Delivery Room Myths - Epidurals Can Cause Nerve Damage or Paralysis

During the course of labor, many women choose to have some sort of pain control. Of those women, a majority will opt for epidural anesthesia.

While practicing obstetrics in the military system, I was assigned the task of teaching a birthing class at the hospital. During the first discussion of epidural anesthesia, I decided to conduct an informal study on the patients and their desires for anesthesia, if any. I placed ten sheets of paper numbered one through ten in sequential order on the floor. I then asked the patients to stand behind a certain number. Patients completely opposed to epidural anesthesia stood behind number one and those defi­nite about using an epidural stood behind number ten. Patients uncertain about epidurals stood behind a number in between. As I repeated this exercise with each class, I discovered consistent desires on the part of patients. Eighty to 90 percent would line up behind number one, while 10 to 20 percent of patients would stand behind number ten. What fasci­nated me was that nobody ever stood behind the numbers in between. This simple study shows how polarizing this issue can be and how intensely ingrained we are in our individual belief structures.

There are hundreds of reasons for having a natural childbirth. If you have a strong desire to experience this, we would certainly encourage it. If the reason for a natural birth, meaning one without pain medication or epidural, is a fear of the epidural itself, then please read ahead with an open mind. Many women fear that the epidural will cause nerve damage or paralysis. This fear usually stems from a story related by a friend or family member.

The first recorded use of an epidural was in 1885 in New York when neurologist J. Leonard Corning injected cocaine into the epidural space of a patient suffering from "spinal weakness seminal incontinence."7 Recent studies from 2002 show that approximately 66 percent of women used epidural anesthesia, and more than half of those patients had vaginal deliveries.8 Interestingly, utilization of epidurals has not increased patient satisfaction with the birthing process.9 Epidurals can influence and affect the birthing hormones by decreasing the pain sensation, but studies have shown that epidurals decrease levels of naturally produced beta-endorphins, which are the body's natural narcotics.

What are the side effects of epidurals, and can they harm or paralyze you? Keep in mind that any surgical procedure—and we consider the placement of an epidural a minor surgical procedure, carries risks and benefits. We would like to remind the reader that these risks are rare. Since epidurals are elective procedures, you should have an extensive consent process, meaning that you should speak with the practitioner who will be inserting the epidural catheter and ask all your questions of him or her.

The following is a list of epidural complications, presented in no par­ticular order:

- Hypotension, or a significant drop in the patient's blood pressure, can be seen in almost half of the epidurals placed.10

- Sedation occurs in 20 percent of women.11

- Nausea and vomiting occur in 1 out of 20 patients.

- Inadequate pain control happens in 10 to 15 percent of patients. This number reflects the patient who has a desire for 100 percent pain control, which, under perfect conditions, may be impossible to obtain. Remember, epidurals are an elective procedure for pain con­trol, not necessarily pain elimination.

- Spinal headache. Approximately 1 percent of patient's receiving an epidural will incur a spinal headache. This complication results from the tip of the needle puncturing the inner lining of the sheath cov­ering the spinal cord. Cerebrospinal fluid can leak out, causing a headache. Patients with spinal headaches have severe migrainelike head pain when they sit upright or stand. The pain tends to improve significantly when the patient lies down. Initial treatments are aggressive hydration by mouth and increased caffeine intake. If the symptoms are severe or persistent, the physician may prescribe a blood patch. The anesthesiologist will draw a small amount of the patient's blood from the arm and inject it into the epidural site. This blood bathes the puncture site and clots over it, thus closing the hole that is leaking. Relief is usually immediate.

- Weakness and numbness after the procedure.12 If this rare compli­cation occurs, it's usually noticed after delivery. The actual occur­rence is anywhere from 4 to 18 per 10,000 patients. In most cases the condition completely resolves within three months of the proce­dure. The complication results when the needle comes in contact with either the spinal cord or the nerves that enter the spinal cord. At the point where the epidural is placed, the spinal cord is not the thick cord that it is higher up in the back. It's called the cauda equine, Latin for "horse's tail." As the name indicates, this part of the spinal cord is a fanned-out group of very small cords, like the hair of a horse's tail. This formation increases the likelihood of injury com­pared to what it would be higher up where the cord is much thicker.

- Permanent disability. A retrospective study of serious nonfatal com­plications of epidural block in obstetric practice was carried out using a postal questionnaire. Two hundred and thirty-three obstetric units in the United Kingdom (responsible for 2,580,000 deliveries from 1982 to 1986) responded. Out of 505,000 epidural blocks per­formed (84 percent for pain relief and 15 percent for cesarean sec­tion), 108, or 0.0002 percent of cases involved complications, and of these 108, only 5 resulted in permanent disability. Indeed, this is an extremely rare event, a 0.000001 percent chance, to be exact.

Many women are concerned that an epidural is the only choice for pain relief during labor, which often exacerbates their fear and anxiety about labor. Eepidurals are safe, but they are not without com­plications. Other options for laboring patients include IV pain medications like morphine, Demerol, Stadol, and Nubain. These medications are all considered to be narcotic sedatives and cross the placenta into the fetus. Women who receive these medications claim that they can still feel pain but that they aren't overwhelmed by it and thus may be more relaxed and less fearful. Also, these medications can make the mother lightheaded and sleepy. These same symptoms can occur in the fetus and are evident with the fetal heart rate tracing. The symptoms are temporary in the mother, and the fetus's symptoms will spontaneously resolve with time. As the labor nears delivery, we stop administering these medications because they can cause respiratory depression in the newborn. This means that during the last portion of labor, as well as during the second stage of labor, which is the pushing stage, these medications are not an option for pain control.

Hypnosis has become more and more popular as a method of pain control in American hospitals. Like the Lamaze Method, hypnosis uses a focused state of concentration. Other nonmedical, natural methods of dealing with pain include the Bradley method, which teaches the mother and her partner the physiology behind labor and how to work as a team, with the partner as coach. Some women rely on a doula during labor. Lit­erally translated from ancient Greek, doula means "woman who serves." Doulas provide emotional and physical support to a patient during labor and the postpartum period. We know women who used massage therapy as well as aromatherapy. We have not personally seen acupuncture used in the delivery room, and that may be because the use of needles in the delivery room would be against hospital policy. We are firm believers in complementary practices such as acupuncture, however, and hope that in the future, this practice will make its way into routine deliveries.