Angela Hupf

Mr. Rudebusch

English Comp IV

19 December 2016

Epidural Anesthesia: Is it Worth the Risk?

Lots of women decide that they want to have a baby in their lifetime, and a serious

question comes into play when those women are in labor: Is it safe for me to receive an epidural?

Epidurals have become the most common form of pain relief during childbirth since they were

first used in 1885 (Buckley para. 1). In 2008, 61% of women in labor chose to receive an

epidural (Osterman Fig. 1).

So, what about the other

39% of women? Well, some

choose not to receive an

epidural because theyre

worried about their own

safety and well-being as

well as the babys; in their eyes, the risks, like an increased chance of instrumental delivery, low

blood pressure, and prolonged labor, outweigh the benefits of epidural anesthesia. However,

most expectant mothers decide to receive an epidural because they insist that epidurals are safe

and especially effective for pain relief. I sympathize with those hesitant mothers; however, while

some expectant mothers question the safety of using epidurals during labor, the benefits from

epidurals, in fact, far outweigh potential complications resulting from epidurals.

 Some expectant mothers strongly believe that epidurals are a major risk to their safety

and well-being as well as the babys health. Those mothers tend to claim that epidurals are not,

in fact, a great help during labor. One risk commonly associated with epidural anesthesia is an

increased chance of instrumental delivery due to prolonged labor. Sometimes, it can become

difficult for the mother to push the baby out when epidural anesthesia is used. There are also

times when the nurses and doctors have a hard time trying to position the baby correctly before

delivery; in times like these, prolonged labor is often a result, and if a labor goes on for too long,

doctors will want to use instruments to remove the baby. Two of the most common instruments

used during delivery are forceps and vacuums. Dr. Stephen Michael Kinsella, doctor in the

anesthesia department at St. Michaels Hospital in Bristol, UK, encountered many different

experiments and came to the conclusion that the majority of randomised trials indicate that

epidural [anesthesia] is associated with slow labour...and a greater rate of instrumental vaginal

delivery (para. 3). In simpler terms, the studies observed by Dr. Kinsella suggest that the use of

an epidural during labor can slow down the delivery process. Because many people dont know

when, exactly, an epidural starts to take effect, a study published in Saudi Journal of Anesthaesia

by Wesam Farid Mousa, Roshdi Al-Metwalli, and Manal Mostafa, professors at anaesthesia and

obstetric universities in Saudi Arabia and Egypt, breaks it down for us: [Epidurals have] no

clear effect on the duration of the first stage [of labor], whereas the second stage is more

constantly prolonged (para. 21). To make this easier to understand, the first stage of labor

occurs when the mother is first starting to have contractions; the second stage starts when the

cervix is fully dilated and the baby starts to move down. With all of this information in mind, a

greater chance of an instrumental delivery is a great reason for mothers to be against receiving an

epidural--or is it?
 Lots of soon-to-be mothers research the risks about epidurals, but what they dont see is

that the complication rate for epidural anesthesia is relatively low. The complication rate is based

on any factor that alters how a labor is progressing; it can range from slightly low blood pressure

to Caesarean section (C-section) or even to death. Lewis Mehl-Madrona, Associate Professor of

Family Medicine and Psychiatry at the University of Saskatchewan College of Medicine,

provides further evidence of the low complication rate by writing, the overall complication rate

of epidural anesthesia is 23% (para. 4). Continue to keep in mind that the complication rate

includes very mild complications as well as severe ones! Besides this 23%, women that receive

epidurals have labors that go smoothly and without problems. Mehl-Madrona also adds that

oxytocin induction and stimulation has an even higher complication rate than an epidural does;

oxytocin is a hormone used to speed up labor. Age can also increase the odds of complications

occurring (Table 1). Mothers can also

be hesitant about receiving an epidural

because they think that the epidural

doesnt allow them to push

sufficiently during labor. However,

Dr. David Mayer, Dr. Kathleen Smith,

and Dr. Fred Spielman from the Department of Anesthesiology at the University of North

Carolina School of Medicine understand and address this concern: Being totally numb during

labor is undesirable because you need to know when and where to push at the end of your labor

(para. 6). All in all, epidurals arent going to numb the mother completely; instead, the epidural

is going to take away the pain from contractions while still allowing the mother to push exactly
when and where she wants. So, despite expectant mothers opinions, epidurals are indeed much

safer than alternative solutions.

