Epidural block has become a popular method of pain management during labor. However, questions persist regarding its safety and effects on mother and baby. Epidural anesthesia is a regional anesthesia, which means it blocks pain from a specific region in the body. The goal of a labor epidural is to block pain impulses from lower spinal segments that can result in decreased feeling in the abdominal and pelvic area. Optimally, this decreases the pain experienced during contractions and labor; however, it allows the patient to retain enough feeling to push the baby out when full cervical dilation is reached.

A combination of medicines is commonly used in epidural anesthesia. These include local anesthetics such as bupivicane, marcaine, or lidocaine, to numb the area; opioids such as fentanyl, or morphine, to decrease pain sensation; and other medication such as epinephrine type drugs that can be used to stabilize the mother’s blood pressure.

Although an epidural may be beneficial due to decreases in labor pain, there are associated risks as well. Maternal side effects can include pain at the spinal injection site as well as leakage of spinal fluid than can cause severe headaches (“spinal headache”) that may require additional treatment.Epidural anesthesia may slow the labor and increase the use of operative delivery techniques such as cesarean section, forceps, or vacuum extraction.

If medical malpractice occurs during placement and management of epidural anesthesia, injury to the newborn may result. After epidural placement, the patient may sustain a drop in blood pressure. The drop in maternal blood pressure may decrease the amount of blood travelling across the placenta and lead to a decrease in blood, oxygen, and nutrients reaching the baby. If the baby was adversely affected by an epidural, there may be abnormal changes in the fetal heart rate pattern.

Medical malpractice may occur in the context of failing to properly manage maternal hypotension (low blood pressure). Decelerations or other non-reassuring patterns in the fetal heart rate can indicate impending damage to the newborn. It is essential that these complications are managed in a timely fashion with appropriate medical intervention to avoid brain injury to the baby from oxygen deprivation.

For example, if the mother’s blood pressure decreases significantly from the epidural, medications can be given to mitigate this effect and raise the blood pressure. By raising the maternal blood pressure, proper placental blood flow is restored or maintained and the baby will be less likely to suffer injury. In addition, oxygen may be administered to the mother during the labor epidural. This can increase the amount of oxygen in the maternal blood, and thereby increase the amount of oxygen in the blood that reaches the baby. This will also serve to decrease the likelihood of fetal injury.

Medical malpractice may occur when maternal blood pressure drops too low causing less oxygen and nutrients to reach the fetus. The baby can suffer permanent brain injury from lack of oxygen. This can manifest as seizures, cerebral palsy, or developmental delay.