What are the Risks of an Epidural?

Epidurals are a popular method of pain control for laboring women, but what are the risks? Is the pain relief worth it? Here are some of the specific questions women often have about epidurals.

Will an epidural make my labor longer? Having an epidural may lengthen your labor. On average, an epidural adds about an extra 40–90 minutes to labor (and this tends to be seen more frequently in women having their first baby). While your labor may be a bit shorter without an epidural, it probably won’t be as comfortable.

Will I need to push longer with an epidural? Studies have shown that women with an epidural do often need to push longer, but the good news is that it only adds about 15 minutes!

Will a C-section be more likely if I have an epidural? Many studies have shown that having an epidural probably does not increase a woman’s chances of needing a C-section. This risk may increase, however, if an epidural is placed very early in labor. Because of this, the American College of Obstetricians/Gynecologists recommends trying to wait until you are 4-5 centimeters dilated before getting an epidural. They state that this is more important in women having their first baby. While this is a recommendation, it should not be a requirement—every case needs to be individualized.

Will I be at risk for back pain after an epidural? The data on this is mixed, and the bottom line is that there are not a lot of good studies looking at this issue. Many women report back pain after pregnancy regardless of whether or not they had an epidural, so it is difficult to tease out an epidural’s effect.

Does having an epidural affect breastfeeding? There are no randomized studies looking at this issue, so again, we could use more information. Some studies have shown that babies born to mothers who had epidurals took longer to latch and establish a good suck, but more recent data has shown no ill effect on the long-term duration of breastfeeding.

What are some other risks with epidurals? After an epidural is placed, occasionally a woman’s blood pressure can drop. This is usually treated easily with fluids, position changes, and medications. If it does not improve, though, sometimes a C-section is needed as the baby’s heart rate can also be affected. Not all epidurals work, and sometimes a woman will notice relief only on one side of her body or not at all. Adjustments can be made to the epidural or a new one can be placed. Lastly, women with epidurals are more likely to need a medication called Pitocin to help their contractions stay strong and frequent to help labor progress.

Sources:

• American College of Obstetrics/Gynecology Practice Bulletin # 36
• Obstetric Analgesia and Anesthesia.
  Gabbe SG et al
• Obstetrics: Normal and Problem Pregnancies
• Obstetric Anesthesia
• Pp 396-427.
  J Riordan and K Wambach
• Breastfeeding and Human Lactation
• Perinatal and Intrapartum Care
• P 217.

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