Epidural analgesia is said to have many side effects, how true are they? Experts from the Department of Women’s Anaesthesia at KK Women’s and Children’s Hospital unravel the truth behind epidural analgesia.
Epidural analgesia (EA) is one of the most reliable and effective ways to relieve labour pain. In this procedure, local anaesthetic drugs are injected into the epidural space, the outermost part of the spinal canal. A variant of the epidural analgesia procedure is the combined spinal-epidural analgesia (CSEA).
“The benefits of EA/CSEA for relieving labour pain during childbirth generally outweigh their possible side effects,” says
Dr Eileen Lew, Head and Senior Consultant,
Department of Women’s Anaesthesia,
KK Women’s and Children’s Hospital (KKH), a member of the
SingHealth group.
Dr Lew debunks some of the myths surrounding epidural analgesia.
Myth 1: Epidural analgesia has many side effects.
Fact: Epidural usage has minor side effects which are transient and self-limiting. These include:
- Loss of feeling and muscle weakness: Numbness of the legs and lower part of the body is to be expected. The urge to pass urine may also be lost, but this can be remedied by the use of a urine catheter. As the epidural drug effect wears out, sensation and strength are restored in the legs and lower body.
- Nausea: This may result from a lowering of the mother’s blood pressure or it could be a direct effect of the epidural drugs used. It can be treated with proper positioning and pressure-boosting medicines.
- Shivering: This may occur although the pregnant woman may not actually feel cold. This is harmless to mother and baby and usually does not require any treatment.
- Itch: A mild itch on the body is more common after CSEA than EA. This is usually self-limiting and does not need treatment.
- Spinal headache: There is a 1 per cent risk of spinal headache after EA/CSEA. The headache usually occurs after delivery and is worsened by the upright posture. Medications and a procedure called epidural “blood patch” can be used to treat severe headaches. In most cases, the headache resolves with time.
Myth 2: Epidural analgesia causes long-term backache.
Fact: Studies have failed to establish a link between long-term backache and EA/CSEA. Backache is common after childbirth, with or without the use of EA/CSEA. Proper back care during pregnancy and after childbirth is important.
Myth 3: Epidural analgesia harms the baby.
Fact: EA/CSEA do not harm the baby. However, some temporary change in the baby’s heartbeat may occur. There is evidence that EA/CSEA may improve blood flow in the placenta.
Myth 4: Epidural analgesia can cause paralysis.
Fact: This is actually very rare. The risk of permanent damage is 1 in 50,000 – 100,000. The risk of paralysis is 1 in 1,000,000.
Myth 5: Epidural can be life-threatening.
Fact: Complications involving breathing difficulty, convulsions, nerve damage and spinal infection are very rare. High standards of medical practice and proper patient selection have contributed to the safety of epidural procedures.
Myth 6: Epidural prolongs labour and increases the risk of needing a C-section.
Fact: EA/CSEA do not result in a greater risk of Caesarean section. There may, however, be a slightly increased risk of needing to use instruments during delivery, although this has not been conclusively proven by studies.
Ref: S13
