Although epidurals are the best anesthesia modern day obstetrics has to offer, they are not perfect and they do not come without risk.  Many women choose to get an epidural the same way they would choose to take Tylenol for a headache.  An epidural, however, is a bit more complicated and a woman should educate herself as she makes her choices.  Often the decision is made during moments of physical discomfort, which is not the best time or place to learn about epidurals.  An anesthesiologist or a nurse anesthetist comes in with a form to sign and a quick run-down of risks and complications.  I have appreciated the handful of anesthesiologists who actually verbalize that death is a risk, of course extremely rare.  The most common risk or complication is that the epidural does not work correctly.  That can be frustrating.  Sometimes the epidural will work too well, making the woman feel like her lower body is dead weight and not a part of her.  That can also be frustrating. Other risks include infection and bleeding at the insertion site.  Less desirable risks can include a spinal headache that is caused by the tiny hole that enters the dura and does not seal properly allowing cerebral/spinal fluid to leak out causing an incredible headache until repaired.  Nerve damage is possible as well as respiratory arrest if the catheter is not well placed and goes “up” rather than “down.”  Ironically, much of the nerve damage that is possible comes from the body mechanics employed by those helping the woman hold her legs while she pushes.  Without the protection provided by sensation, nerves can be damaged.  Some birth facilities will not place an epidural until a certain point in dilation is reached, often 4 cm.  Contrary to what you may hear, it is rarely “too late” to receive an epidural, depending on the situation.  I have seen women have epidurals placed at 10 cm, again, depending on the situation.  At least a liter of fluid needs to be given via an I.V. before an epidural is placed, which can take extra time.  Epidurals often cause a drop in blood pressure so a nurse will closely and frequently monitor blood pressure after the placement.  An epidural can be a wonderful tool during the labor process.  It can help facilitate relaxation so the body can completely relax and open.  Given too early it can sometimes cause labor to slow, creating a need for pitocin and possibly other interventions.  A woman with an epidural loses much of her mobility and use of gravity to help the baby rotate and descend.  An epidural also comes with a bladder catheter as she is no longer able to get up to use the bathroom.  The catheter is usually placed about an hour after the epidural takes effect, which can increase the risk of infection in the bladder.   While epidurals are useful tools during the labor process, they are not the only or best tool available to a laboring woman.  For many professionals who work in labor and delivery, it is the only tool they are aware of so the use of epidurals is quite high in the United States but can vary widely by region.  Some hospitals may have a 60% epidural rate while others may have a 99% epidural rate.  Epidurals are used more frequently if the woman has been induced with pitocin.  Educate yourself as you prepare for your birth experience.

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