Epidural Side Effects

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Epidurals are usually considered safe, but as with all medical treatments, side effects and complications can occur.  Epidural medication consists of a local anesthetic – bupivacaine and ropivacaine are commonly used and often mixed with an opioid.  Two common opioids used are fentanyl or sufentanil.  Sometimes, epinephrine or sodium bicarbonate are also added to the epidural to enhance its onset, duration, or intensity. Your doctor can provide further information and advice on the drugs to be used and risks of developing complications.

 

Increased medicalization of birth & breastfeeding difficulties

  • Blood pressure monitoring
  • Pulse ox monitoring
  •  Extra IV fluids 

  • Pitocin augmentation 

  • Bladder catheter
  • Fetal monitoring and contraction monitoring, include internal fetal monitoring
  • Higher risk of needing vacuum delivery
  • Increased risk of C-section for fetal distress
  • Breastfeeding supplementation (which may not be necessary)
  • Increased risk of early weaning (before 6 weeks)

Many of the above items are explained in more detail below.  It’s important you have additional support throughout labor and breastfeeding than someone having an unmedicated birth.

 

Risks for your baby

A drop in your blood pressure can compromise the transfer of oxygen to your baby.  Since opioids cross the placenta, they carry an increased risk of abnormal fetal heart rate tracings, low Apgar scores (whitch rates a baby's appearance, pulse, responsiveness, muscle activity, and breathing), respiratory depression, poor muscle tone, and difficulties with breastfeeding.  However, effects are less severe with regional analgesia (epidural) compared to IV opioids. 

 

Low blood pressure & edema

It's normal for blood pressure to fall a little when you have an epidural. Sometimes this can make you feel sick.  Your blood pressure will be closely monitored. If necessary, fluids and additional medication can be passed through a drip to keep your blood pressure normal.  These fluids can affect breastfeeding, making it more difficult for your baby to attach due to extra fluids in breast.  Your baby may appear to be losing more weight because of extra fluids you received during labor. 


Loss of bladder control

After having an epidural, you may not be able to feel when your bladder is full because the epidural affects the surrounding nerves.  A catheter is usually inserted into your bladder to allow urine to drain away. Your bladder control will return to normal as soon as the epidural wears off, however, the catheter is usually left in place for some time after giving birth.


Itchy skin

This can be a side effect of the pain relief drugs that may be used in your epidural.  Medication can be given to help the itching, or the drug in the epidural can be changed.  Sometimes the itching cannot be controlled. 

 

Feeling sick

Feeling sick is less common with an epidural than with other pain relief methods like morphine and other opiates.  It can be treated with anti-sickness medicines, or by raising your blood pressure if it's low.

 

Slow breathing

Occasionally, some drugs used in the epidural can cause slow breathing or drowsiness.  You will be monitored closely as a result. 

 

Inadequate pain relief

The epidural may not block all your pain.  About 1 in 8 mothers do not have adequate pain relief.  You may be offered an additional or alternative pain relief method.

 

Prolonged pushing

The epidural can prolong the 2nd stage of labor when you are pushing.  There is also an increase of operative vaginal birth procedures (such as forceps and vacuum extraction) that can cause severe tears and/or require episiotomy.  Ropivicaine is a long-acting anesthetic with an average half-life of 4.2 hours, so turning the epidural off prior to pushing may not make a difference.


Headache

A severe headache can be caused if the bag of fluid that surrounds the spine is accidentally punctured. You may need specific treatment for the headache.  A procedure known as a blood patch may be used to seal up the puncture. It involves taking a small sample of your blood and injecting it into the puncture.  When the blood thickens (clots), the hole will be sealed and your headache will stop.  Not all headaches require a blood patch. Your doctor will discuss your options with you.


Infection

An infection can occasionally develop around the skin next to the epidural tube.  It's rare for the infection to spread. Antibiotics may be necessary or, rarely, emergency surgery.

 

Fever

You are more likely to develop a fever with epidural analgesia compared to those with an unmedicated labor, which may put you at higher risk for receiving antibiotics.  Your doctor is more likely to intervene surgically if you have a fever.  Your baby is more likely to be taken to the NICU for additional observation.  This fever is associated with neonatal brain injury, manifest as cerebral palsy, encephalopathy (a term for any brain disease that alters brain function or structure), and learning deficits in later childhood. 


Temporary nerve damage

The needle or epidural tube can damage nerves, but this is uncommon. This can cause loss of feeling or movement in parts of the lower body.  The most common symptom is a small numb area with normal movement and strength. This usually gets better after a few days or weeks, but can sometimes take months.

 

Permanent nerve damage

In rare cases, an epidural can lead to permanent loss of feeling or movement in, for example, one or both legs.  The causes are:

 

  • Direct damage from the epidural needle or catheter
  • Infection deep in the epidural area or near the spinal cord
  • Bleeding in the epidural area, causing pressure on the spinal cord
  • Accidentally injecting the wrong drugs down the epidural catheter
  • Poor positioning for labor and birth

These are rare events, and doctors undergo extensive training to reduce the chances of these complications. 

Nerve damage can also happen for other reasons during surgery unrelated to the epidural.

 

Other complications

Other very rare complications of an epidural include:

  • Convulsions
  • Severe breathing difficulties
  • Death

Before deciding to have an epidural, you should discuss the procedure with your doctor.  They can provide further information and advice on the risks of developing complications.

 

 

 Nothing on this website shall be construed as medical advice.  Talk with a care provider before putting this information into practice.  Content is not guaranteed to be 100% accurate or up to date. 

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