According to a 2008 data collected by the Centers for Disease Control (CDC), approximately 61% of women who delivered babies vaginally had epidural or spinal injections for pain relief. An epidural involves a catheter placed into the epidural space (between epidural column and outer membrane of the spinal cord), which can permit a constant infusion of pain medication (usually bupivacaine, lidocaine, or a similar drug) during labor. A spinal injection (or spinal block, as they are sometimes called) is a one-time injection of medication into the subarachnoid space of the spine. More often than not, these injections are safe, provide adequate pain relief, and assist in easing labor. However, done incorrectly they can cause serious injuries.
Standard of Care
This medication is typically administered by an anesthesiologist during the active phase of labor, when the cervix dilates rapidly and contractions are more forceful. From medical school, anesthesia doctors are taught the four P’s:
- Preparation: physicians must use the correct needle, amount and type of medicine
- Position: the patient must be properly positioned (typically on her side)
- Projection: the needle should be placed where it is to be inserted
- Puncture: the needle must be pushed in to the intended area without deviation
Risks of Epidural and Spinal Injections
At every stage, something can go wrong if doctors are not careful. The wrong medication, incorrect patient position, or incorrect amount of force can cause injury to the expectant mother. Possible injuries include:
- Low blood pressure and cardiac arrest
- Respiratory problems
- Nerve damage
The unborn baby can also be injured—brain injuries, strokes and death are all possibilities. Injections often cause an increase in the mother’s temperature, and temperature increases are linked to higher risks of infant injuries. In fact, babies born to mothers who had fevers during labor have a two to six times increased risk for lower blood oxygen, and the need for ventilation after birth, seizures and other problems. Some studies indicate that anesthesia may be linked to difficulty with breastfeeding.
The decision about whether and when to use anesthesia during labor is a personal one that should be made in concert with the treating doctor. Childbirth can be incredibly painful, and these medications can provide significant pain relief when done properly. However, done incorrectly, it can cause devastating injuries to both mother and child. Even if the anesthesia was done correctly, such causes a risk to the mother and fetus. If you have questions about the use of anesthesia, contact us at (440) 252-4399.