Another risk commonly associated with epidurals is a drop in blood pressure, or

hypotension. When this occurs, its usually because the medications in an epidural impact the

nerves and blood vessels; everything slows down while the nerves and muscles relax and become

less active. Dr. Sarah Buckley, medical doctor and physician, shows her concern for this in

writing that hypotension is [the] most common side effect of epidurals(para. 21). In other

words, this is the side effect that shows up most often during labor. Mothers with chronic low

blood pressure must be very cautious if they choose to receive an epidural because more serious

complications can occur with them: cardiac arrest or loss of consciousness (Buckley para. 21).

The women that already have low blood pressure could be greatly affected by the epidural

because it is likely to lower their blood pressure even more. Hypotension is common in epidural

anesthesia, but should it be a motivating reason behind not getting an epidural?

Lots of women are scared by the fact that low blood pressure is the most common side

effect of epidural anesthesia; however, even though one-third of patients encounter low blood

pressure as a result of an epidural, only 12% of those patients experience serious hypotension

complications (Mehl-Madrona para. 31). So, even though many women have a slight drop in

blood pressure, a very small amount of women have serious complications because of it. Dr.

Mayer and his associates also want to put expectant mothers to ease by saying, Your blood

pressure might fall slightly but is easily and rapidly treated, and they also add that when a blood

pressure drop occurs, doctors can easily raise it with IV fluids (para. 8). In other words, unless

the drop in blood pressure is severe, patients shouldnt be worried about their health because a

slight drop in blood pressure can be fixed easily. Even though hypotension is very common after
an epidural, only 12% of cases are severe, so, contrary to some mothers worries, there really is

no need to deny an epidural because of hypotension.

Not only do expectant mothers care about their own safety and well-being, but they also

care about how the epidural will affect their baby. Sometimes, babies develop fetal distress after

the mother receives an epidural. Fetal distress can be caused by a mother having severely low

blood pressure (Mehl-Madrona para. 37). The baby relies on the mother for not only nutrients

but also blood supply, and when a mothers blood pressure drops, the baby can loose some of

that vital blood supply. A study from 2008 by the National Center for Health Statistics published

by Michelle J.K. Osterman, M.H.S. and Joyce A. Martin, M.P.H. indicates that epidural

anesthesia can increase the risk of the fetus being in an irregular position when the time comes

for the mother to give birth (para. 8). Irregular positions include any position where the baby

isnt going to come out of the vagina head-first with the belly facing upward. Brigham Narins,

health and science writer and author of The Gale Encyclopedia of Nursing and Allied Health,

agrees that the baby is at risk when an epidural is given to the mother: an overfull bladder can

block the descent of the baby's head (para. 15). Before an epidural is given, mothers are able to

get up and go to the bathroom; however, after an epidural is given, the mother can no longer get

up, move around, or go to the bathroom. So, if the mother doesnt empty her bladder before she

receives an epidural, the delivery process could be stalled, putting the baby at risk. It would

make sense to deny any medications or drugs that could potentially harm your baby, wouldnt it?

Well, I guess well find out.

When mothers research the risks associated with epidurals, all theyre looking for are

reasons to not receive one. They dont look at the risks and see that all potential problems can be

avoided. First and foremost, Dr. Mayer and his associates want to ease all mothers worries by
saying, If you have an epidural anesthetic, your baby will be safe. The epidural will not depress

your breathing or put your baby to sleep (para. 2). Some mothers worry that an epidural will put

their baby to sleep or drug them up, but there is no need to worry about that: Brigham Narins

will explain why. Narins writes, It is believed that very little of the anesthetic is absorbed

throughout the body (systemically), therefore epidural anesthesia is ideal because it does not pass

the medication into the fetal circulation (para. 19). In other words, the epidural will not directly

affect a baby because the medication in an epidural wont enter the flow of anything going to the

fetus. In cases where hypotension could affect the baby, nurses and doctors will make sure that

the mothers blood pressure raises by giving her extra IV fluids to keep her and her baby safe. If

a fetal malposition, or irregular positioning, is detected, the nurses and doctors will usually be

able to manually move the baby back into position by pushing on certain spots of the stomach.

