What Is an Epidural?
Epidurals are the most common type of pain management used during labor. More than 50% of women choose epidurals to manage their pain while giving birth. A regional anesthetic, the goal of an epidural is to block pain emanating from the lower half of a woman’s body during labor while leaving her with control and sensation in her upper half.
Epidurals are used in both vaginal and cesarean (C-section) deliveries. A correctly executed epidural can help women when the pain of childbirth interferes with the process of delivery. It allows women to rest when labor is prolonged and helps them to remain alert and active during labor.
The process of preparing a patient for an epidural is simple but must be done carefully. Mistakes made in the delicate region surrounding the spine can be serious.
- Before a patient is prepared to receive an epidural, informed consent must be given. Doctors should thoroughly explain the process and its potential risks.
- The patient is started on IV fluids. Most patients receive 1-2 liters of fluids throughout the process.
- The patient is positioned. Patients are allowed to sit up or lay down on their left sides, but the back must be kept arched. Proper positioning can help increase effectiveness and prevent complications down the line.
- The injection site is disinfected and a local anesthetic is given.
- A long needle is inserted and a very thin tube — called a catheter — is threaded through the needle.
- The needle is removed leaving the catheter behind. The catheter is taped in place so it cannot be dislodged during labor.
- The pain-relief medication is given through the catheter. Doctors may use periodic injections or infuse the medication continuously.
- When labor is over, the medication is stopped, and the catheter is carefully removed. The injection site is bandaged and must be carefully monitored for signs of infection and other complications.
The success of an epidural is strongly tied to the skill of the doctor administering it. Epidurals should only be administered by trained anesthesiologists or experienced obstetricians.
Causes of Epidural Injury
Epidurals are routine and commonplace procedures. Unfortunately, poor training or a lack of proper care can turn what should be a simple process into a potential tragedy caused by medical negligence.
Common causes of epidural injury include:
- Allergic reactions to medication
- Dosage errors
- Failure to monitor the distress levels of mother and baby
- Ignoring contraindications (blood thinners, low platelet count, maternal hemorrhage, signs of infection)
- Incorrect placement of the needle
- Premature administration (before dilation reaches 4 cm)
Before an epidural is given, patients should always be thoroughly screened for potential risk factors. Even if no contraindications are found, patients should be monitored closely both during the procedure and after it to prevent complications that may develop.
Risks and Symptoms of Epidural Injury
Epidurals can cause a host of symptoms, some of which are routine and some of which may be severe or life-threatening. They also pose a serious risk of creating complications during delivery, which creates further risks for birth injuries for both the mother and baby.
Maternal Risks and Symptoms
Since epidurals can affect how labor progresses, women who choose them as a form of pain relief face a variety of potential complications. The dangers presented by these complications are worsened when mistakes are made during the procedure. The resulting symptoms and side effects can be serious, and not every patient should be subjected to the increased risks.
Symptoms and risks include:
- Backache/soreness at the injection site
- Cardiac arrest
- Difficulty urinating
- Epidural hematoma
- Fluctuation in blood pressure
- Increased risk of cesarean section
- Increased risk for episiotomies
- Increased risk of forceps and vacuum extraction
- Paralysis (temporary or permanent)
- Prolonged labor
- Nerve damage
- Ringing ears
- Severe headache (caused by spinal fluid leakage)
When epidurals are poorly managed, women can end up paying the price, sometimes in ways from which they will never fully recover.
Fetal Risks and Symptoms
The dangers from mishandled epidurals don’t only impact the mother. Babies may also suffer from the additional risk of complications.
Fetal risks and symptoms include:
- Brain damage
- Breathing difficulties
- Changes in fetal heart rate
- Difficulties with breastfeeding
- Fetal malpositioning/breech birth
- Low Apgar scores
- Oxygen deprivation (leading to conditions like cerebral palsy and other permanent disabilities)
Whenever labor becomes prolonged or difficult, the risk of traumatic birth injury is increased. Mistakes made in seconds can leave children facing a lifetime of consequences.
Epidural Injuries and Medical Negligence
Epidurals are a popular choice for pain relief during labor, and they’re often treated as simple or routine. No application of anesthesia comes without risk, however, particularly in a delicate region like the spine.
Mistakes made during an epidural can have serious, long-term consequences for mothers and babies. If you or someone you love has suffered as a result of mistakes made during an epidural, you can find help with a free case review.
Frequently Asked Questions About Epidural Injury
Can epidurals increase the risk of birth injuries?
Yes, epidurals can increase the risk of traumatic birth injuries. Women who undergo epidurals may experience prolonged labor, and babies may experience fetal malpositioning — both of which make delivery more difficult.
These issues increase the likelihood that doctors will need to use instruments like forceps or vacuums during delivery, which have the potential to cause a wide variety of birth injuries. Epidurals may also increase the likelihood that the mother will require surgical intervention in the form of a cesarean section or an episiotomy.
Are epidural injuries treatable?
Epidural injuries vary widely in type and level of severity. Many types of epidural injuries are treatable if doctors move quickly to intervene. Infections, spinal fluid leakages, blood pressure fluctuations, and neurologic defects leading to temporary paralysis can often be treated, and many people fully recover.
That said, some women and children face severe complications from which they will never recover. Babies can develop lifelong conditions like cerebral palsy, and 1 in every 240,000 women will face persistent neurologic injuries that can cause paralysis or otherwise inhibit their freedom of movement forever.
Can epidural injuries be prevented?
Yes, most epidural injuries are preventable. Medical mistakes made during the procedure and poor monitoring afterward account for most causes of epidural injuries. More thorough training and ensuring that the proper staff is available to deal with emergencies can help eliminate mistakes.
Doctors have a duty to their patients — called duty of care — to provide them with appropriate and timely medical intervention. This duty is not waived during emergencies, and when doctors fail to deliver on this promise, it may qualify as birth injury malpractice.