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Study Of 80,000 Birthing Moms Suggests Epidurals Safer Than Thought

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I subscribe to the dentistry school of birthing babies. That is, I wouldn't want to get a tooth filled without Novocaine, and I wouldn't want to have a baby without an epidural.

I know that opinions — strong ones — vary on this, but for those of my ilk who'd like yet another data point to support the pain-relief side, here it is: A national study, one of the biggest yet, of complications from epidurals has just been presented at the annual conference of the American Society of Anesthesiologists now under way in New Orleans. And it suggests that epidurals are even safer than previously thought, with rates of the most-feared complications well under 1 percent.

Dr. Samir Jani, a senior resident in anesthesiology at Beth Israel Deaconess Medical Center, presented the findings, gleaned from a giant national database of anesthesiology cases, the National Anesthesia Clinical Outcomes Registry.

He found that among more than 80,000 cases of anesthesia during labor and delivery, 2,223 involved complications, for an overall rate of 2.78 percent. But most of those concerned medication errors — over-dosing, under-dosing, or use of expired drugs.

The rate of the complications that many women fear most — nerve damage or an excruciating "spinal headache" — were even lower than previously estimated, Dr. Jani said: .2 percent — that's 2/10 of one percent — for the headache; .002 percent for spinal nerve damage and .14 percent for damage to other nerves.

"So it’s well under 1 percent for the kinds of complications that I think a lot of women worry about," he said, not the 1-2 percent that he's been quoting his patients based on textbook teachings.

An awkward question: But don't anesthesiologists tend to be pretty pro-anesthesia? Mightn't that bias the results?

"Actually," Dr. Jani said, "Whenever I talk to all my patients, I tell them, 'I'm not here to sell you an epidural. it's your ultimate decision.' And I think that that's the mentality that almost all of us have. We aren't ever going to force on a patient what they don't want. But in that informed consent process, it's important we quote not only possible complications but the rates to the best of our knowledge. At the end of the day, it's good to be able to tell your patient that this is a safe and efficient method to be able to control labor pain."

And what about the common belief that getting an epidural can hinder the pushing process in labor?

The study did not look at that question, Dr. Jani said, but "in our current knowledge, we don't believe that's the case. If a woman is going to have dysfunctional labor, it's going to happen with or without the epidural."

Bottom line, he said: Most epidurals are considered elective, and patients need to be informed accurately of possible complications. "Prior to this knowledge, I'd mention that the most common risk would be a headache afterward and potential nerve damage — but now I can be more confident in saying it's even less than we thought and it's extremely low."

Readers, thoughts? Experiences?

Carey Goldberg Twitter Editor, CommonHealth
Carey Goldberg is the editor of WBUR's CommonHealth section.

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