What are the potential side effects and complications of labor epidurals. How common are epidural allergic reactions. What precautions do anesthesiologists take to prevent complications during labor epidurals. How are epidural-related complications managed and treated.

Understanding Labor Epidurals: Benefits and Potential Risks

Labor epidurals are a widely used method of pain relief during childbirth, offering effective analgesia for many women. However, like any medical procedure, they come with potential side effects and complications. While serious adverse events are rare, it’s crucial for expectant mothers to be well-informed about the possible risks associated with epidural anesthesia.

Anesthesiologists take special precautions to minimize complications, but it’s important to discuss individual circumstances with your healthcare provider. Let’s explore the various side effects and complications that can occur with labor epidurals, their frequency, and how they’re typically managed.

Common Side Effects of Labor Epidurals

While most women experience no significant issues with their epidurals, some may encounter minor side effects. These are usually temporary and can often be managed effectively:

• Shivering
• Decreased blood pressure
• Mild itching
• Localized back pain
• Difficulty urinating

Shivering During Labor

Shivering is a common reaction that can occur during labor and delivery, even without anesthetic medications. It’s not always directly related to the epidural. How can shivering be managed? Keeping the mother warm often helps alleviate this symptom. Healthcare providers may offer additional blankets or adjust the room temperature to ensure comfort.

Blood Pressure Changes

Epidurals can sometimes cause a decrease in blood pressure. To mitigate this risk, intravenous fluids are typically administered before the epidural is placed. How is blood pressure monitored during labor with an epidural? Anesthesiologists and nurses closely monitor blood pressure throughout the procedure and labor, quickly addressing any significant changes with appropriate interventions.

Itching as a Side Effect

Mild itching can occur as a result of the narcotics used in epidural medications. For most women, this sensation is mild and tolerable. If itching becomes bothersome, can it be treated? Yes, anesthesiologists can provide medications to relieve severe itching if necessary.

Rare but Serious Complications of Epidurals

While uncommon, more serious complications can occur with labor epidurals. These require prompt recognition and management:

1. Local anesthetic reactions
2. Breathing problems
3. Accidental injection into veins
4. Persistent pain or inadequate pain relief
5. Nerve damage or paresthesias
6. Post-dural puncture headache
7. Epidural hematoma or abscess

Local Anesthetic Reactions

Allergic reactions to local anesthetics used in epidurals are rare but can be serious. Why is it important to disclose your medical history to the anesthesiologist? Informing your healthcare provider about any previous allergic reactions to local anesthetics is crucial for preventing potentially life-threatening complications.

Respiratory Concerns

In rare cases, epidural medication may affect chest muscles, making breathing more difficult. How is this managed if it occurs? Oxygen can be administered to alleviate breathing issues, and the anesthesiologist will closely monitor respiratory function throughout the procedure.

Neurological Complications: Myths vs. Reality

Concerns about nerve damage or paralysis from epidurals are common, but it’s important to separate fact from fiction:

Are permanent neurological complications from epidurals common? No, major complications such as severe nerve damage, paralysis, or persistent neurological deficits are extremely rare. Most nerve-related issues following labor and delivery are more commonly due to the natural birthing process rather than the epidural itself.

What causes temporary nerve sensations during epidural placement? Transient feelings of nerve sensations or “electric shocks” can occur as the epidural catheter brushes against nerves in the epidural space. These sensations are usually brief and do not indicate lasting damage.

Post-Epidural Headaches: Causes and Management

Headaches following labor and delivery can have various causes, not all related to epidural anesthesia. However, a specific type of headache, known as a post-dural puncture headache, can occasionally occur after an epidural.

Understanding Post-Dural Puncture Headaches

What causes a post-dural puncture headache? This type of headache results from a small hole in the dura (the sac containing spinal fluid) caused by the epidural needle. Spinal fluid leakage through this hole can lead to headache, typically occurring within 24 hours of the procedure.

How is a post-dural puncture headache characterized? These headaches are often positional, worsening when sitting or standing and improving when lying down. They may be accompanied by neck pain, nausea, or sensitivity to light and sound.

Treatment Options for Post-Epidural Headaches

What are the initial management strategies for post-dural puncture headaches? Conservative measures include bed rest, increased fluid intake, caffeine consumption, and over-the-counter pain medications. These approaches are often effective in managing symptoms.

