Chapter 13 - Epidurals and outcome

Summary

Epidurals are the most effective mode of analgesia for labor pain. Neurological complications, although rare, remain one of the most important causes of anxiety in the parturient and it is important to provide reassurance while providing accurate data for informed consent. Central nervous system (CNS) lesions secondary to epidural analgesia are very rare. They can be classified into four etiologies: traumatic, ischemic, infective, or chemical, or can sometimes be a combination thereof. High-quality evidence supports that there is no causal relationship between epidural labor analgesia and the development of new chronic back pain. High-dose epidural fentanyl may be associated with an adverse effect on breastfeeding. Women who labor with epidural analgesia experience an increase in temperature, which is associated with administration of antibiotics to both mother and babies, increased neonatal sepsis workups, as well as possibly increased operative deliveries.