8 Facts About Epidurals and Epidural Side Effects

From headaches and back pain to low blood pressure, here's everything you need to know about epidurals and epidural side effects.

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While epidurals are a relatively common form of pain relief during labor, the procedure remains something of a mystery. It is quite frequently misspoken about and misunderstood. Even health care providers use the word "epidural" generically to encompass three similar yet distinct procedures: epidurals, spinal blocks, and a combined spinal epidural (CSE), or "walking" epidural.

What Is an Epidural?

An epidural is a medication injected into the space around your spinal cord in your lower back. It provides continuous pain relief through a catheter during labor, numbing you from the waist to the upper legs.

For most people, deciding whether or not to have an epidural involves evaluating the benefits and risks well before labor begins. So, read on for facts about epidural side effects, the difference between epidurals and spinal blocks, how soon they offer relief, and more.

Epidural Side Effects are Usually Minimal

According to the American Society of Anesthesiologists (ASA), epidurals are very safe, and complications are rare. However, as with any medication, complications can occur and can range from short-term and bothersome to (far more rare) long-lasting or life-threatening.

According to the American College of Obstetricians and Gynecologists (ACOG), epidural side effects include:

  • Itching
  • Nausea and vomiting
  • Drop in blood pressure
  • Fever
  • Headache
  • Back soreness
  • Shivering
  • Difficulty emptying your bladder
  • Reactivation of cold sores
  • Breathing problems (rare)
  • Numbness, tingling, rapid heartbeat (rare)
  • Injury to the spinal cord and nerves (rare)

Other rare risks include infection, bleeding, and nerve damage near where the injection is given. If the drug is accidentally injected into the bloodstream, this can cause breathing to slow or stop, seizures, or even death.

However, William Camann, MD, director of obstetric anesthesia at Brigham and Women's Hospital in Boston, Massachusetts, and co-author of Easy Labor: Every Woman's Guide to Choosing Less Pain and More Joy During Childbirth says, "Most anesthesiologists will go through a whole career and never see a case of these rare complications."

Hypotension

The most common epidural side effect is hypotension, a drop in blood pressure. According to research in the American Journal of Obstetrics and Gynecology, low blood pressure occurs in 30% of those who receive an epidural during labor.

This occurs more with higher doses of medication. "With treatment, hypotension has no consequences to the pregnant person or baby," says Dr. Camman.

Itching

Itching is also an extremely common epidural side effect. Epidurals contain a combination of narcotics and anesthesia. Narcotics are often the culprit behind the itching. According to a 2021 study in BMJ, itching occurs in up to 60% of people who receive an epidural with morphine.

Fever

Another epidural side effect possibility is a fever. According to a 2023 review in the American Journal of Obstetrics and Gynecology, 15-25% of people who receive an epidural in labor end up with a fever. This can lead to diagnostic testing to determine the cause and, sometimes, treatment with antibiotics.

Headache

A less common complication is a "spinal headache" after an epidural: a severe headache following local anesthesia that worsens upon standing upright. According to a 2015 study in Neurology Clinical Practice, a headache following an epidural occurs around 0.5-1.7% of the time.

"This occurs in less than 1 percent of patients in this hospital but can last for several days and be very uncomfortable," says Laura Riley, MD, obstetrician and gynecologist-in-chief at NewYork-Presbyterian/Weill Cornell Medical Center in New York.

Epidurals vs. Spinal Blocks

An epidural is the most common form of pain relief in labor. According to the World Population Review, epidurals are used by 67% of people who give birth in the U.S.

Epidurals involve injecting pain-blocking medication into a space between the vertebrae. The drug generally numbs you from your belly button to your thighs. The procedure usually takes about 15 minutes to work and lasts as long as needed. With an epidural, the catheter that delivers the drug is left in the epidural space until the baby is born so the medication can be administered continuously.

A spinal is an injection directly into the spinal fluid. Unlike an epidural, an anesthesiologist does not leave a catheter in place. According to the ASA, the effects are immediate and last 90 minutes to three hours.

"What medication is given and how much is administered varies depending on the individual and the hospital; some routinely combine epidurals with spinal, and some do not," says Dr. Riley.

