What Are the Risks and Side Effects of an Epidural During Labor?

Giving birth can be a beautiful experience. And while most of us know it can be painful, many options are available to help you manage your pain during labor. One of these pain management options is an epidural.

What Is an Epidural?

An epidural is a procedure that involves administering one or more pain medications, called anesthetics, through a small tube (or catheter) placed in your back that opens into the space around your spinal nerves known as the epidural space, according to the American College of Obstetricians and Gynecologists (ACOG). The medicine, which causes a loss of feeling in the lower half of the body, is given through the tube for as long as needed. According to a 2018 study in JAMA Network Open, the rates of epidural use during labor range from 36.6% to 80.1%, depending on the state you live in (the lowest was Maine, and the highest was Nevada).

Christine Greves, MD, an ob-gyn at the center for obstetrics and gynecology at Orlando Health in Florida, told Health that though epidurals are safe, there are side effects and risks—as there are with most medical procedures. Here, Dr. Greves explained those side effects and risks since knowing the possibilities ahead of time can help you decide whether an epidural is a good option for you.

Epidural Side Effects

Itching

Some of the pain medications used in an epidural, such as opioids, can make your skin itch, said Dr. Greves. While scientists know that opioids can cause itching, the mechanism of why is not clearly understood.

One 2017 study in the journal Nature Chemical Biology explained one possibility. When your body's mast cells, which are a part of the immune system, are activated, they release histamine, a chemical that causes itching. Opioids trigger a similar response in the body.

If the epidural causes itching in your body, your healthcare provider might change the medication you're being given to alleviate this symptom, or they could give you another medication to relieve the itching.

Low Blood Pressure

It's normal for your blood pressure to fall slightly when you have an epidural, said Dr. Greves. According to a 2017 study published in the journal Obstetrics and Gynecology, up to 30% of people who choose epidural during labor experience a decrease in blood pressure, aka hypotension. The study authors noted that this hypotension rate was higher than what has been reported in other literature.

Hypotension during an epidural happens because epidurals affect the sympathetic nervous system, a series of nerves that spread out from your spine to your body that help control several involuntary bodily functions, including blood flow.

Your blood pressure will be closely monitored if you choose to have an epidural. If necessary, fluids and medication can be administered through an IV to keep your blood pressure regular. Your healthcare provider may also recommend using compression on your legs to help keep your blood pressure up. The same 2017 study in Obstetrics and Gynecology showed that using a sequential compression device (which is kind of like a blood pressure cuff that goes around your legs and alternates between providing compression on the legs and relaxing) significantly decreased the rates of hypotension in individuals during labor who were receiving epidurals.

Nausea and Vomiting

A drop in blood pressure can sometimes make you feel lightheaded and nauseous, said Dr. Greves. Some people are also more sensitive to opioids than others, Dr. Greves added, and the body may try to vomit in response to the drugs. Ask your healthcare provider if they can give you anything to help calm your stomach.

Fever

According to a 2020 study published in the Turkish Journal of Anaesthesiology and Reanimation, 11-33% of individuals who get an epidural during labor run a fever, compared to 1-7% of individuals who did not get an epidural during labor. These same researchers also found that the longer the fever lasted, the higher the chances of complications, like needing a surgical vaginal delivery (like forceps or vacuum extraction to help get the baby out—both methods typically require the laboring individual to need an episiotomy to open up the birth canal) or cesarean (C-section) delivery.

Why fevers can occur during labor in some individuals, especially with epidurals, isn't known. The study suggests that the epidural induces an inflammatory response and may alter temperature regulation in the body, causing a fever. "We do not exactly understand why a fever can occur," said Dr. Greves.

Difficulty Urinating

An epidural will numb the nerves that alert you when your bladder is full, said Dr. Greves. A catheter may need to be inserted to empty your bladder for you. But don't worry. You should regain bladder control once the medication has worn off.

Potential Risks

Severe Headache

If the epidural needle accidentally punctures the membrane that covers the spinal cord and fluid leaks out, it can cause a severe headache, said Dr. Greves and assured that it isn't very common. Dr. Greves noted that if it were to happen, the headache could often be treated with oral pain relievers and fluids.

In some cases, a procedure known as a blood patch may be needed to seal the puncture. According to Johns Hopkins Medicine, this involves taking a small sample of your blood and injecting it into the puncture. When the blood thickens (or clots), the hole will be sealed, and the headache will stop.

Breathing Problems

Dr. Greves said that opioids sometimes cause slow breathing or other breathing problems. You'll be monitored closely to watch for this, and your healthcare provider will intervene if you have difficulty breathing.

Infection

There's always a risk of infection when an opening is made in the skin, even by injection with a needle. However, it's unlikely you'll get an infection from an epidural, as the needle is sterile and your skin is cleaned before it's inserted, said Dr. Greves.

Inadequate Pain Relief

In some cases, the epidural may not block all your pain. Dr. Greves sees this particular risk factor more often than most of the other risks mentioned in this article and added that the overall failure rate in providing adequate pain relief is about 12%. If an epidural doesn't work, you may be offered an additional or alternative pain relief method.

Nerve Damage

It's very rare, but the needle used to deliver the epidural can hit a nerve, leading to temporary or permanent loss of feeling in your lower body. Nerve damage can also be caused by bleeding around the spinal cord and using the wrong medication in the epidural. While it's difficult to pinpoint exact numbers, according to the American Society of Regional Anesthesia and Pain Medicine, nerve damage following an epidural is rare, affecting about 1 in 4,000 to 1 in 200,000 people.

Be sure to alert your healthcare provider immediately if you experience numbness or tingling after the epidural is supposed to have worn off.

Baby's Potential Risks

Research on how epidurals affect the baby is somewhat ambiguous, though the ACOG states that the opioids in an epidural increase the risk that your baby will experience a change in heart rate, breathing problems, drowsiness, reduced muscle tone, and reduced breastfeeding. These effects will vary depending on many factors and are usually short-term.

According to the American Pregnancy Association, it's also possible a baby may struggle with latching on during breastfeeding if an epidural is used during delivery. The baby may also become lethargic in-utero and have trouble getting into position for delivery—which could explain the higher rate of C-section and surgical vaginal delivery in people who have epidurals.

There is no one-size-fits-all solution to pain relief during labor and delivery. After weighing the benefits and risks to you and your baby, make the choice that you feel is best for both of you.