Epidurals: Understanding the risks

Monday May 09 2016

An epidural is a spinal block injection that is often administered to women when they are giving birth to relieve pain in the lower half of their body.

Some women are keen to avoid requiring an epidural, as the numbness can cause them to strain vital muscles in their backs when pushing without realising, leading to long-term health problems.

But just how risky are epidurals? And what is the safest way for them to be carried out to avoid the risk of a sharps injury, or other complications?

How popular are epidurals?

Statistics from the UK's Royal College of Midwives show that epidurals are increasingly popular among women in labour. In 1989, just 17 per cent of expectant mothers opted for this form of pain relief, but this had risen significantly by 2009 to 33 per cent.

Since then, the number of epidurals administered in Britain has continued to increase, with reports suggesting that this figure had climbed to 40 per cent by 2011.

This form of pain relief is so popular because it takes away the majority, if not all, of the pain associated with natural childbirth, whereas alternative options are only able to relieve women from some of it, temporarily.

A study carried out in 2007 by doctors from the University of Leuven in Belgium led to the discovery that the majority of women who opt for an epidural do so because this form of pain relief has been recommended to them by female friends or family members.

The research paper also found that women were scared of the pain associated with labour, but when it came to the insertion of the epidural needle - which would feel like a sharp scratch at least - they were not as worried.

An epidural numbs the entire lower body from the bottom of the back downwards, meaning women may put unsafe levels of strain on their hips and pelvis while pushing as they cannot feel what they are doing. The injection also means they are unable to feel when they need to go to the toilet, so a catheter is usually fitted after the injection has been administered.

However, there are risks associated with epidurals, for both the patient and the anaesthetist.

Potential risks: For the patient and the anaesthetist

For the anaesthetist, an epidural carries the same potential risks as all other injections. There will always be a slight risk of a sharps injury, but by making sure a needlestick safety cap is used and the correct safety and hygiene guidelines are adhered to at all times, this can be avoided. Needles must never be reused, and clean surgical gloves must be worn whenever any kind of injection is being administered.

All injections carry a slight sharps injury risk for the patient as well, which is why it is so important for patients to remain as still as possible when the epidural is being inserted. This also helps to prevent any complications from arising, such as longer-than-expected paralysis due to the wrong part of the spine being hit.

However, these risks are only small, with US statistics showing that of the two million women who receive an epidural each year in America, just eight will suffer serious complications.

Therefore, as long as the correct safety procedures are followed and women are made aware of the potential risks, there is no reason why an epidural can't be a safe form of pain relief.

Image: ChaNaWIT via iStock