HealthONE - June 20, 2018

An epidural is an ideal form of anesthesia during labor and delivery. It  numbs certain parts of the body to relieve pain. While commonly used in childbirth, many expecting mothers are still apprehensive about opting for an epidural during labor.

Dr. Julie Gelman, an OB/GYN at Swedish Medical Center, says there’s less to worry about when using an epidural than expecting mothers might think. More than half of women who give birth in a hospital use an epidural. Dr. Gelman answers the most common questions and concerns moms-to-be often ask about epidurals:

Q1: What is an epidural?
A: Typically, women who use an epidural during childbirth experience less pain, while still staying awake during delivery. Epidurals can also be used during other procedures that involve the lower parts of the body, like the legs, pelvis, urinary tract or female reproductive organs.

During an epidural, an anesthesiologist uses a needle and a small tube (called a catheter) to administer the anesthetic to the area located next to the spinal cord in the lower back. The epidural starts working within 10 to 20 minutes after insertion. Immediately after placement the needle is removed and the catheter is left in position, so that more anesthetic can be administered as needed.

Q2: Who can get an epidural? And who can’t get one?
A: Epidurals are the most common pain-relief method used during labor. According to the American Pregnancy Association, epidurals are safe for most women. However, there are some restrictions.

"If a woman has difficulty forming blood clots, this may be one concern when using an epidural," says Dr. Gelman. Women with certain bleeding disorders, like hemophilia and von Willebrand disease, might be at an increased risk of excess bleeding around the spine, during and after an epidural. In these certain circumstances, consultation with our anesthesia team is very helpful.

Those who are taking blood thinners for a medical condition might also be at an increased risk of epidural-related internal bleeding. The U.S. Food and Drug Administration advises patients to speak with their doctors about taking blood thinners following an epidural.

In some rare cases, a woman might not be able to use an epidural if the anesthesiologist can't properly insert the catheter, due to a prior back surgery or scoliosis.

Q3: How will an epidural affect labor?
A: Some women worry that getting an epidural will result in a longer delivery process, or that an epidural increases the likelihood of having a C-section.

"An epidural does not increase the likelihood of a woman needing a C-section while in labor," adds Dr. Gelman.

While it’s unclear if an epidural affects the length of delivery, one study suggests that it doesn’t. A 2017 study involving 400 women determined that an epidural had no effect on the length of time between cervical dilation and delivery. Of the women in the study, half were injected with epidural anesthetic and the other were injected with a saline solution. The study found no noticeable differences in labor duration, position of the fetus or the rate of episiotomy.

An epidural might make it harder for a woman to sense when it’s time to push while in labor, but it doesn’t affect her ability to push. In some cases, an epidural might increase the chances of a woman needing an instrumental delivery, in which a doctor uses forceps or a vacuum cup to assist in vaginal delivery.

"Opting for an epidural is not a sign of weakness," says Dr. Gelman. An epidural can ease labor pain and help women relax during delivery.

Q4: Will an epidural hurt the baby?
A: For the baby, there are no known long-term disadvantages to using an epidural while in labor. Minimal amounts of anesthetic do reach the baby, but typically this does not have a negative effect on the mother or the newborn.

"It’s important to know that when an epidural is administered, a woman may experience a decrease in blood pressure, which might slow the baby’s heart rate. However, this can easily be treated with fluids or medication via IV," says Dr. Gelman.

Q5: For the mother, what are the risks of an epidural?
A: "There are risks with any medical procedure, but the chances of someone having a serious health complication from an epidural is very low," says Dr. Gelman.

Although fairly uncommon, serious risks of complication from an epidural include bleeding around the spine, nerve damage, allergic reactions and infections such as meningitis. While not a major or permanent concern, epidurals can cause a decrease in blood pressure, so it’s important to monitor this in both the mother and the baby. 

Q6: Are there any bad or harmful side effects after using an epidural?
A: The majority of the side effects of an epidural are not serious. Sometimes, the anesthetic can cause itching of the abdomen, arms or legs.

Roughly 15 percent of women who receive an epidural might have difficulty emptying their bladders for a short time, mainly due to the numbing of the legs. Additionally, an estimated 23 percent of women who use an epidural might experience an epidural-related fever.

Another potential side effect is post-epidural headaches, which can last for up to a week. These headaches are likely the result of an epidural injection that has punctured the layer around the spinal cord, allowing some spinal fluid to leak. This happens in only one percent of women who have an epidural. As the puncture heals, the headache usually subsides on its own. Overall epidurals are very safe during labor and delivery. Any patient who has additional questions regarding epidural or other anesthesia option has the ability to talk with our anesthesia team prior to labor and delivery.