No two pregnancies — or the pain associated with labor — are the same. Whether you are pregnant, or planning to become pregnant, I recommend doing your research in advance for labor. Weigh your pain management options, and learn the truth about epidural side effects.
Today, over 60 percent of women in the U. S. receive an epidural during labor to ease the pain. (1) However, epidural side effects can occur, ranging from headaches to lowered blood pressure to more severe, though less common, side effects such as seizure. Ironically, epidurals may make the labor process take longer and also impact a woman’s ability to push, sometimes resulting in the need for a cesarean birth, or C-section. That said, each pregnancy, and each woman’s needs, are different. Read on to learn more about epidurals and conventional pain management, as well as some suggestions for natural labor pain management.
What Is an Epidural?
An epidural is a local anesthetic, which is injected into a pocket near the spinal cord, called the lumbar epidural space. (2) The process starts with the insertion of a small tube that delivers drugs near the nerves that are responsible for the pain during labor. The procedure takes 5–10 minutes, and pain relief often begins within 15 minutes.
Conventional Labor Pain Management
Pain management during labor may include analgesia and/or anesthesia. While analgesics lessen pain, but do not take away muscle movements, anesthetics block all feeling, rendering the area virtually numb. Typically, epidurals during labor are analgesics, but anesthetics may be required due to a cesarean section, or forceps-assisted birth.
Epidural medication is considered a local anesthetic. The drugs used may include bupivicaine, chlorprocaine and lidocaine. They may also be combined with opioids or narcotics such as fentanyl and sufentanil to relieve the pain and lessen the need for as much local anesthetic.
Epidural complications are not unheard of, and serious epidural side effects are possible. Epidurals provide for regional pain relief, while allowing patients to remain fully conscious. It decreases the pain, by blocking nerve signals from both motor and sensory nerves, while generally immobilizing the lower part of the body.
The term “walking epidurals,” is a misnomer as most women will not be able to walk. These epidurals may be administered in more mild concentrations, but still can numb the lower body.
It should be noted that epidurals do decrease pain, but do not provide total relief, as this would impair the body’s natural pushing reflexes. Epidurals in general are not recommended for individuals with blood clotting problems, those on blood thinning medications, with certain neurologic disorders, and patients who have had certain types of lower back surgery. (3, 4)
Types of Epidurals
Throughout labor, once an epidural has been administered, the mother and the baby’s heart rate is continuously monitored for any signs or symptoms of distress. In fact, epidural side effects are associated with a number of mild-to-severe complications during labor. Here are the common types of epidurals: (5, 6)
- Continuous Epidural: This is the most common epidural used in the United States today because it offers a constant stream of medication for pain relief.
- Intermittent Epidural: Medication is administered as needed by the anesthesiologist or certified registered nurse anesthetist (CRNA). This type of epidural causes ebbs and flows in pain.
- Patient-Controlled Epidural: Self-regulated administration of pain medication, called PCEA. The mother is able to add extra doses as pain returns. This, like the intermittent epidural, can cause ebbs and flows of pain, not continuous relief.
- Spinal Analgesia: This type of epidural involves the injection of narcotic painkillers into the spinal fluid.
- Epidural Block: Often used shortly before a cesarean section or prior to forceps or vacuum extraction to block the pain, while allowing the mother to remain conscious.
- Spinal Block: This is the strongest pain relief epidural typically reserved for cesarean sections. It provides pain relief for one to two hours.
Epidural Impact on Hormones
Throughout pregnancy and labor, hormones fluctuate based on what your body needs and what the baby needs to develop properly. One of the most important hormones we have is oxytocin. Oxytocin is responsible for contractions, anxiety reduction, feelings of security and contentment, and contributes to mother-baby bonding.
Throughout labor, the body self-regulates the amount of oxytocin necessary. At the beginning stages of labor, pulses of oxytocin are released every 3–5 minutes. It helps to encourage rhythmic contractions as the baby descends the birth canal.
