Hypotension (Drop in blood pressure)

The most commonly occurring risk: 

30 – 35%[14] [15]

·          Mother’s blood pressure must be of sufficient levels to assure oxygenation of the fetal blood.

·          Reduces blood supply to the placenta; baby is distressed.

·          At-risk babies may not have the reserves to handle an even small drop in mother’s blood pressure. 

·          Maternal and fetal respiratory distress

·          To help prevent epidural-induced hypotension, you’ll receive 1 – 2 L. of IV saline before the epidural is placed.  You may also be asked to lie on your left side.  

·          Ephedrine may also be given through your IV to restore blood pressure.  You may also be given more IV saline fluid.

·          Stay off your back.  Compression of the abdominal aorta and the inferior vena cava may decrease uterine arterial pressure and increases uterine venous pressure.

Urinary Retention;

Postpartum bladder dysfunction

Virtually all women will have a urinary catheter to prevent urine retention and bladder distention during labor.

25% - 34% will have bladder dysfunction after childbirth.[16] [17]

·          Increase in urinary tract infection.

·          Full bladder inhibits dilation of cervix and rotation of the baby’s head

·          Bladder control may be lost for days, weeks, or months because of strain on numbed pelvic floor muscles.

·          Nurse will insert a urinary catheter to drain your bladder.

·          Choose a CSE, or intrathecal epidural so that you are more likely to feel the need to urinate and may also go to the bathroom yourself, if hospital policy allows.

·          Practice pelvic floor exercises (Kegels) before and after childbirth.

Uncontrollable Shivering

Frequent[18]

·          Uncomfortable for mother.

·          Use blankets, heat sources and massage to relieve shivering

Itching of the face, neck and throat

Common[19]

·          More common with CSE epidurals because of the narcotics used.

·          More of a nuisance than a serious medical problem.

·          You may be given a drug to combat the itching, which may have side effects of its own.

Nausea/Vomiting

Common[20]

·          Uncomfortable for mother.  Usually lasts for a short time (30 minutes?).

·          Can waste needed resources and deplete mother of energy.

·          Medicine may be given to treat nausea.  This sometimes makes the mother intensely sleepy.

Postpartum Backache

10% - 22%[21] [22]

·          May last a few days or continue for years.  Possibly due to “stressed” positions in labor exacerbated by muscular relaxation and the absence of feedback pain to tell you to get out of a damaging position.

·          May (rarely) be caused by nerve damage.

·          Change positions frequently

·          Stay off your back

·          Practice pelvic and back strengthening exercises to prepare for childbirth.

·          Consider choosing a CSE, or intrathecal epidural to allow you more sensation and to avoid awkward positions.

Maternal Fever

15%  if epidural is in place longer than 4 hours.

Percentage increases the longer epidural is in place.[23]

·          Epidural anesthesia affects your ability to sweat.  If you can’t sweat, you can’t as easily dissipate excess body heat.

·          Uncomfortable for mother.

·          Baby’s heart rate may become distressed from mother’s fever, increasing odds of cesarean section.

·          Babies are often separated from their mothers immediately after birth to check for infection.  May include a spinal tap to check for sepsis.  Baby may stay in hospital for several days for antibiotic treatment while mother goes home.

·          Do not accept epidural anesthesia before active labor is established (5 cms or more).

·          Try to keep cool.  Eat ice chips or drink ice water, keep ice packs under arms, under belly or between legs.

·          Have a birth attendant mist and fan you during labor to promote heat dissipation.

Spinal Headache

1% - 10%[24]

·          Most likely caused by postdural puncture and leaking cerebrospinal fluid.  Can range from mild to debilitating and last from days to weeks.

·          Rest at home in a supine position (on your back).

·          Drink caffinated drinks, with the approval of your care provider.

·          May resolve on its own or you may need a blood patch procedure.

Uneven, incomplete or nonexistent pain relief.

10%[25], [26],[27]

·          Some mothers find incomplete, blotchy pain relief to be just as stressful as no pain relief at all.

·          Talk to your care provider if feel there is inadequate pain relief. 

·          Epidural can be replaced or needle moved. 

Feelings of emotional detachment

Depends on the mother.

·          Some mothers report feeling “detached” from the experience of childbirth as a result of the full effects of epidural anesthesia.  Some mothers may not feel like participants in their births.

·          May affect mother-baby bonding.

·          Talk to your care provider and get support for new parents.

Postpartum feelings of regret or loss of autonomy

Depends on the mother.

·          Mother may have felt pressured to have epidural anesthesia or regrets her decision.  Mother may not have been well supported or respected during her labor.

·          Talk to your care provider and get support for new parents.

Inability to move about freely on your own.

100%

·          Inhibits labor progress

·          Boring, annoying, and discouraging for some mothers.

·          Increases likelihood of cascade of interventions

·          Talk to your care provider about your concerns.

·          Wait until you are at least 5 cms dilated before you request an epidural.

·          Exhaust all other comfort measures before requesting an epidural.

Loss of perineal sensation and sexual function[28]

Unknown 

·          Most likely due to use of forceps and episiotomy, but may also be due to nerve damage.

·          Talk to your care provider about any sexual dysfunction after childbirth.  This is certainly not normal and there are options for correcting perineal pain.  There may be no treatment for nerve damage, however.

Very serious risks

•  Convulsions    Resp.paralysis     Cardiac Arrest Allergic shock

•  Nerve Injury

•  Epid. absces

• Maternal death

Extremely rare. 

Ranging from 1/3,000 to 

2/million[29]

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