Epidurals have come a long way since they were first used in the 1880s for surgery. It wasn’t until the early 1940s that they were first used in childbirth.
These days, epidurals have become one of the most popular methods of relieving labor pain. Around 50% of women who birth in hospitals will have an epidural.
Epidural anesthesia blocks the nerve impulses from the lower spine, which prevents pain messages from traveling to the brain.
Considering how popular epidurals are, it’s vital to understand how they work and the potential risk of side effects.
Everything You Need to Know About Epidurals During Labor provides an in-depth understanding of how epidurals work.
Epidural side effects
Although epidurals are considered safe for use during labor and birth, it’s important to understand there are side effects and possible complications.
This is true for any medical treatment, and if you are thinking about having an epidural, getting the relevant information should be part of your informed decision-making process.
These effects of epidurals might not seem to be of concern, but can affect your birth:
- Limited movement due to the additional monitoring required during an epidural
- Possible slowing of labor. Although this can be treated with medications to speed up labor, the medications also have side effects that need to be considered
- Longer recovery time as you wait for the epidural to wear off.
Here are 7 common side effects of epidurals:
#1: Low blood pressure
The most common side effect of an epidural anesthetic is a drop in blood pressure. This happens because the anesthesia block affects the nerve fibers that control muscle contractions inside the blood vessels.
The blood vessels relax, which leads to low blood pressure (hypotension). If not monitored and treated, it can lead to complications such as feeling faint to more extreme effects, such as cardiac arrest.
Your care provider will give you intravenous fluids before the epidural is placed and your blood pressure will be closely monitored at 15-minute intervals. Hypotension is treated with more IV fluids to restore normal blood pressure.
#2: Loss of bladder control
An epidural affects the nerves surrounding your bladder, which means you can’t feel when it’s full. It’s common practice to have a urinary catheter inserted to allow urine to drain away.
Your bladder will fill quickly due to the IV fluids you receive, but it’s important to keep it empty during labor. A full bladder can get in the way of your baby’s head descending through the pelvis and slow your labor unnecessarily.
Some of the medications used in epidurals, including opiates, can cause itching of the skin (pruritus).
Your doctor can treat this with medications to help the itching, or change the medicine in the epidural.
#4: Nausea and vomiting
Some women feel nauseous or even vomit. This can be a reaction to the medications or be caused by low blood pressure.
Your doctor might treat it with anti-nausea medicine or, if the nausea is related to low blood pressure, increase the rate of IV fluids.
#5: Breathing difficulties
Occasionally, pain medications, such as opiates, can cause unexpected breathing difficulties and extreme drowsiness.
Your doctor will closely monitor you for this to avoid serious complications. It can be treated easily with other drugs.
A fever over 38C (100.4F) is another common epidural-related side effect. It’s not properly understood why this happens, but it’s thought internal thermoregulation is somehow disrupted.
A raised temperature increases the longer the epidural lasts. Unfortunately, fever during labor can affect your unborn baby.
Studies show babies born to mothers who develop an epidural-related fever during labor are at greater risk of having problems after birth, including breathing difficulties, poor muscle tone, low Apgar scores, and seizures.
#7: Inadequate pain relief
Up to 12% of epidurals will fail as an adequate pain relief method. It’s extremely uncomfortable when the epidural works well in one area but only partially in another area.
This can happen due to incorrect placement in the epidural space. Some nerves continue to receive pain messages, reducing the effectiveness of the medication.
You might be offered the option of extra or alternative relief.
Find out alternative pain relief in 13 Natural Pain Relief Options For Labor.
How long does it take for an epidural to wear off?
The effects of an epidural will last for about 2 hours after the medication has been stopped.
You might then start to feel some discomfort from the effects of giving birth, such as tenderness in the vaginal area, bruising, and sore back and hips.
Spinal blocks are single injections of pain relief medication; if they are not given again, the effect typically wears off after a few hours.
Epidural side effects on baby
Any medication you have during labor reaches your baby. With an epidural, the amount that enters your bloodstream is very small; with a spinal block, it’s even smaller.
Studies show the amount of medication your baby is exposed to isn’t harmful. Epidurals don’t appear to have a direct effect on Apgar scores, or on admissions to neonatal intensive care.
The main problem for babies is the effect of the epidural on their mothers during labor. This can cause decreased fetal heart rate.
Epidurals can also slow labor down, meaning the risk of interventions such augmentation or forceps is increased.
Can you feel the baby coming out with an epidural?
The best way of understanding how it feels to push when you have an epidural is to think about how it feels when you have an injection at the dentist.
You’re given a local anesthetic injection to numb the gums and roots of the teeth. You don’t feel any of the pain of drilling but you can still hear the drill and feel the pressure of your dentist’s fingers prodding about in your mouth.
After the injection and procedure, your mouth is numb and you might find it difficult to swallow or even talk.
It’s very similar when you have an epidural.
The lower half of your body is numb but you’re still aware of what is happening. Keep your hands over your belly so you can feel the tightening and hardening of your belly during your contractions. This will make sure you still breathe deeply and consciously through contractions to support your baby.
Epidural side effects after birth
An epidural can be a wise choice in the right circumstances. As with all choices you make about your birth, know what questions to ask your ob-gyn so you’re empowered and informed if the situation arises.
Although the occurrence of serious side effects after birth aren’t common, epidurals have related problems.
Epidural side effects back pain
It’s commonly thought epidurals can cause long-term back pain after birth.
According to the American Society of Anesthesiologists, there’s no credible evidence having an epidural will lead to permanent back pain. It’s just as common to experience back pain after labor and birth without an epidural.
Epidural side effects nerve damage
It’s very uncommon for the needle or epidural catheter to cause nerve injury or nerve damage.
You might be left with a small area that feels numb to the touch, but has normal strength and range of movement. It’s similar to the feeling after an injection of local anesthetic. It usually resolves within weeks, or possibly months.
A permanent loss of feeling or movement (paralysis) in one or both legs following an epidural is a rare but very serious complication.
It is called cauda equina syndrome and is caused by:
- 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
These are rare events, and anesthetists have extensive training to reduce the risks of these complications.
Epidural side effects headache
A very small number of women experience a severe headache and light sensitivity after epidurals. The headache is relentless and intense and doesn’t respond to medication.
The severe headache results from the bag of fluid that surrounds your spinal cord being accidentally punctured during the procedure.
You’ll be advised to lie flat, drink plenty of fluids and take paracetamol or ibuprofen. The hole at the injection site will resolve itself after a few days.
If the headache persists or is very severe, a procedure known as a blood patch might be used to seal the puncture.
You can read more in Epidural Headaches – Causes And Treatment.
Essentially you will undergo the same epidural procedure but this time you receive an injection of your blood into the puncture, via the epidural space. When the blood clots it will seal the hole and your headache will stop.
Check out Where Does an Epidural Go? to understand more.
Epidural side effects shaking after epidural
Uncontrollable shivering or shaking is a common side effect of anesthesia. It’s completely normal and has nothing to do with being cold, although being wrapped up in a warm fluffy blanket certainly helps.
Although it’s very distressing, especially for partners and family members, it’s not dangerous and should stop within 20 to 30 minutes.
Slow-paced breathing can help get the shivering under control; a calm and reassuring presence also helps.