Is epidural block safe? The single most important new trend in modern obstetrics is a universally agreed principle that all obstetric practice must be based on the best scientific evidence. What is the evidence on the safety of epidural block?
First, a procedure can hardly be called 'safe' when close to a quarter (23%) of women receiving epidural block have complications. The risks to the woman are many and serious, starting with the possibility the woman will die because of the epidural. The maternal death rate for women having epidural block for normal labour pain is three times higher than for women with normal labour not having the block. For every 500 epidurals performed there will be one case of temporary paralysis of the woman and the paralysis will be permanent in one of every half million epidurals. The woman has a fifteen to twenty percent chance of fever after receiving an epidural, necessitating a diagnostic evaluation for possible infection in the woman and baby which can sometimes be invasive such as requiring a spinal tap of the baby. Between fifteen and thirty five percent of women given an epidural will suffer from urinary retention after the birth.
How effective is epidural block in relieving pain? In around 10% of epidural blocks it doesn't work and there is no pain relief. Even when it works, around a third of women given an epidural will trade a few hours of pain-free labour for days or weeks of pain after the birth. Thirty to forty percent of women receiving an epidural during labour will have severe backs pain after the birth and 20% will still have back pain a year later.
A great deal of scientific research has shown that women receiving epidural block for normal labour pain will have a significantly longer second stage of labour. This, in turn, results in a four times greater risk of using forceps or vacuum extraction and at least a two times greater risk of caesarian section and these operative interventions during birth carry their own serious risks as well. While many women might be willing to take risks with their own bodies to gain pain relief, it is highly unlikely they are willing to put their babies at risk. One common complication in the woman after an epidural is started is sudden loss of blood pressure leading to a sharp drop in blood flow through the placenta to the fetus, resulting in mild to severe lack of oxygen to the fetus as shown on a fetal heart rate monitor. In another typical high-tech strategy of using a second intervention to try to stop the bad effects of the first intervention, doctors give the woman a great big dose of fluid through an IV to try to prevent the drop in blood pressure from the epidural but this does not always work. So lack of oxygen to the baby during the epidural remains a possibility and the American College of Obstetricians and Gynecologists reports that the electronic fetal heart monitor shows severe fetal hypoxia in eight to twelve percent of infants whose mother's are given an epidural block for normal labour pain.
There are other risks to the infant including some data suggesting poor neurological function at one month of age in some babies whose mothers had epidural block. More recent innovations in epidural block, such as changing the type of drugs used or the drug doses used or the 'walking epidural', do not eliminate these risks to the woman and her baby.
One reason for the epidemic of epidural in many countries is that women are not told the scientific facts about all of the risks to them and their babies when epidural block is used for normal labour pain. Indeed, at one meeting of obstetric anesthesiologists in the US, discussions were held on how to prevent any information on risks of epidural from reaching the public. The excuse used was the typical patronizing approach of some doctors: "We don't want to scare the ladies." It is absolutely essential that any women offered epidural must be told all the scientific facts about the risks before she gives informed consent to the procedure.
With all these risks of epidural block to woman and baby, why are doctors urging women to use it? Research shows that doctors prefer the woman to have an epidural because then she is quiet and compliant. Furthermore, it is the frequent use of epidural for normal labour which has created a new specialty, obstetric anesthesiology, which is highly lucrative and flourishing---witness that obstetric anesthesiology journals contain advertisements urging doctors to purchase private jet airplanes.
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trpila, plakala, jaukala, isto mi je bilo- pokušavala sam se suzdržati maximalno zbog mlijeka!
