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Is it safe? · Pregnancy Smart

Epidural during labor: benefits and risks

Assigned clinical reviewerMichael Yuzefovich· MD, FACOGDraft · pending clinical reviewUpdated

What does the evidence say about epidural during labor during pregnancy?

  1. ACOG describes an epidural as medication delivered through a thin catheter in the lower back, usually producing pain relief within 10 to 20 minutes. Listed effects include itching, nausea, low blood pressure, fever, headache, soreness, shivering, and bladder difficulty. 1
  2. Current ACOG labor guidance recommends offering neuraxial anesthesia for pain relief during any stage of labor and reports that neither neuraxial type nor timing affected cesarean risk in the systematic review it assessed. 2
  3. A Cochrane review of 40 trials with more than 11,000 women found better pain relief with epidural than opioid analgesia and no significant cesarean-rate difference. Epidural groups had more hypotension, fever, motor block, and urinary retention; evidence quality ranged from moderate to low. 3
  4. Epidural placement may be unsuitable with patient refusal, infection at the puncture site, raised intracranial pressure, uncorrected clotting problems or therapeutic anticoagulation, low platelets, hemodynamic instability, or inability to maintain safe positioning. 4
  5. MedlinePlus explains that the needle is removed after a soft catheter is placed outside the spinal cord. Temporary blood-pressure reduction can slow the fetal heart rate, while headache, breathing difficulty, seizure, or medicine entering the spinal fluid are rare complications. 5

Is epidural during labor safe in each trimester?

  • First trimester. Early pregnancy is a useful time to make sure spine surgery, bleeding disorders, low platelets, anticoagulants, local infection history, and prior anesthesia reactions are documented for later planning.
  • Second trimester. Ask what labor analgesia options and anesthesia consultation are available at the intended hospital. An antenatal anesthesia visit can be useful when a medical condition or prior spine procedure may affect placement.
  • Third trimester. Neuraxial analgesia can be offered at any stage of labor when clinically appropriate. Requesting it before birth is imminent leaves time for assessment, positioning, catheter placement, dosing, and effect.

Frequently asked questions

How is a labor epidural placed?

After numbing the skin, an anesthesia clinician advances a needle into the epidural space in the lower back, threads a soft catheter, and removes the needle. Medication then runs through the catheter while blood pressure and fetal status are monitored.

How long does an epidural take to work?

ACOG and MedlinePlus describe pain relief beginning about 10 to 20 minutes after medication starts. Assessment, consent, positioning, placement, and dosing add time, and the block may need adjustment if relief is uneven.

Does an epidural increase the chance of a C-section?

Current randomized-trial syntheses do not show a significant increase in cesarean birth with epidural analgesia. ACOG also states that timing and neuraxial type did not affect cesarean risk in the systematic review used for its current labor guidance.

What are the common side effects of a labor epidural?

Common or recognized effects include itching from opioid medication, temporary low blood pressure, fever, shivering, nausea, soreness, leg heaviness or weakness, and difficulty emptying the bladder. Monitoring allows staff to respond if blood pressure or fetal heart rate changes.

Can an epidural cause permanent nerve damage?

Permanent neurologic injury is possible but rare. Serious complications include nerve or spinal-cord injury, epidural hematoma, abscess, meningitis, or a high spinal block. Screening for infection, clotting risk, and anatomy helps reduce avoidable risk.

Who may not be able to receive an epidural?

An epidural may be inappropriate with refusal, infection at the insertion site, certain clotting problems or anticoagulant timing, low platelets, unstable circulation, raised intracranial pressure, or inability to hold the required position. The anesthesia clinician evaluates the individual situation.

Will I still feel pressure or be able to move?

An epidural reduces pain but may not remove all pressure from contractions or vaginal examinations. Many patients can move their legs but cannot walk safely. The amount of numbness depends on the medication concentration, dose, and response.

Can an epidural affect the baby?

A temporary drop in maternal blood pressure can slow the fetal heart rate, so the team monitors and responds to changes. In the Cochrane review, epidural groups did not show clear differences in low five-minute Apgar scores or neonatal intensive-care admission. Evidence about rare complications and long-term newborn outcomes was limited.

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References

  1. Medications for Pain Relief During Labor and Delivery

    ACOG · https://www.acog.org/womens-health/faqs/medications-for-pain-relief-during-labor-and-delivery

  2. First and Second Stage Labor Management

    ACOG · https://www.acog.org/clinical/clinical-guidance/clinical-practice-guideline/articles/2024/01/first-and-second-stage-labor-management

  3. Epidural versus non-epidural or no analgesia for pain management in labour

    PubMed · https://pubmed.ncbi.nlm.nih.gov/29781504/

  4. Epidural Anesthesia - StatPearls

    NCBI Bookshelf · https://www.ncbi.nlm.nih.gov/books/NBK542219/

  5. Epidural block - pregnancy

    MedlinePlus · https://medlineplus.gov/ency/patientinstructions/000484.htm

These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.