When are more aggressive treatments considered? If conservative measures fail to provide relief, or if the headache is severe and persistent, an epidural blood patch may be recommended. This procedure involves injecting a small amount of the patient’s own blood into the epidural space to seal the leak.

Minimizing Risks: The Role of Patient Cooperation

While many factors influencing epidural complications are beyond a patient’s control, there are ways expectant mothers can contribute to a safer procedure:

• Provide a thorough medical history
• Inform the anesthesiologist of any allergies or previous reactions to medications
• Remain as still as possible during epidural placement
• Communicate any unusual sensations or concerns during the procedure
• Follow post-procedure instructions carefully

How does staying still during epidural placement help reduce complications? Minimizing movement helps ensure accurate placement of the epidural needle and catheter, reducing the risk of accidental dural puncture and subsequent headache.

Long-Term Effects: Separating Fact from Fiction

Concerns about long-term effects of epidurals, particularly regarding back pain, are common among expectant mothers. Let’s address some of these concerns:

Epidurals and Chronic Back Pain

Do epidurals cause chronic back pain? Research has shown that mothers who have natural childbirth are just as likely to experience generalized back pain in the days following delivery as those who receive epidurals. The increased incidence of back pain after pregnancy is more likely related to the physical stresses of pregnancy and childbirth rather than the epidural itself.

What causes localized back pain after an epidural? Some women may experience localized soreness at the site of epidural insertion, which typically resolves within a few days. This is different from the generalized back pain that many women experience postpartum, regardless of their pain management choice during labor.

Impact on Breastfeeding and Infant Outcomes

Does epidural anesthesia affect breastfeeding success? While some studies have suggested a potential link between epidural use and early breastfeeding challenges, the evidence is not conclusive. Many women who receive epidurals go on to breastfeed successfully. Factors such as early skin-to-skin contact and lactation support may be more influential in breastfeeding outcomes.

Are there long-term effects on infants whose mothers received epidurals? Current research does not indicate any significant long-term adverse effects on infants born to mothers who received epidural anesthesia during labor. The medications used in epidurals are chosen for their safety profile and minimal transfer to the fetus.

Alternatives to Epidural Anesthesia: Weighing Your Options

While epidurals are a popular choice for pain management during labor, they’re not the only option available. Understanding alternatives can help expectant mothers make informed decisions about their pain management strategy:

Non-Pharmacological Pain Management Techniques

• Breathing and relaxation techniques
• Hydrotherapy (labor tubs or showers)
• Movement and positioning
• Massage and counterpressure
• Hypnobirthing
• Transcutaneous electrical nerve stimulation (TENS)

How effective are non-pharmacological methods for pain relief? The effectiveness of these techniques can vary widely between individuals. Many women find them helpful for managing early labor pain or as complementary approaches to other pain relief methods.

Pharmacological Alternatives to Epidurals

What other medical pain relief options are available during labor?

1. Nitrous oxide (laughing gas)
2. Intravenous opioids
3. Pudendal nerve block
4. Combined spinal-epidural (CSE) technique

Each of these options has its own set of benefits and potential side effects. Discussing these alternatives with your healthcare provider can help you determine the most appropriate pain management strategy for your individual needs and preferences.

Making an Informed Decision: Discussing Epidurals with Your Healthcare Provider

The decision to have an epidural during labor is a personal one that should be made in consultation with your healthcare team. Here are some key points to consider and discuss:

Questions to Ask Your Anesthesiologist

• What is your experience with administering labor epidurals?
• How often do complications occur in your practice?
• What measures do you take to prevent and manage potential side effects?
• How might an epidural affect my labor progress and ability to push?
• Are there any specific risk factors in my case that I should be aware of?

Factors to Consider in Your Decision

When weighing the pros and cons of epidural anesthesia, consider the following:

1. Your pain tolerance and anxiety levels
2. The anticipated length and complexity of your labor
3. Your overall health and any pre-existing medical conditions
4. Your birth plan and personal preferences for the labor experience
5. The availability of alternative pain management options at your birthing facility

How can you prepare for the possibility of needing an epidural, even if it’s not your first choice? It’s helpful to discuss epidurals with your healthcare provider in advance, even if you’re hoping for an unmedicated birth. Understanding the procedure and its potential risks and benefits can help you make an informed decision if circumstances change during labor.

Remember, the goal is to have a safe and positive birth experience. Being well-informed about all your options, including epidurals and their potential side effects, can help you feel more confident and prepared as you approach your delivery date.

