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| Procedure | Epidural anesthesia |
| What Is It? | Regional anesthesia of lower two-thirds of body |
| Who Needs It? | Women who do not have access to comfort measures and are not able to tolerate or don't want to tolerate the pain of labor |
| Who Doesn't Need It | Women with continuous support and access to a wide variety of comfort measures and maternal positions; women with blood-clotting problems |
| Risks | 1. Decrease in maternal blood pressure 2. Decrease in fetal heart rate 3. Lack of variability in fetal heart rate 4. Urinary retention requiring catheterization 5. Increase in chance for urinary infection 6. Itching if intrathecal narcotics used 7. Prolonged labor 8. Increase in need for instrumental delivery via forceps or vacuum aspiration 9. Reported increase (in some studies) of cesarean section (two to fourfold), especially in first-time mothers 10. Increase in need for episiotomy 11. Headache 12. Respiratory arrest or paralysis in rare cases 13. Increase in labor interventions 14. Infection 15. Ineffective pain relief 15. Increase in maternal temperature 16. Breastfeeding difficulties |
| Benefit | Pain relief when other comfort measures are ineffective or when a cesarean section is needed |
Note: Research suggests the use of these procedures in a routine way creates unnecessary risks for mother and baby. At the same time, there are clear indications for the use of most procedures when a medical complication arises. In the case of epidural anesthesia, when other comfort measures are either unavailable or ineffective.
