Epidural Analgesia For Labor: What It Is And Side Effects

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The process of giving birth is painful. One widely used method that helps relieve pain in women is epidural analgesia for labor. According to the American Pregnancy Association, more than 50 percent of women who opt for hospital birth use epidural anesthesia. Most women choose this technique to cope with the pain during labor and childbirth. If you are a first-time mom, you may be wondering about the safety, efficacy, and other aspects of this medication. Reading this post may help you explore the contents, benefits, side effects, and more on administering epidural during labor.

What Is An Epidural?

Epidural analgesia is local anesthetic injected into the epidural space of the spine, to numb the spinal nerves and offer relief from the pain during labor

(1). The drug travels through the epidural space to the nerves and works by stopping the pain signals from reaching the brain. Choosing the right anesthetic technique can help manage pain during labor and reduce the risk of anesthesia complications.

Since it is injected into the lumbar region of the spine, pregnant women do not feel any sensation in the lower half of the body. For women who do not want to experience natural labor pain and do not want to take medications, epidural analgesia has become the choice of labor pain relief.

Note that an epidural is not the medicine itself, but a procedure of administering anesthetics for pain management.

Drugs In An Epidural

Epidural medications are a combination of local anestheticsⁱMedications used during the surgeries and tests to cause numbness. (bupivacaine, levobupivacaine, or ropivacaine) and opioidsⁱA category of painkillers that interact with opioid receptors in the body to relieve pain. (fentanyl, diamorphine, morphine, and sufentanil). The opioid dosage used in epidural is (2):

Local anestheticsⁱMedications used during the surgeries and tests to cause numbness. lidocaine and chloroprocaine are not used nowadays because the action time for chloroprocaine is too short and repeated doses of lidocaine are found to cause tachyphylaxisⁱReduced response of the body to a drug after repeated exposure or administration.

.

When administered the right way, these epidural combinations can be highly effective and beneficial for managing pain during delivery.

What Are The Benefits Of Epidurals?

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Epidurals (3):

• Are more effective than other pain-relief options during labor.

• Make movement easy and give you the strength to push out your baby.

• Can be administered at any stage of labor.

• Are very safe in experts’ hands.

• Help you stay awake and alert during delivery (4).

• Can be used to numb only the lower part of the body in case of a C-section.

• Help you get rest and stay focused, especially if you feel exhausted.

Elissa Levy, a mother of two, shares how epidural helped her have a positive birthing experience. She says, “Those contractions were horrible… The epidural needle hurt WAY less than last time, and the epidural worked like magic. I was comfortable for a while. The nurses kept asking if I needed anything, and I was like, “Nope, I’ll never need anything again, as long as I have this epidural.” They said when I feel pressure when I feel like it’s time to start pushing, they’ll call the doctor. Then I started to feel my contractions more strongly despite the epidural, though it was still much more tolerable than before the epidural. The nurse said I can keep my epidural strength (or even ask for more, which I didn’t) as long as I could feel my contractions in order to be ready to push… Finally, the doctor came back and said I could push (i).”

Besides the benefits, you should also know about the exact procedure of epidural analgesia before opting for it.

Quick fact

You are less likely to experience nausea and vomiting with an epidural than with general anesthesia (15).

How Is An Epidural Administered?

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An anesthetist administers the epidural. The procedure is explained next, in detailed steps (5):

• Before giving you the anesthesia, the doctor will insert a drip into your arm.

• You will be asked to sit upright straight or lie on your side with the back curving towards the anesthetist. A nurse can help you to get into the desired position.

• The specialist will apply a cold, antiseptic solution to the area of the skin where he injects the local anesthetic.

• You have to stay still and not move when the doctor puts the epidural in. The doctor may ask you to report any contractions at this time.

• A needle with a catheter containing the epidural medication will be inserted into the epidural space of the spine. The needle will be removed, and the catheter stays put in that place, secured with a bandage, until after delivery.

• 15 minutes after epidural administration, you will feel the pain subside.

• You will be able to move around or on the bed comfortably, with the catheter attached at the back. However, you should not slide or drag the lower back as it can pull off the catheter.

• If the initial dose does not work well, then the midwife can give you more medication.

Once the epidural is given, the doctor will monitor the fetal heart rate continuously during the labor. A CTG machineⁱA cardiotocograph machine used to monitor fetal heart rate and uterine contractions. is used to measure the fetal heart rate and your contractions.

Doctors may give you synthetic oxytocin (Pitocin) to induce contractions.

Though epidural analgesia reduces pain during delivery, it can have some side-effects.

Side-effects Of Epidural

Epidurals are generally safe, but there are some side-effects (6).

• Epidurals can lengthen the second stage of labor.

• They can cause a drop in the blood pressure, making you dizzy and nauseated. In the case of a sudden blood pressure drop, IV fluids, oxygen, and medication may be given to you.

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• Around 23 out of 100 women get a fever due to the epidural (7).

• Loss of excess spinal fluid, if the needle is inserted accidentally in the subarachnoid spaceⁱThe space containing cerebrospinal fluid (CSF), main blood arteries, and cisterns (fluid-filled spaces). , can result in a headache.

