Epidural's Impact: Newborn Problems And Solutions

Epidurals are a common method of pain relief during labour, with around 67% to 75% of women in the US opting for this procedure. While epidurals are generally considered safe, there are some risks and side effects that can affect both the mother and the baby.

For the mother, side effects can include a drop in blood pressure, difficulty urinating, itching, fever, headaches, and in rare cases, nerve damage. For the baby, epidurals can cause changes in heart rate, reduced muscle tone, and may increase the likelihood of an assisted delivery.

While epidurals can provide much-needed pain relief during labour, it is important for women to be aware of the potential risks and side effects and to discuss these with their healthcare provider when making an informed decision about their birth plan.

Nerve damage

The needle or epidural tube can cause temporary nerve damage, resulting in a loss of feeling or movement in parts of the lower body. This is uncommon, and the most common symptom is a small, numb area with normal movement and strength. In rare cases, an epidural can lead to permanent loss of feeling or movement, such as in one or both legs. This can be caused by direct damage to the spinal cord from the needle or catheter, infection, bleeding, or the injection of the wrong medicine into the catheter.

The risk of nerve damage is very small, with studies reporting rates of less than 1% of cases. Anaesthesiologists have extensive training to reduce the chances of these complications occurring.

Low blood pressure

To treat low blood pressure caused by an epidural, more IV fluids can be given. If the hypotension is severe, injections of epinephrine (adrenaline) may be administered.

It's important to note that low blood pressure is usually temporary and can be effectively managed by medical professionals.

Fever

Effects on the Mother

Maternal fever during labour can cause decreased uterine contractions, increased caesarean delivery rates, and increased postpartum haemorrhaging.

Effects on the Baby

Maternal fever during labour can have adverse effects on the baby, including:

• Neonatal encephalopathy
• Respiratory distress syndrome
• Meconium aspiration syndrome
• Neonatal intensive care unit admission
• Fetal acidosis
• Low Apgar scores

Treatment

There are currently no safe and effective treatments for epidural-related maternal fever. Antibiotics are often administered to manage maternal fevers, but this is primarily to mitigate the risk of infection.

Breathing problems

Babies whose mothers have an epidural are more likely to develop respiratory distress syndrome in the period immediately after birth. The most common form of epidural used is a local anesthetic with a narcotic or opioid.

Most care providers believe the small amount of epidural medication that reaches the baby is not enough to cause any ill effects. However, it is known that opiates can cross the placenta during labor and cause respiratory depression. This means the baby is not getting enough oxygen and can’t excrete enough carbon dioxide.

Babies who develop respiratory distress syndrome will need help with breathing. In some cases, babies cannot breathe efficiently on their own at birth and will need resuscitation, which is an emergency and can be a very stressful and frightening experience for parents.

There is also medication that can reverse the respiratory depression caused by opiates in babies. This medication is given intravenously (through a vein) and the effects are usually quick and last for about 2 hours.

If babies are born with breathing trouble, following an epidural, it makes sense that they will not have high scores on their Apgar chart.

The Apgar score is a quick test performed on newborns at 1 and 5 minutes after birth. The 1-minute score shows how well the baby tolerated labor and birth. The 5-minute score determines how well the baby is doing outside the mother’s womb.

The Apgar score is based on a total score of 1 to 10. If the score is lower than 7 the baby will need medical attention.

After having breathing problems and poor Apgar scores, babies who have been affected by epidurals, as a follow-up measure, will probably be taken to a neonatal intensive care unit (NICU) for observation and continued medical attention.

While staying in the NICU doesn’t seem to be harmful in itself, it means that mother and baby are separated immediately after birth. This can have significant effects on the baby’s physical wellbeing, as well as on the emotional wellbeing of both mother and baby.

Babies who are separated from their mothers are less likely to experience early breastfeeding. Being held skin to skin promotes oxytocin production in both mother and baby. Oxytocin stimulates the milk let-down reflex, and promotes mother-baby bonding. The production of this hormone in mothers, however, is lowered when epidurals are used.

Babies are also more likely to have problems regulating their temperature when they are separated from their mother’s body. Separation also increases a baby’s distress; babies are biologically developed to signal to their mothers to be held, fed and kept safe. If these needs are not met, babies can go into what is known as a despair state, where they become still and quiet.

Tips For Post Epidural Support

The choice to have an epidural is a personal one, and should be made while taking into consideration the risks and benefits. You might wish to avoid an epidural, but perhaps your care provider has a high induction rate (epidurals are more common with inductions), or you have a fear of birth and worry about coping with the pain of labor. Ensure you are well informed about your options for birth, so an epidural doesn’t have to be automatic at some point.

If you do choose to have an epidural, being aware of how this might affect your baby will help you to work with your care providers so as to provide the best start to your baby’s life. Here are a few ways you can promote a positive experience after birth:

• Leave the umbilical cord: while the cord is left intact, babies are receiving vital oxygenated blood stores. If your baby’s breathing isn’t ideal after birth, they will still be getting oxygen for several minutes while the cord continues to pulsate.
• Keep your baby near you: talk to your care provider about providing resuscitation methods on the bed, where you and your baby will be after birth. Most resuscitation methods can be provided simply, such as giving oxygen via a mask, or stimulation.
• Keep your baby close: skin-to-skin contact is one of the most vital aspects of post-birth support for your baby. Your baby will feel warm and safe. If you aren’t able to do this for some reason, ask your partner to strip off his shirt and hold the baby close to his chest and heart.
• If your baby needs more help and support in NICU, talk to your care provider about having as much skin-to-skin, and breastfeeding support, as possible.

Reduced breastfeeding

While epidurals are a common form of pain relief during labour, there are concerns about their impact on breastfeeding. The medication in an epidural can cross the placenta and get into the newborn's circulation, and has also been found in breast milk.

Some of the ways in which epidurals could theoretically affect breastfeeding include:

• The medications could affect the newborn's ability to suck and latch onto the breast.
• The medications could lead to the mother developing a fever during labour, which is linked to lower Apgar scores in the baby and potentially more health problems that could make breastfeeding more difficult.
• The medications could influence the mother's hormones, which may impact breastfeeding.
• Epidurals are linked to higher rates of vacuum and forceps delivery, which could impact breastfeeding due to the need for stitches, bruising, or delayed skin-to-skin contact.
• The longer second stages of labour associated with epidurals could tire the mother and baby, making breastfeeding more difficult.
• The higher amounts of IV fluids given during an epidural could lead to painful breast swelling, or engorgement, which can make breastfeeding difficult.

However, the research evidence on the impact of epidurals on breastfeeding is conflicting. Some studies have found that epidurals harm breastfeeding, while others have found no impact or even a positive impact. Two high-quality randomised controlled trials have examined the dose of medication in epidurals and its impact on breastfeeding, with one finding no impact and the other finding that a very high dose may negatively influence breastfeeding.

At this time, an evidence-based approach would be to provide mothers with alternatives to epidurals for pain relief during labour, and to provide additional support for breastfeeding to mothers who received an epidural, especially if a high dose was used.

Frequently asked questions