Does an epidural put me or my baby at risk?

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Q: I’m nine months pregnant and will deliver shortly. I’m scared to death of labor pains, and my doctor has assured me that an epidural will be available. Does it put me or my baby at greater risk?

A: There have been tremendous numbers of studies looking at the safety of epidurals, each comprised of hundreds, even thousands, of women.

One of the most recent was a systematic review by the Cochrane Collaboration of 21 clinical trials involving more than 6,500 women. These studies were performed over the past few years and compared the results of labor and delivery in women who received epidural anesthesia for pain relief to women who received other forms of pain relief or no pain relief at all.

So here’s the good news — they found no increase in C-section rates among women who chose to or needed to have epidural anesthesia. They did, however, find that there was about a 15-minute increase in duration of the second stage (the pushing stage) of labor.

In addition, among women using epidurals, there was a slight increase (about 18 percent) in the need for pitocin, a synthetic hormone that is used to induce or speed up labor. There was a 20-fold increase in risk of maternal hypotension and a 17-fold increase in urinary retention (difficulty in voiding after delivery).

The researchers also compared Apgar scores, used to measure the well-being of the baby, and found no difference between the babies delivered after epidural anesthesia and those that were delivered by mothers who did not have epidurals. Nor did they find a difference in the duration of the first stage of labor (the time it takes to become fully dilated); maternal satisfaction with the delivery experience; and subsequent maternal depression, nausea vomiting or drowsiness.

You also should know that the types of epidurals currently used have even lower doses of anesthetia than those used in most of these studies. So we expect that with these lower doses, the need for pitocin enhancement of labor will become less necessary.

Dr. Reichman’s Bottom Line: An epidural will ensure diminished discomfort during labor and delivery. If you and your doctor decide to utilize this form of anesthesia, it appears to be safe and should not adversely affect your delivery.

Dr. Judith Reichman, the “Today” show's medical contributor on women's health, has practiced obstetrics and gynecology for more than 20 years. You will find many answers to your questions in her latest book, "Slow Your Clock Down: The Complete Guide to a Healthy, Younger You," which is now available in paperback. It is published by William Morrow, a division of HarperCollins.