If you've not gone through labor yourself, then you've likely heard someone else's delivery story, chocked-full of advice and warning: do get the epidural, don't get the epidural. Swayed by a multitude of variables, each woman's experience with labor anesthetics and analgesics can be as different as night and day, feeling like the best thing since over-the-counter emergency contraception to one lady and like pure hell to another. So what's to distinguish these differing experiences? Should you opt for the epidural, or against it?
The answer is, opting for neuraxial anesthesia (epidurals and/or spinals) depends on the individual. Not every woman is comfortable with the sensations of numbness and heaviness that go along with bathing your spinal nerve roots in a cocktail of local anesthetic and opioid drugs (often bupivicaine and a special type of morphine called duramorph). Receiving an epidural also means that for the next several hours of labor until the baby is born, mom cannot get up from bed, walk, or eat food or dark liquids (all safety or precautionary measures). For women who have very low blood pressure, skin infections on the lower back, or who have had back surgeries and/or conditions like scoliosis, epidural placement may be contraindicated.
The good news is, however, for the majority of laboring women, epidural and spinal placement is extremely safe, for mom and baby. That said, it's worth listing the several risks you might hear when you request an epidural. The first and most common is that the epidural won't work. In one out of 10 women, the epidural will be "patchy," covering half, part, or most but not all of the area that is meant to be numb. In this case, the anesthesiologist administering the epidural might take out the original sterile catheter and try to place a second into a better location within the epidural space.
Other risks include infection (just as with anything entering from the outside environment: IVs, catheters, needles), headache, and damage to nerves. All of these are extremely rare however, occurring in only one in 100 women for headache and one in several thousand women for temporary nerve damage.