Epidurals
Epidurals substantially increase the incidence of oxytocin augmentation, instrumental delivery, and bladder catheterization[1]
In first-time mothers, epidurals substantially increase the cesarean rate due to “failure to progress”[2]
Epidurals decrease the probability that a posterior or transverse baby will rotate.
Epidurals do not protect the foetus from distress. In fact, they cause abnormal foetal heart rate, which may occur with or independent of maternal blood pressure.[3]
With an Epidural the mother will have restricted mobility, IV, and Electronic Foetal monitoring (which has been shown to increase caesarean rates[4])
Women who have epidurals are more likely to have longer labours, a higher chance of operative vaginal delivery, higher risk of mal presentation, higher percentage of hypertension, higher temperature and higher chance of a c-section[5],[6]
Mothers are three times as likely to have an operative (i.e. forceps, episiotomies, caesarean) delivery[7]
Maternal complications of epidurals include:[8],[9]
o Maternal hypo tension - reduces blood supply to the placenta and can cause foetal distress.
o Uneven, incomplete or non existent pain relief
o Respiratory paralysis
o Cardiac Arrest
o Allergic Shock
o Prolonged labour
o Nausea, vomiting, shivering (frequent)
o Convulsions
o Spinal headache and migraines
o Increased maternal core temperature
o Temporary urinary incontinence
o Long-term backache (weeks to years)
o Neurological complications
o Paresthesia ("pins and needles")
o Faecal and urinary incontinence or bladder dysfunction (inability to urinate)
o Postpartum feelings of regret, loss of autonomy
o Loss of perineal sensation and sexual function
o Complications to the baby may include7:
o Direct drug toxicity
o Drowsiness at birth, poor sucking reflex
o Foetal distress, abnormal FHR (can lead to emergency caesarean)
o Poor muscle strength and tone in the first hours
o Increase in temperature
o Decreased maternal-infant bonding
o Neonatal jaundice [10]
[1] Saunders, NJ, et al. "Oxytocin infusion ... primiparous women using epidural..." BMJ 1989;299:1423-1426
[2] (12 studies cited) [Thorp, JA, et al. "The effect of intrapartum epidural ..." Am J Ob Gyn, 1993;169(4):851-858]
[3] Stavrou C, et al. "Prolonged fetal bradycardia during epidural analgesia" S Afr Med J 1990;77:66-68
[4] Electronic fetal monitoring. Lessons from a formative case of health technology assessment Int J Technol Assess Health Care. 2002 Fall;18(4):762-70. Banta HD, Thacker SB
[5] SC Morton, MS Williams, EB Keeler, JC Gambone, KL Kahn. Effect of epidural analgesia for labor on the Cesarean delivery rate. Obstetrics & Gynecology 1994 83: 1045-52.[
6] SH Helpern et al. “Effect of epidural vs parenteral opioid analgesia on the progress of labour”. JAMA 1998 280: 2105-10.
[7] Department of Health NHS maternity Statistics, table 19
[8] [Uitvlugt, A. "Managing complications of Epidural Analgesia" International Anesthesia Clin. 1990;28(1):11-16]
[9] Cohen, Nancy Wainer. Open Season, 1991: .Enkin, M., M. Keirse, and I. Chalmers. An Guide to Effective Care in Pregnancy and Childbirth, 1992. : Goer, Henci. Obstetric Myths versus Research Realities: A Guide to the Medical Literature, 1995.: Rothman, Barbara Katz (ed.). The Encyclopaedia of Childbearing, 1993
[10] Macauley, JH, et al. Epidural analgesia in labor and fetal hyperthermia in Obstetrics and Gynecology, October 1992 80(4):665-669.