• You can feel weakness in the leg muscles.

• Numbness in the lower body makes it difficult for you to sense the urge for urination. Thus a urinary catheter needs to be inserted. 15 out of 100 women face this problem.

• The chances of vaginal delivery reduce to some extent.

• Reduced muscle strength and the inability to push effectively during labor can lead to assisted or instrumental delivery using forceps and vacuum extraction. Around 14 out of 100 women who have an epidural have an assisted delivery (7).

• An assisted delivery requires an episiotomy (a cut in the back of vagina) that needs stitches.

• Stopping the epidural in the later stage of labor can result in more pain and doesn’t make birthing easier.

• Epidurals can cause itching, which can be treated with antihistaminesⁱMedications that relieve allergic symptoms. .

• You may experience pain or tenderness in the injected area.

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• Slow breathing or drowsiness can be a side effect.

• The epidural catheter can cause temporary damage to the nerve.

• Permanent nerve damage that can cause loss of movement or sensation in one or both legs, although rare, can be a major side-effect (8).

• A bruised feeling and possible infection around the skin where the catheter is inserted.

If the epidural analgesia fails to block the pain entirely, the procedure might be repeated, or you will be offered an alternative method of pain relief (9).

Some alternative methods of pain relief utilized by surgeons during childbirth or an obstetric surgery may include regional anesthesia and neuraxial anesthesia. However, a pain relief technique is chosen after considering the patient’s safety and minimizing the risks of the chosen method.

While it is uncommon, there may be instances of anesthesia complications during labor. However, the risk of such complications can be minimized by using suitable pain control measures and ensuring careful monitoring.

Very rare complications of an epidural include:

• fits (convulsions)
• severe breathing difficulties
• death

Did you know?

An infection from the epidural procedure may cause an epidural abscessⁱA puss-filled infection in the epidural, the space between the spine and skull bones. , discitisⁱInflammation of the intervertebral disc area that is present between each vertebra. , meningitisⁱInflammation of the protective membranes and fluid that surround the brain and spinal cord. , or osteomyelitisⁱInfection-induced bone inflammation causing pain. (15).

Alternatives To Epidural

Expectant mothers who choose not to use epidural anesthesia for pain relief may opt for alternative birthing methods, which may include (10) (11):

• Breathing and relaxation techniques
• Hypnosis or hypnobirthing (may include visualization, relaxation, and deep breathing techniques)
• Birthing ball
• Water birthing
• Using TENS (transcutaneous electrical nerve stimulation) technique

Natural Birth Vs Epidural

Natural childbirth typically does not involve any medical interventions such as pain medications, epidurals, or continuous fetal monitoring. It is suitable for low-risk pregnancies and offers the benefits of avoiding the side effects of medicines, such as nausea, altered speed of labor, and hypotension. However, it is not advisable for high-risk pregnancies (10). On the other hand, an epidural could be administered for medical reasons during the childbirth process, and it provides effective pain relief for the mother. However, as mentioned above, it has a risk of certain side effects. Ultimately, the choice between a natural birth and an epidural birth significantly relies on pain tolerance levels, medical factors, and personal preferences of the mother, and it is essential to talk to your healthcare providers to make an informed decision considering your health circumstances.

If you are considering an epidural but still have doubts about it, keep reading to get the answers.

Infographic: Epidural Analgesia Administration Procedure To Counter Labor Pain

One of the most challenging parts of pregnancy and childbirth is labor pain. However, epidural analgesia, a local anesthetic approach, helps relieve labor pain. In the below infographic, we present the procedure of epidural administration and what happens after that, helping you make informed decisions related to this procedure.

Illustration: Momjunction Design Team

Whether it is your first birth or you’re experiencing slow labor progression, your doctor may advise you for epidural analgesia to safely and effectively manage labor pain. Watch this video to learn more about this procedure.

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Reviewer Author Editor Fact Checker

Dr. Suman LalMD, FICOG, FIMSA, FICMCH

Dr. Suman Lal is an obstetrician and gynecologist. She graduated from Patna Medical College and completed her post-graduation from AIIMS, New Delhi with a university gold medal in gynecology. With an experience of 22+ years, she currently works in notable medical institutions in Gurgaon and South Delhi.

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shreeja pillaiMSc

Shreeja holds a postgraduate degree in Chemistry and diploma in Drug Regulatory Affairs from the University of Mumbai. Before joining MomJunction, she worked as a research analyst with a leading multinational pharmaceutical company.

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Rebecca MalachiBSc

Rebecca is a pregnancy writer and editor with a passion for delivering research-based and engaging content in areas of fertility, pregnancy, birth, and post-pregnancy. She did her graduation in Biotechnology and Genetics from Loyola Academy, Osmania University and obtained a certification in ‘Nutrition and Lifestyle in Pregnancy’ from Ludwig Maximilian University of Munich (LMU).

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Dr. Joyani DasM.Pharm, PhD

Dr. Joyani Das did her post-graduation from Birla Institute of Technology, Mesra and PhD in Pharmacology. Previously, she worked as an associate professor, faculty of Pharmacology, for two years. With her research background in preclinical studies and a zeal for scientific writing, she joined MomJunction as a health writer.

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