Pros and Cons of Epidurals

Pros

• Very effective pain relief during childbirth, cesareans and various operations.

• Provides excellent pain relief immediately after cesarean section.

• Effective form of pain relief for forceps delivery - particularly for mid-cavity/high forceps procedures such as Keilland's rotation for turning of a baby in posterior presentation.

• Allows mother undergoing cesarean section to stay awake during the procedure.

• Enables mother to rest during a long labor.

• Lowers blood pressure, so is very effective for pregnancy induced hypertension.

• Very good alternative to having a general anesthetic where indicated in certain operations.

• May enable a more emotionally positive birth experience if mother's simply cannot cope with the pain.

• Has been used extensively for many years during labor and childbirth.

• Used for relief of severe, unrelenting back/limb pain in the non-obstetric patient.

CONS

• Mild to very severe, incapacitating headaches (postural in nature) caused by puncture of the dura. About 1%. Read "Epidural Headache (with a late onset)". If this does not resolve naturally in a few days, or fixed with a blood patch, can lead to other problems as outlined in the link above.

• Uncontrollable shivering.

• Ringing in the ears.

• Often causes a drop in blood pressure (sometimes quite dramatic).

• Increase in likelihood of instrumental birth ie, forceps/vacuum suction.

• Increase in likelihood of cesarian section.

• Increases likelihood of need for augmentation of pitocin as contractions are sometimes slowed down.

• May increase length of labor.

• Block is sometimes one-sided. Rolling onto side where pain is still present often rectifies the problem, otherwise reinsertion or adjustment is needed.

• Sometimes several attempts are needed due to difficulty inserting.

• Occasionally block doesn't take and in an emergency situation, a general anesthesia is needed.

• Being confined to bed with an epidural inhibits an active birth.

• Inhibits the urge to push and makes pushing very difficult as you are numb from the waist down. It is usually adjusted down or stopped during the pushing stage so you will regain feeling.

• Can cause fetal heart-rate changes.

• Need to be closely monitored, ie Blood Pressure, Electronic Fetal Monitoring, urinary catheter.

• May cause long term backache.

• May cause nausea/vomiting.

• May cause difficulty urinating.

• May cause nerve damage, Arachnoiditis, Cauda Equina Syndrome.

• Very rarely, but importantly, has been known to cause respiratory distress, epidural abcess, paralysis and death.