Epidurals - What Are The Risks?

Epidurals вЂ" What are the Risks?

She is a twenty-year old newlywed, pregnant with her second child. She wants the best for her family, especially the unborn child inside her, but she's not exactly sure of the questions to ask, let alone the consequences of her decisions. The doctors voice rings out again waking her from her internal struggle, "Do you think you'd like medication during the birthing process or would you like to adopt a more natural approach?" She looks again to her husband whose vacant stare has become all too familiar during these medical visits.

This was the encounter that I had when going through the pre-birthing advisement. Though I feel confident that the information I received was competent and honest, I am equally confident that I was not aware of all of my options and the resulting consequences of each of them. While every mother wants what is best for her unborn child, many laboring women are uninformed when it comes to the epidurals that they give consent for and what it does or can do to themselves and their child.

Women have been giving birth since the beginning of time and yet only in recent decades has pain relief been available during childbirth. According to a British medical journal, as recently as 1946, women were using labor drugs including chloroform and nitrous oxide as pain relief. Even then, still 68% of women opted for no pain relief at all. Twelve years later, that percentage was cut in half, to only 34% birthing with no pain relief. In 1990, there were no records of any women going through labor without any pain relief. These statistics were based on experiences of 10,000 women giving birth in Britain during one week of that particular decade. As previously stated, in 1946, chloroform and nitrous oxide were the most popular pain relievers. Chloroform is no longer used because of its toxicity. In 1958 the choices of pain relieving drugs were nitrous oxide, trilene, which is short for trichloroethylene, and pethidine, which is better known as Demerol. Trilene was a drug that was inhaled and was eventually taken off the market because of adverse side effects. Pethidine achieved its highest popularity from 1958 to 1970 and is now being used less. While nitrous oxide is a mainstay, epidurals are becoming more and more popular.

Epidural analgesia is a well-known, popular way of providing the mother-to-be with pain relief during labor. The use of this form of pain relief is reported to be in excess of 50% in many of the hospitals around the country. “Requests from patients and obstetricians, coupled with an increased number of providers who have expertise and interest in regional anesthesia for obstetrics, have resulted in a substantial increase in the use of epidural analgesia during childbirth over the past two decades.” In a survey of the use of anesthesia in the United States concluded that the percentage of women who were given an epidural increased from 22% in 1981 to 51% in 1992 at those hospitals that delivered at least 1,500 babies each year. It seems as though the increase can be attributed to greater involvement in the birthing process by anesthesiologists. In addition, the availability of drugs, specifically epidurals, along with positive feedback from those women who have made the choice to have an epidural has helped to redefine the expectations of pregnant women. As more and more women feel entitled to a pain-free, or less painful labor and delivery, it is important for doctors to know and relay all of the benefits and risks of epidural analgesia.

It is understood that the labor process and delivery is exciting and joyful as well as intense and painful. I am not aware of anyone who would willingly choose to be in pain. With that said, many women rush into the decision to have an epidural without insisting on being educated of all the possible complications that may occur with her body as well as her child’s. In researching this paper, I am aware that there are not many resources that give impartial, unreserved and knowledgeable information in regards to what the complications may be. But there is information out there and any woman who is thinking about consenting to an epidural should educate themselves accordingly.

One area that a woman should think about is the possible complications that may arise and affect her own body. There are many documented cases in which an epidural brought on hypotension, that is, low blood pressure. This is a very risky situation because low blood pressure can be known to cause a significant decrease in blood flow to the uterus and placenta. These are the baby’s life-line and if the blood flow is jeopardized, so is the oxygen to the baby. The most common postpartum complication is a postdural headache. This is a result of a leakage of spinal fluid. In some cases the headache resolves on its own. Other times, drinking a caffeinated beverage works. Finally, if nothing else resolves the issue, an autologous epidural blood patch is administered. This is an injection of 15 to 20mL of the patient’s fresh blood into the original puncture site. In addition, an epidural can slow down the labor process as well as increase the need for an operative delivery using forceps, vacuum or even a cesarean section.

The second area that a woman should think about when it comes to possible complications from an epidural is the effects that her decision may bring to her baby. Most likely related to the mother’s drop in her blood pressure, the baby often experiences fetal distress. This can be manifested by an abnormal heart rate, drowsiness, poor muscle strength and tone, or a poor sucking reflex. All of these issues can severely affect how the baby

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