Epidurals: Fact vs. Fiction (Pt. 2)

All that is left on Fact and Fiction of the big “epidural”:

Perception A woman can move around throughout labor if she has a “walking” epidural.

Reality: “Most women do not walk with one,” says Gilbert J. Grant, M.D., director of obstetric anesthesia at New York University Medical Center and author of Enjoy Your Labor: A New Approach to Pain Relief for Childbirth (Russell Hastings Press, 2005). Once one is given, continuous fetal monitoring and an IV are needed, and many doctors do not encourage women to walk with these, he explains. “A better name would be ‘epidural lite,’ because it has to do with the dose being low,” Grant says.

Perception None of the medication used reaches the baby.

Reality: “Any medication that you take to relieve pain will reach the baby,” Grant says. “However, with an epidural, the amount that enters your bloodstream is quite small, and with a spinal, it’s even smaller.” While further studies are needed, the small amount of medication absorbed by the baby is not known to cause harm, says Cynthia Wong, M.D., an associate professor of anesthesiology at Northwestern University Feinberg School of Medicine in Chicago.

Perception Epidurals pose a high risk of serious side effects.

Reality: Epidurals are very safe for the vast majority of patients. Complications do occur, though, and can range from the short-term and bothersome to the (far more rare) long-lasting or life-threatening. The most common side effect is hypotension, a drop in maternal blood pressure that could affect the baby; this occurs more with higher doses of medication. “With treatment, hypotension has no consequences to mother or baby,” Camann says.

Other relatively common and treatable side effects are nausea, which affects roughly 20 to 30 percent of women who receive epidurals; and itching, which affects approximately 30 to 50 percent.

Another possibility is that the mother will develop a fever if an epidural is in place for about six hours or more; this can lead to diagnostic testing and, sometimes, antibiotics for mother and child. “With first births, about 20 percent of mothers have an elevated temperature, because the first birth is usually the longest,” Camann says. A much rarer complication is a severe “spinal headache.” “This occurs in less than 1 percent of patients in this hospital, but it can last for several days and be very uncomfortable,” Riley says.

Other rare risks include infection, bleeding and nerve damage near where the injection is given. If the drug is accidentally injected into the bloodstream, this can cause breathing to slow or stop, seizures or even death. However, Camann says, “most anesthesiologists will go through a whole career and never see a case of these rare complications.”

Perception Epidurals often don’t work.

Reality: According to Wong, less than 5 percent of women have unrelieved labor pain after receiving an epidural. This can be caused by the baby’s position, but sometimes the anesthesiologist simply needs to give more medication.

Occasionally, the pain is relieved on only one side of the body, either because the catheter is mispositioned or dislodged or because the mother stays in the same position for too long; this problem is easily remedied. An increasingly popular option is patient-controlled epidural analgesia (PCEA); the laboring woman can control the amount of pain relief she gets, but overdosing is extremely unlikely.


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