Different techniques, medications, and doses have different results and risks, so being educated about the procedures used where you will deliver can help you make a decision that is right for you.

Epidural Procedures Do Not Hurt

While many people worry about epidural needles, the injection process is rather simple. A small spinal needle the width of a thick piece of hair is inserted into the space between vertebrae. The needle is then left in place for a minute or two—just long enough to insert a skinny, flexible catheter into place.

But before this happens, the injection site is numbed with a local anesthetic, at which point you will feel a pinch and sting for about 10 seconds. When the epidural or spinal is given, you'll feel pressure, but not pain.

Epidurals Do Not Usually Affect Your Ability to Push

Some people worry that epidurals will affect their ability to push, but the opposite may be true—particularly when combined with a spinal.

"One advantage of combining spinals with epidurals is that it typically allows for less medication to be given than with an epidural, so you get pain relief without total numbness," says Dr. Camann. This lower dose makes pushing easier than with a higher-dose epidural, reducing the likelihood of a forceps- or vacuum-assisted delivery.

You Can't Actually Walk After a "Walking" Epidural

A "walking" epidural is another name for a combined spinal epidural (CSE). According to ACOG, CSEs have the following combined benefits:

  • The spinal acts quickly to immediately relieve pain.
  • The epidural offers continuous pain relief.
  • Lower doses of medications are used than with an epidural alone.

"Most people do not walk with one," says Gilbert J. Grant, MD, director of obstetric anesthesia at New York University Medical Center and author of Enjoy Your Labor: A New Approach to Pain Relief for Childbirth.

He explains that once the epidural is given, continuous fetal monitoring and an IV are needed, and many doctors do not encourage people to walk with these. "A better name would be 'epidural lite' because it has to do with the dose being low, not the patient's ability to move," he adds.

Some Medication May Reach the Baby

While epidurals are relatively safe, they are not without risk. "Any medication that you take to relieve pain will reach the baby," says Dr. Grant. "However, with an epidural, the amount that enters your bloodstream is quite small, and with a spinal, it's even smaller."

According to ACOG, the opioids in an epidural are the culprit for epidural side effects on a baby. These effects are short-term but could include:

  • Change in heart rate
  • Breathing problems
  • Drowsiness
  • Reduced muscle tone
  • Reduced breastfeeding

Studies have found mixed results when it comes to epidural effects on newborns. In a 2021 cohort study of 435 ,281 gestational parent and child pairs, researchers found an association between epidurals and neonatal resuscitation, neonatal unit admission, and increased health conditions. However, they did not find an association with lower APGAR scores or adverse childhood developmental outcomes at 2 years.

Sometimes Epidurals Don't Work

Studies have found epidural failure rates between 8-23%. In one study that looked at the experience level of the anesthesiologist, researchers found that the failure rate was significantly associated with the anesthesiologist's year of training. Those with five or more years of training had a 10.4% failure rate, much lower than those with less training.

Older studies have found the following as reasons an epidural may not work:

  • Incorrect placement
  • The catheter falls out
  • If you move while it's inserted
  • Not enough medication

Occasionally, the pain is relieved on only one side of the body, either because the catheter is mispositioned or dislodged or because the person stays in the same position for too long, but this problem is easily remedied.

An increasingly popular option is patient-controlled epidural analgesia (PCEA). With this option, you can control the pain relief you get, but overdosing is extremely unlikely. In fact, research has found that PCEA is associated with higher maternal satisfaction and less overall medication use compared to continuous epidural.

An Epidural Takes Time

Epidurals are not instantaneous. They're far more complicated than getting a shot in the butt. From the moment you ask for one to the moment you get relief, you might have to wait anywhere from a half-hour to an hour—or longer.

The wait for the procedure is mostly about anesthesiologist availability. They may be busy putting in another person's epidural, in the operating room, or on call and not in the hospital.

While it used to be advised to wait until you were dilated a certain amount, ACOG says that unless medically contraindicated, a person's request is a sufficient medical indication for pain relief at any time during labor. However, receiving an epidural may be too late if you are too close to delivery.

While every effort will be made to ensure you get your epidural ASAP, don't expect it to be an instant deal. It takes time, and this is one area where you don't want a doctor to take shortcuts.

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Sources
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