As labor progresses, the body responds and oxytocin is released more and more often, to help facilitate the fetal ejection reflex for birth. After birth, it facilitates in the passing of the placenta, and encourages a healthy mother-baby bond. However, with an epidural, natural oxytocin production is inhibited, resulting in decreased plasma oxytocin concentrations. (7)
As a result of this epidural side effect, many women are then given synthetic oxytocin (brand name Pitocin). Synthetic oxytocin is often prescribed to induce contractions before labor begins naturally, or while in the midst of labor to strengthen contractions. If this last part seems contradictory, it is. Basically, pain relief in the form of an epidural causes a reduction in natural oxytocin, requiring the administration of the synthetic form, to help cause contractions since the woman’s body is not able to do so normally because of the epidural. Synthetic oxytocin can cause a range of side effects, including nausea and vomiting, and more rarely, the potential for heavy bleeding and a ruptured uterus. (8)
Other side effects of synthetic oxytocin may include: (9)
- difficulty breathing
- fast or irregular heartbeat
- severe headaches
- chest pain
Epidural Side Effects: For the Mother
- Inhibits production of oxytocin
- Numbness or tingling in the legs
- Ringing in the ears
- Difficulty urinating
- Lowered blood pressure
- Lengthens labor process
- May increase the risk of severe vaginal tears (10)
- May increase the need for cesarean delivery (11)
- Decreases the chances for spontaneous vaginal delivery
- Increases the chance of complications from instrumental delivery (including vacuum and forceps)
- Increases the risk of pelvic floor problems (including anal, sexual and urinary)
- Complications from infections and epidural abscess and vertebral osteomyelitis (12)
- Potential complication from accidental puncture of the spinal cord coverings (13)
- Potential for permanent nerve damage
Epidural Side Effects: For the Baby
- May affect fetal oxygen (14)
- May cause fetal bradycardia (15)
- May interfere with breast-feeding and mother-baby bonding (16), (17)
- Increased vulnerability for low blood sugar (18)
Postpartum Epidural Side Effects
In addition to prolonged labor, the decrease in natural oxytocin may cause difficulty in breastfeeding. As mentioned above, oxytocin is important for many functions, including mother-baby bonding and the “letdown reflex” required for lactation. Oxytocin is produced naturally after birth as well, to stimulate uterus contraction, preventing postpartum hemorrhage. (19) It is simply not a hormone you want to be deficient of during labor and recovery.
It is not just the mother who produces oxytocin during labor; the baby also produces oxytocin resulting in the release of “happy loving hormones” for both mother and baby. Levels further increase with skin-to-skin contact, causing a significantly heightened potential for mother-baby bonding. This is one of the epidural side effects that is not often considered, when a mother’s oxytocin levels decrease during labor, so does her baby’s.
The health benefits of breastfeeding are well founded, and any potential risk that could delay breastfeeding, should be avoided. My article Breast Milk: The Original Fast Food discusses the nutrients and antibodies that naturally occur in breast milk that help give infants a healthy start.
Natural Ways to Ease Labor Pain
Today, epidurals are so common place that many women just assume they are safe. However, in the vast majority of births, epidurals are not necessary. While pain is real, and every woman experiences pain in different ways, there are many effective ways to control labor pain naturally. Here are just a few ways to approach a natural childbirth. (20)
The laboring mother relaxes in a tub of warm water. The water helps the mother relax and ease her anxiety. The buoyancy of the water also helps her to move more easily and find more comfortable positioning. (21)
These may include breathing techniques, or other sources of comfort to help soothe mother and baby, such as favorite music, a favorite pillow and lap blanket.
This includes moving around and finding positions throughout labor that are most comfortable for the expectant mother. While birthing centers and hospitals encourage women to be flat on their backs during labor, this is actually the worst possible position for pain. Being mobile throughout labor gives the woman ultimate flexibility to get comfortable. This is, of course, next to impossible after being given an epidural, as they result in a general numbness in the lower body.
An aromatherapy diffuser filled with your favorite oils can create a sense of calm. Essential oils such as lavender, fennel and sage can help ease tension and anxiety when diffused.diffuser filled with your favorite essential oils can create a sense of calm. Essential oils such as lavender, fennel and sage are wonderful and can ease tensions even when diffused.
For pain in the lower back and tailbone, a heat pack can provide relief during labor and afterwards.
Loving long strokes throughout labor can provide relief from pain and anxiety, while helping to improve mood. Massage can be given on the scalp, feet, legs, shoulders, hands and lower back. Prepare a custom massage oil in advance, with a few drops of your favorite essential oil mixed with coconut oil.
Lavender oil smells great, and one of the top 5 lavender oil benefits includes a reduction in anxiety and emotional distress, which can result in a more positive, and less painful, birthing experience. Peppermint oil also eases pain and refreshes, but avoid using it while nursing as it can affect the milk supply.
Myrrh, helichrysum and frankincense also aid in healing and pain.
- Epidural side effects can range from mild to severe.
- When combined with synthetic oxytocin, labor can be longer, and cause significant stress to both mother and baby.
- The unintended epidural side effects can interfere with the natural birthing process and mother-baby bonding. Of course, in certain circumstances, epidurals can be helpful, especially in the event of a cesarean section.
- There are many natural ways to manage labor pain, including using a birthing tub, relaxation techniques, aromatherapy, heat packs, trying different body positions and massage, among others.
- Take the time to research and make an informed choice when it comes to pain management during labor. Talk with your obstetrician or midwife prior to giving birth about pain management options and what to expect during labor.
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