Epidural Anesthesia

         If you were told that you were four times more likely of having a cesarean section (a major abdominal surgery) by getting an epidural would you still choose this most superior choice of pain relief available during labor ?  This is a tough question because most woman are not given this type of information when receiving an epidural.  And as the cesarean section rate rises to an astronomical rate of one in four deliveries, there is an abundant amount of information that is lacking when woman are receiving informed consent for this procedure.  The literature shows that there are issues that need to be addressed that are not being included in the process of informed consent.  I will try and share with you some of the issues that should be considered before deciding upon an epidural anesthesia. 

        According to the literature epidural anesthesia has been proven to prolong labor, increase the risk of uterine infection, and increase the number of operative deliveries two- to fourfold (Ramin, Gambling, Lucas, Sharma, Sidawi, and Leveno, 1995).   Other adverse effects include prolonged first and second stages of labor, increased use of oxytocin (synthetic medication to induce labor), and increased amount of not only cesarean sections, but vaginal operative deliveries.  Other frequently mentioned side effects include headache, hypotension, urinary retention, fever, and nausea (Mann and Albers, 1997).  So why would almost 60-85% of woman make a choice to have an epidural?  Are women aware of these side effects?  When deciding the right choice for yourself remember that usually an intervention (procedure or medication) is followed by an intervention.  What do I mean by this you are asking?  For example you choose to have an epidural, you become hypotensive ( blood pressure drops), in response the fetal heart rate will drop, and the doctor determines fetal distress and off you are swept for a cesarean section.

According to Hawkins, Koonin, Palmer, and Gibbs, (1997) Death due to anesthesia is the sixth leading cause of pregnancy-related mortality in the United States.  This study was conducted from 1979-1990 as a retrospective study involving 155 cases of deaths related to obstetrical anesthesia.  It was found that 82% of the women who died were undergoing a cesarean section, and approximately 5% of the deaths were associated with vaginal delivery. Of the women 52% of the woman who died were undergoing general anesthesia, problems such as intubation, inadequate ventilation, aspiration, and respiratory failure were the causes of death.  About one fourth of the deaths were from complications associated with problems administering regional anesthesia.  Most deaths from regional anesthesia about 70% were from women receiving epidural anesthesia, and about 30% from spinals.  These deaths were usually the result of local anesthetic toxicity or a high epidural or spinal block (Hawkins, Koonin, Palmer, and Gibbs,1997). 

       The information I have given you is straight from medical based literature.  The literature I have mentioned can be found in the bibliography of this web site.  I encourage you to read the medical literature and when discussing with your health care provider make sure that you make an informed choice regarding epidural anesthesia.  Alternative birth choices are safe and beneficial to you and your baby.  Alternative birth choices and pain management can be found within the empowering section of this web site.  I also would suggest that you can obtain more information from the following web site: childbirth.org