Epidurals for labor pain

  • Possible effects on newborn behavior -- We know that epidural anesthetics and narcotics get into the baby’s circulation, but we have little data on what effects they might have (18). The few studies that evaluate the newborn use a relatively crude test intended only to detect drug effects on muscle tone. It would miss subtle deficits that would be picked up on tests of behavioral competencies. Even so, the crude test found a difference with one type of narcotic-epidural a day after birth, compared with another type and a plain epidural (18). Of course, all mothers in that study had some type of epidural. We don’t know how the babies might have compared with babies whose mothers had no drugs. In any case, by increasing the likelihood of having Pitocin, instrumental delivery, cesarean delivery, and of keeping babies in the nursery for treatment or observation, epidurals also almost certainly have indirect effects on mothers, babies, and their early interactions.
  • The epidural variations introduce some additional potential problems. The narcotic in a narcotic-epidural can cause itching.

    Combined spinal-epidurals have all the drawbacks of narcotic-epidurals plus:

    • Nausea (7,9,14)
    • Severe postpartum headache -- Compared with an epidural, the incidence of a particularly vicious and prolonged headache rises from 4 per 1,000 to 4 per 100 (1,4,15,19). Improvements in technique may be reducing this risk (2).
    • Maternal respiratory depression -- This is due to the narcotic. This complication is reported to occur as often as one in a thousand cases, and it can be life-threatening (12).
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