Side Effects And Complications of Labor Epidural

The anesthesiologist takes special precautions to prevent complications.  Although side-effects are rare, they occasionally include the following. Some of the side effects may be specific to the circumstances of your presentation. Therefore you should discuss them with your anesthesiologists.

Shivering: Shivering may occur and is a common reaction. Sometimes it happens during labor and delivery, even if you have not received any anesthetic medications. Keeping you warm often helps it subside.

Decreased blood pressure: You will receive intravenous fluids and your blood pressure will be carefully monitored and treated. Decreases in blood pressure are expeditiously corrected.

Mild itching during labor: This is a result of narcotics used in the epidural/spinal medications. If itching becomes bothersome, your anesthesiologist can treat it with medications. Most women find itching to be mild.

Local anesthetic reaction: While local anesthetic reactions are rare, they can be serious. Be sure to tell your anesthesiologist if you ever had any allergic reaction to local anesthetic medications.

Breathing problems: On rare occasions, the anesthetic medication may affect the chest muscles and make it harder to breathe. Oxygen can be given to relieve this and help the breathing.

Injection into veins: The veins located in the epidural space become swollen during pregnancy. There is a risk that the anesthetic medication could be injected into one of them. To help avoid unusual reactions stemming from this, your anesthesiologist will first administer a test dose of medication and you may be asked if you notice any dizziness, a funny taste, numbness of ears, dizziness or rapid heart beat.

Persistent pain in some areas/no pain relief: Sometimes the anesthetic does not reach an area leaving a “spot” which is still painful. Your anesthesiologist may change your position on the bed or withdraw the epidural catheter to relieve the pain. Occasionally the epidural catheter may need to be removed and reinserted again if you do not get adequate pain relief. Your anesthesiologist will work with you  to make you comfortable.

Paresthesias (feeling of nerve sensations): Transient “Feeling of nerve sensations/electric shock” (hitting your funny bone) can occur while inserting the epidural catheter as it brushes against the nerves in the epidural space. Although these sensations are common during epidural injections, permanent nerve damage is extremely rare. 

Back pain: You may have localized back pain from the needle insertion, which should last a day or so. On the other hand, you may experience generalized back pain, which is not necessarily attributable to the epidural. Studies have shown that mothers who have natural childbirth deliveries are as likely to experience generalized back pain lasting a few days as those who have epidurals. It seems that pregnancy itself can increase the incidence of back pain because of softening of the ligaments resulting in back strain.

Headache: There may be several reasons why you can get a headache after labor and delivery that are unrelated to epidural anesthesia. However, although uncommon, a headache may develop following the epidural block procedure (<1%). This occurs as a result of a needle hole in the sac containing fluid (spinal fluid) during the epidural procedure. Leakage of spinal fluid into the epidural space may result in headache. By holding as still as possible while the epidural needle is placed, you help to decrease the likelihood of a headache. Usually the headache occurs in about 24 hours following the epidural block. Typically, the headache occurs while you sit up and relieved by assuming lying down position. The head and neck discomfort sometimes lasting few days, often can be reduced or eliminated by simple measures such as lying flat, drinking fluids and taking pain tablets. Occasionally, a patient may need additional treatment if the headache persists, or associated with other features such as nausea,  difficulty in seeing light, or hearing noises.

A major complication such as nerve damage, bleeding into the epidural or spinal space, paralysis, and infection areextremely rare events. 

Since epidural anesthesia involves needle placement in the back, there is a natural tendency to assume that any post-delivery nerve problem is due to the epidural anesthesia.  However, the majority of nerve problems following labor and delivery are commonly due to the impinging of the nerves by the moving baby along the birth canal, and rarely to regional anesthesia.  If you experience any weakness in the legs or other nerve problems, your anesthesiologist will help to evaluate the problem and make sure you have the proper follow-up.  

Next to FAQ

Side effects of an epidural

Epidurals are usually safe, but as with all medical treatments, side effects and complications can sometimes happen.

For more on side effects of epidurals in labour, read about pain relief in labour. 

Low blood pressure

It’s normal for your blood pressure to fall a little when you have an epidural. Sometimes this can make you feel sick.

Your blood pressure will be closely monitored. If necessary, fluids and medicine can be given through a drip to keep your blood pressure normal.

Loss of bladder control

After having an epidural, you may not be able to feel when your bladder is full because the epidural affects the surrounding nerves.

A catheter may be inserted into your bladder to allow urine to drain away. Your bladder control will return to normal when the epidural wears off.

