Epidural analgesia is a very popular method of pain relief in labor. It is a regional analgesia which blocks pain in particular part of the body. It blocks pain impulses from lower spinal segments. Drugs are delivered into the epidural space of the spine. Drugs used are mostly local anesthetics and opioids. It has certain effects both on the mother and baby which are as follows-
Effects of an Epidural on the Mother:
Hypotension – BP can drop leading to nausea and dizziness. So IV fluids are started before active labor and before epidural the patient receives 1-2 liters of IV fluids. Doctor while giving you asks to arch your back and maintain a particular position either sitting up or lying on the side. It is very important to cooperate with the doctor to prevent problems and increase the effectiveness of epidural. Continuous monitoring of both mother and baby is done during labor and in case of fall of BP, the patient is given fluids, oxygen and other medications.
Fever– Is a common complication of epidural but is easily manageable. Fetal heart rate can increase and show tachycardia because of maternal tachycardia.
Numbness or tingling in legs.
Issues during urination – It may make urination a bit difficult and you may need a urine pipe to assist you in passing urine.
Headache – If the injection goes too deep, it can pierce the dura and spinal fluid may leak out. It can lead to a severe headache lasting several days. The incidence of this is less than 1%.
Slow labor – It is due to the effect of the drugs on the pelvic floor muscles which guide the baby’s head as it enters the birth canal in the proper position. If the muscles are not working, dystocia or poor progress is the result.
Itching of the skin or pruritis – This can occur depending on the drugs given. This is more common with opiates.
Nausea, vomiting, and shivering can occur.
Effects of an Epidural on the Baby:
Any medication used on the mother during labor enters the child’s bloodstream as well. Birth takes longer as labor progresses at a slower speed with an epidural. Baby may not be in the best position to deliver and may need instruments for delivery like vacuum or forceps application.
Issues during breastfeeding – Some babies have trouble in “latching on” causing breastfeeding difficulties.
Baby may also have respiratory depression, malposition, fetal heart rate variability, need for instruments and episiotomy as told earlier – Medication can also cause respiratory depression, decreased FHR which is not harming to the baby but may have subtle effects on the newborn.
An effect may not be known – The effect of epidural on the baby is ambiguous and not predetermined based on the dosage, length of labor and characteristics of the individual baby.
The baby may become lazy – Sometimes baby becomes lethargic in utero and position for delivery is not proper.
So to conclude we can say that though epidurals are safe in the majority of patients, complications do occur ranging from short-term to bothersome to long-lasting. To bring a baby into this world are two routes – vaginal and cesarean. Vaginal delivery is really painful. So either you are ready for the pain or you opt for painless delivery with all the possible side effects in mind. Still it is a boon to the laboring mother in terms of effective pain relief as majority patients these days are not able to tolerate labor pain as soon as they go in active labor.