The hidden risks of epidurals - a midwife's perspective

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“There are no risks with epidurals” NOT!

Believe it or not, I actually heard these words come out of the mouth of an anesthesiologist in a hospital setting. This was his reply when the laboring woman asked him if there were any risks of this procedure. He blatantly replied: “There are no risks with epidurals!” My jaw dropped and I was actually left speechless! Hard to do that to me! This was clearly NOT informed consent. No wonder hospitals have lost the trust of so many women.

First off, there is inherent risk in just getting out of bed in the morning! More than 400 people die every year in the US from falling out of their beds! People die from things falling on their heads, getting twisted up in sheets and clothing, so many weird things! Just look that up online!

So, there is no such thing as “NO RISK!” Hospital staff do, of course, try to minimize the risks as much as possible. We like to think that no one would intentionally put us at risk. But hospital procedures do increase risk to both mother and baby despite our best efforts.

Epidurals have been around long enough now to have been studied intently. One certainty that was discovered over all others. Epidurals lengthen labor. That’s a fact. The medications that are added to the epidural mix relax the mother’s body. This can be helpful if a mom is particularly anxious or tense. But it also relaxes the uterine muscle. This will make the labor longer for sure. Many women don’t think about this effect because they get sleepy at the same time and take a long nap.
Epidurals also decrease mother’s blood pressure. If the mom has been tense and anxious, and experiencing a lot of pain, her blood pressure may rise. In this case, lowering her blood pressure can be helpful. However, if her blood pressure is already in the normal range, the epidural medications may cause it to drop dangerously low.
Epidurals make moms very itchy! This is a common and quite annoying side effect. Women feel that their skin is just crawling and itchy all over. This makes it hard to rest.
Epidurals may have incomplete anesthesia. This means that one side of the woman, or one area of her abdomen isn’t numb. So, she still feels all the pain in this area.
Epidurals numb the nerves that tell us when our bladder is full and control how we urinate. A full bladder will actually prevent the baby from coming out!
Epidurals can raise the mother’s body temperature, making it hard to figure out if she has an infection or it’s just from the epidural.
In the very worse-case scenario, a woman can be paralyzed, stop breathing, or even die as a result of this procedure.

Lots of people talk about the “slippery slope” concept. Getting an epidural can sometimes start this slope toward more and more interventions. If the mom’s blood pressure drops, it can decrease blood flow in the placenta so the baby’s heartrate may drop also. This is treated with more IV fluids given rapidly, changing the mom’s position and sometimes giving the mom epinephrine in the IV. If the contractions become decreased, then the staff will start Pitocin to hasten them again. If the mom is itchy, they will give her IV Benadryl or a narcotic. If she develops a fever, she will be given Tylenol and/or antibiotics. If baby’s heartrate goes too low mommy might have a cesarean birth. Thus, the slippery slope, right to the operating room.

Does this all mean that epidurals are bad, or we should never use them? Absolutely not, but it does mean that we should never take them lightly or be so cavalier about using them. An epidural certainly has its place in labor and delivery, but today it has become the norm in the hospital setting, rather than a tool to be used only when needed and appropriate.