Epidural Research

There is a common belief that epidural medication is completely safe and does not cross the placenta to affect the baby. New research is challenging this assumption. Not only does this research question the safety of routine epidural use, it suggests a possible link between long-term learning and behavioral issues and regional anesthesia during delivery. It is our hope that, by including these study findings, we will give women a more complete body of information by which to make their birth decisions.

Summary Findings: Epidural Effects on Mothers

Epidurals substantially increase the incidence of oxytocin augmentation, instrumental delivery, and bladder catheterization. (21 studies cited) [Saunders, NJ, et al. “Oxytocin infusion … primiparous women using epidural…” BMJ 1989;299:1423-1426]

In first-time mothers, epidurals substantially increase the cesarean rate for dystocia. (12 studies cited) [Thorp, JA, et al. “The effect of intrapartum epidural …” Am J Ob Gyn, 1993;169(4):851-858]

Having an epidural at 5cm dilation or more eliminates both excess posterior/transverse and excess cesarean for dystocia. (2 studies)

Epidurals may not relieve any pain or may not relieve all pain. (3 studies)

Innovations in procedure – lower dosages, continuous infusion, adding a narcotic – have not decreased epidural related problems. (13 studies) [Naulty, JS. “Continuous infusions of local …” (this is a literature review) Int. Anes. Clin. 1990;28(1):17-24]

Delaying pushing until the head has descended to the perineum increases the chances of spontaneous birth. (a time delay of 1 hour is not really delaying – it needs to be a positional not timed thing…) Evidence is divided as to whether letting the epidural wear off before pushing increases spontaneous delivery. (4 studies)

Maternal complications of epidurals include: [Uitvlugt, A. “Managing complications of Epidural Analgesia” International Anesthesia Clin. 1990;28(1):11-16]

  • Maternal hypotension (5 studies). This reduces uteroplacental blood supply and can cause fetal distress. (8 studies)
  • Convulsions (4 studies)
  • Respiratory paralysis (3 studies)
  • Cardiac Arrest (6 studies)
  • Allergic Shock (2 studies)
  • Maternal nerve injury due to needle injury, poor positioning, forceps injury, infection, hematoma, or subarachnoid injection of chloroprocaine. The last three usually cause permanent injury. (9 studies)
  • Spinal headache (3 studies)
  • Increased maternal core temperature. (2 studies)
  • Temporary urinary incontinence. (1 study)
  • Long-term backache (weeks to years), headache, migraines, numbness, or tingling. (2 studies)

Serious complications occur despite proper procedure and precautions. The epinephrine test dose can cause complications. (12 studies)

Epidural anesthesia may relieve hypertension, but hypertensive women are at particular risk of epidural-induced hypotension, which reduces placental blood supply. (2 studies)

Summary Findings: Epidural Effects on Babies

Epidural anesthetics “get” to the baby. (5 studies)

Epidurals do not protect the fetus from distress. In fact, they cause abnormal fetal heart rate, sometimes severe, which may occur with or independent of maternal blood pressure (11% – 43% depending on the study and type of medication used – the 43% was found with Bupivacaine, the most common drug for epidural.) (15 studies) [Stavrou C, et al. “Prolonged fetal bradycardia during epidural analgesia” S Afr Med J 1990;77:66-68]

Epidurals may cause neonatal jaundice. (2 studies) [Clark, DA & Landaw, SA. “Bupivacaine alters red blood cell … jaundice associated with maternal anesthesia” Pediatr. Res. 1985; 19(4):341-343]

Epidurals may cause adverse neonatal behavioral and physical effects. (these are both direct effects and indirect effects from the increased rate of labor complications and interventions.) The importance of this is debated. (4 studies)

Epidurals decrease the probability that a posterior or transverse baby will rotate. Oxytocin does not help. (7 studies)