, I thought I would write about some of the risks you need to consider. First let me give you a definition of an epidural from an anesthesiology website “Epidural anesthesia is most commonly placed in the low back (lumbar region). Unlike Spinal this technique may also be accomplished in the mid-back (thoracic region) for surgery in the area of the chest. After a sterile prep and draping, local anesthetic is placed in the skin numb the area where the Epidural need will be placed. The needle for Epidural passes between the vertebrae of the Spinal column to the Epidural space. Once the position is verified, a very small catheter(tube) is placed via the needle. The needle is then removed and the catheter remains in the Epidural space. The catheter is then taped to the patients back. Local anesthetics and narcotics given epidurally via this catheter. The procedure usually takes 10 – 25 minutes.”

One great website with a fabulous article is http://www.healing-arts.org/mehl-madrona/mmepidural.htm

The doctor writing the article posts these concerns. A possible increase to having a cesarean birth, Hypotension- a drop in your blood pressure. Fetal Distress, Toxic issues, Trauma to blood vessels, Dura punctures causing spinal headaches, Infection, Backache, Pitocin being needed and causing abnormal contractions, Inability to push effectively, Mothers expecting great pain relief and not getting it, Medication getting into spinal area instead causing issues, heart attack and heart issues, Drug interactions, Fever, Respiratory issues, Nuerological issues, Fever, and more…

“Local anesthetics rapidly cross the placenta, and when used for epidural, caudal or pudendal anesthesia, can cause varying degrees of maternal, fetal and neonatal toxicity….

Adverse reactions in the parturient, fetus and neonate involve alternations of the central nervous system, peripheral vascular tone and cardiac function….

Neurologic effects following epidural or caudal anesthesia may include spinal block of varying magnitude (including high or total spinal block); hypotension secondary to spinal block; urinary retention; fecal and urinary incontinence; loss of perineal sensation and sexual function; persistent anesthesia, paresthesia, weakness, paralysis of the lower extremities and loss of sphincter control all of which may have slow, incomplete or no recovery; headache; backache; septic meningitis; meningismus; slowing of labor; increased incidence of forceps delivery; cranial nerve palsies due to traction on nerves from loss of cerebrospinal fluid. ”

So, if you think this guys is off his rocker- let’s list the issues that an anesthsiology abstract stated http://journals.lww.com/anesthesiology/pages/articleviewer.aspx?year=2006&issue=08000&article=00023&type=fulltext

“Of the 4 million annual births in the United States, 2.4 million involve epidural analgesia. Serious adverse events are rare but are important in young women. Robust estimates for the risk of harm are not available. Data for superficial and deep infections, hematoma, and transient and permanent neurologic injury were obtained from studies reporting adverse events with obstetric epidural analgesia, and incidence presented as individual risk for a woman, number of events per million women, and percentage incidence. A total of 1.37 million women received an epidural for childbirth, reported in 27 articles. Most information (85% of women) was in larger (> 10,000 women) studies published after 1990, with risk estimates as follows: epidural hematoma, 1 in 168,000; deep epidural infection, 1 in 145,000; persistent neurologic injury, 1 in 240,000; and transient neurologic injury, 1 in 6,700. Earlier and smaller studies produced significantly higher risk estimates for transient neurologic injury plus injury of unknown duration.”

Another good website to share information from is http://www.americanpregnancy.org/labornbirth/epidural.html

“What are the Disadvantages of epidural anesthesia?

* Epidurals may cause your blood pressure to suddenly drop. For this reason your blood pressure will be routinely checked to make sure there is adequate blood flow to your baby. If this happens you may need to be treated with IV fluids, medications, and oxygen
* You may experience a severe headache caused by leakage of spinal fluid. Less than 1% of women experience this side effect from epidural use. If symptoms persist, a special procedure called a “blood patch”, an injection of your blood into the epidural space, can be done to relieve the headache
* After your epidural is placed, you will need to alternate from lying on one side to the other in bed and have continuous monitoring for changes in fetal heart rate. Lying in one position can sometimes cause labor to slow down or stop
* You may experience the following side effects: shivering, ringing of the ears, backache, soreness where the needle is inserted, nausea, or difficulty urinating
* You may find that your epidural makes pushing more difficult and additional interventions such as Pitocin, forceps, vacuum extraction or cesarean may become necessary
* For a few hours after birth the lower half of your body may feel numb which will require you to walk with assistance
* In rare instances, permanent nerve damage may result in the area where the catheter was inserted.
* Though research is somewhat ambiguous, most studies suggest some babies will have trouble “latching on” which can lead to breastfeeding difficulties. Other studies suggest that the baby may experience respiratory depression, fetal malpositioning; and an increase in fetal heart rate variability, which may increase the need for forceps, vacuum, cesarean deliveries and episiotomies.”

So, although they are sometimes necessary- realize that there is risk involved. Now you may think this entry to my blog is one sided. The truth is we all know the reasons why folks want to get an epidural- pain relief. But the risks are so overlooked I thought it was worth reviewing the risks.

If you truly need an epidural in your labor, you will be able to be informed and know the risks. Sometimes doing the next best thing does include an epidural. It will sometimes keep you from having more interventions. But realize that although it is common place it is not without risks.