Itchy skin

This can be a side effect of the pain relief medicines that may be used in your epidural.

Medicine can be given to help the itching, or the medicine in the epidural can be changed.

Feeling sick

Feeling sick (nausea) is less common with epidural medicines than with other pain relief medicines such as morphine and other opiates.

It can be treated with anti-sickness medicines, or by raising your blood pressure if it’s low.

Inadequate pain relief

The epidural may not block all your pain. You may be offered an extra, or alternative, pain relief method.

Headache

A severe headache can happen if the bag of fluid that surrounds your spine is accidentally punctured. You may need specific treatment for the headache.

A procedure known as a blood patch may be used to seal the puncture. It involves taking a small sample of your blood and injecting it into the puncture.

When the blood thickens (clots), the hole will be sealed and your headache will stop.

Not all headaches from an epidural require a blood patch. Your anaesthetist will discuss your options with you.

Slow breathing

Occasionally, some medicines used in an epidural can cause slow breathing or drowsiness.

You will be monitored closely to look for this, and it can be treated easily.

Temporary nerve damage

The needle or epidural tube can damage nerves, but this is uncommon. Nerve damage can cause loss of feeling or movement in parts of your lower body.

The most common symptom is a small, numb area with normal movement and strength. This usually gets better after a few days or weeks, but can sometimes take months.

Infection

An infection can sometimes happen around the skin next to the epidural tube.

It’s rare for the infection to spread. Antibiotics may be necessary or, rarely, emergency surgery.

Permanent nerve damage

In rare cases, an epidural can lead to permanent loss of feeling or movement in, for example, 1 or both legs.

The causes are:

• direct damage to the spinal cord from the epidural needle or catheter
• infection deep in the epidural area or near the spinal cord
• bleeding in the epidural area, causing pressure on the spinal cord
• accidentally injecting the wrong medicine into the epidural catheter

These are rare events, and anaesthetists have extensive training to reduce the chances of these complications.

Nerve damage can also happen for other reasons during surgery, which are unrelated to the epidural.

Other complications

Other, very rare, complications of an epidural include:

• fits (convulsions)
• severe breathing difficulties
• death

Before deciding to have an epidural, you should discuss the procedure with your anaesthetist.

They can provide further information and advice on the risks of developing complications.

Page last reviewed: 01 February 2023
Next review due: 01 February 2026

All about epidural anesthesia – Private maternity hospital Ekaterininskaya Clinics

What to do if long-term epidural anesthesia (analgesia) is contraindicated for you or you for some reason do not want to do it during childbirth?

There is, in fact, only one real alternative – childbirth can be anesthetized with narcotic analgesics (usually fentanyl or promedol).

In certain situations (regular strong contractions, good dilatation of the cervix, satisfactory condition of the child according to ultrasound and CTG), it is safe and effective.

But, firstly, the duration of the effective action of narcotic analgesics in childbirth is much shorter (from 30 minutes to 1 hour) than the duration of the effect of DEA. Secondly, the possibility of prolonging such pain relief is significantly limited, since high doses of narcotic analgesics increase the risk of respiratory depression in mother and child. This method is usually used when there are contraindications to DEA.

There are no medical procedures that do not carry potential risks and have no contraindications for the patient. Long-term epidural anesthesia (DEA) is no exception, and it would be irresponsible not to talk about them.

What are the contraindications for DEA?

• Injuries of the spine and metal structures in the lumbar region, some congenital diseases of the spine and severe forms of curvature (scoliosis).
• Severe disorders of blood coagulation in the direction of reducing the density of the blood clot (hypocoagulation).
• Allergy to local anesthetic ropivacaine (very rare).
• Severe heart disease with fixed cardiac output.
• Tattoo in the lumbar region (the paint may contain salts of heavy metals, the entry of which into the epidural space is highly undesirable).
• The categorical written refusal of the patient from DEA (with justification of the reasons for the refusal).

What is the risk of complications and side effects with DEA?

• Insufficiently effective pain relief (mosaic block).
• Unintentional puncture of the dura mater with the development of post-puncture headache syndrome.
• Sudden drop in blood pressure.
• Nausea, vomiting, chills.
• Post-puncture back pain.
• Respiratory and cardiac arrest.
• Urinary retention and dysfunction of the pelvic organs.
• Development of persistent neurological complications in the form of paresis and paralysis.

A very impressive and intimidating list, especially the second half of it.