Besides talking about the risks associated with epidural anesthesia, I think that it would

be helpful to talk about the benefits of receiving an epidural. As most women know, epidurals

are used to help relieve most of the pain and pressure a mother feels during labor. UW Health, an

academic medical center and health system for the University of Wisconsin, says that an epidural

can provide good pain control with fewer of the side effects that are often seen with intravenous

(IV) pain medicines, (para. 2). Some side effects of IV medications not seen in epidurals

include infections, swelling, blurred vision, and vomiting. Dr. Mayer and his associates also

agree that contractions are less painful and more manageable thanks to epidurals (para. 6). Labor

is very painful, and most mothers have a hard time dealing with the immense pain, so they seek

pain relief, usually in the form of epidural anesthesia. Narins writes that [e]pidural anesthesia,

because it virtually blocks all pain of labor and birth, is particularly helpful to women... (para.

4). Epidurals can be helpful in ways other than pain relief too; they take away pain, causing
mothers to be more relaxed when their babies come into the world. Simply, an epidural can take

away some of the stress in the delivery room. Because many of the risks that make expectant

mothers hesitant about receiving an epidural are avoidable or untrue, the benefits, especially to

me, clearly outweigh the risks of epidural anesthesia.

Some mothers choose not to receive an epidural because theyre worried about their own

safety and well-being as well as the babys health; in their eyes, the risks, like fetal distress,

prolonged labor, or hypotension, outweigh the benefits of epidural anesthesia. However, actually,

epidurals are safe for the baby! They also have a low complication rate and relieve the immense

pain thats associated with labor. Even though some women say that labor pain isnt that bad,

Zawn Villines, a first time mother, has a very different view. She went through labor without

receiving an epidural, and she describes the pain that she endured during labor: [Its the] worst

back pain you've ever experienced, coupled with the pain of a severe stomach virus, the pressure

of someone jumping on your cervix, and the intensity of being repeatedly kicked in the

abdomen (para. 11). As you can see, labor without an epidural is no walk in the park. Wouldnt

your babys birthday be a more memorable and happy day to remember if you, as a mother,

didnt have to look back to the immense pain that took place during labor? Essentially, no matter

what decision a mother chooses to make about epidural anesthesia, she wont be wrong.

However, epidurals make labor and childbirth easier and less painful.
 Works Cited

Buckley, Sarah. "Epidurals: Risks and Concerns for Mother and Baby." 28 July 2016. Web. 02

Nov. 2016.

Kinsella, Stephen Michael. "Epidural Analgesia for Labour and Instrumental Vaginal Delivery:

An Anaesthetic Problem with an Obstetric Solution?" British Journal of Obstetrics and

Gynaecology 108.1 (2001): 1-2. Print.

Mayer, David, Smith, Kathleen, and Spielman, Fred. Epidural Analgesia for Pain Relief in

Labor. "Department of Anesthesiology. Web. 03 Nov. 2016.

Mehl-Madrona, Lewis. "The Medical Risks of Epidural Anesthesia (Epidurals)." Medical Risks

of Epidural Anesthesia During Childbirth. Web. 03 Nov. 2016.

Mousa, Wesam Farid, Roshdi Al-Metwalli, and Manal Mostafa. "Epidural Analgesia during

Labor vs No Analgesia: A Comparative Study." Saudi Journal of Anaesthesia. Medknow

Publications & Media Pvt Ltd, 2012. Web. 03 Nov. 2016.

Narins, Brigham. The Gale Encyclopedia of Nursing and Allied Health. Detroit: Gale Cengage

Learning, 2013. Print.

Osterman MJK, Martin JA. Epidural and spinal anesthesia use during labor: 27-state reporting

area, 2008. National vital statistics reports. vol 59 no 5. Hyattsville, MD: National

Center for Health Statistics. 2011.

UW Health. Epidural Analgesia/Anesthesia: Answers to Common Questions. Health Facts

for you. 2015. Print

Villines, Zawn. What Does Child Labor Feel Like? Pregnant and Feminist: Pregnancy is a

Feminist Issue. 11 Nov. 2016. Web. Accessed 15 Dec. 2016.