But according to world statistics for the 1990-2000s, the risk of fatal complications of regional anesthesia (DEA is a regional method) is 25-38 cases per 10 million obstetric patients, and does not differ significantly from the risk of general anesthesia.

The risk of developing any complications of EA (not only fatal, but generally all) is higher, but it is also quite low, and, according to various estimates, is 1 case per 50,000-80,000 births. This risk is about 8-10 times less than the risk of dying in an accident (driver, passenger or pedestrian).

Despite the impressive list of contraindications and risks, there are many undeniable advantages of using long-term epidural anesthesia (DEA).

There is practically no effect on the child – the area of ​​action of the anesthetic is limited to the nerve roots of the spinal cord of the woman in labor; neither blood flow in the umbilical cord nor fetal heart rate is affected by DEA performed in compliance with all safety rules.

If the situation in labor is such that there is an indication for an emergency caesarean section, an epidural catheter inserted in labor allows you to quickly inject a large dose of anesthetic (about 4 times more than for pain relief in labor), adequate for a caesarean section – and more one significant plus DEA. This is called “conversion of analgesia to anesthesia”.

In such a situation, drugs for general anesthesia are either not used at all, or are used in small doses (depending on the situation), which significantly reduces the burden on the body of the mother and child, and allows the patient to recover faster after the operation. DEA lowers blood pressure by 15-20 percent of baseline, and in patients with high blood pressure, it is a real lifesaver.

What can be said in conclusion of this large, complex and rather acute topic?
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Absolutely safe medical manipulations with a degree of risk equal to zero do not exist in principle. But compliance with all the rules, safety precautions, indications and contraindications allows you to reduce the risk to an insignificant minimum. Epidural anesthesia, like any other medical manipulation, is performed when the potential benefit significantly (hundreds and thousands of times) exceeds the possible risks. And in the vast majority of cases, that is exactly what it is. One of the most important tasks of the anesthetist is to assess the risk-benefit ratio for each individual patient, and convey this information to the patient so that she understands it and can make the right decision.
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articles of Oxford Medical Rivne Medical Center

Modern medical statistics show that about 7% of patients have a partial or complete allergy to local anesthesia (anesthetics). The rejection of the body is caused not by the injections themselves, but by the chemicals that make up this or that anesthesia.

Paradoxically, even the safest and most common lidocaine can cause a serious allergic reaction in a certain category of people, which can only be detected experimentally. We are talking about urticaria, various dermatological rashes, a critical deterioration in well-being and even the risk of anaphylactic shock.

Cause of an allergic reaction

Recognizing an allergic reaction to a harmless anesthetic that has been successfully used by thousands of doctors around the world is quite simple. However, first you need to deal with the nature of the problem itself, because in most people local anesthesia does not cause any negative consequences and rejection of the immune system.

Any anesthetic substance is, in fact, an irritant for the body. Most often, the body successfully fights the administered dosage, however, in some cases, sensitization occurs, due to which the immune system begins to perceive the anesthetic as a serious irritant. With subsequent “acquaintances” with the drug, the body rapidly produces antibodies, and signs of a formed allergy appear on various parts of the body: skin, nasopharynx, mucous membranes, on the surface of the bronchi and lungs.

Symptoms of drug allergy to anesthetics

Most often, allergy to anesthetic drugs manifests itself in the following reactions:

• dermatitis in various forms – redness, peeling, deterioration of skin tone;

• urticaria, in which the size, nature and total number of wheals may vary;

• allergic rhinoconjunctivitis with copious nasal and eye discharge;

• bronchospasm, the nature of which is similar to acute attacks of bronchial asthma;

• angioedema following urticaria;

• acute attack of anaphylactic shock.

The best (and sometimes the only) way to check the patient’s response to lidocaine and other local anesthetics is a test performed using a subcutaneous injection of a microdose of the substance (no more than 0.1 ml).

First aid for anaphylactic shock

Anaphylactic shock is an allergic reaction of the body to the injected drug, which is characterized by a state of hypersensitivity of the body. This reaction is dangerous with the risk of death in the absence of immediate medical care: according to medical statistics, an acute attack of anaphylactic shock as one of the types of drug allergy has 5-10% of cases of sudden death of a patient.

Anaphylactic shock occurs in 0.03-0.05% of cases of anesthetic administration, but the risk is there and real. There is a percentage of people in whom the test does not cause any reactions, or has a delayed effect. Therefore, unfortunately, not a single person is immune from anaphylaxis.