Weeks after the Food and Drug Administration warned of serious complications from epidural steroid injections, American Society of Anesthesiologists (ASA) called the risk of complications from epidurals during childbirth a “myth” and said the procedure was “one of the most effective, safest and widely used forms of pain management for women in labor.”
The ASA also published a new study in the journal Anesthesiology, calling the risk of serious complications “very rare,” occurring in about 1 of 3,000 cases.
The complications may be rare, but for those who have them, they are devastating.
“This procedure can relieve pain for a few hours, or it can cause pain worse than labor every day for the rest of your life,” says Dawn Gonzalez, whose spine was punctured and permanently damaged by an epidural during child birth.
Gonzalez now suffers from Arachnoiditis, a chronic inflammation in the arachnoid membrane that surrounds her spinal cord. Her membrane was punctured by a needle during the epidural, triggering inflammation that caused scar tissue to adhere to the nerves in her spinal cord. Eventually her nerves become encased in scar tissue, causing severe chronic pain and disability.
“As a mother injured by an obstetric epidural myself, it took three years before two plus two was put together, and it was realized that I had adhesive Arachnoiditis from my single birth epidural. It’s all about informed consent. Honest, true informed consent,” said Gonzalez, who wrote about her experience in a column on National Pain Report published alongside this article.
Epidurals during child birth or to control back pain are two of the most common medical procedures performed today. About 9 million epidural steroid injections, mostly for back pain, are performed annually in the U.S. And more than 60 percent of American women in labor get an epidural, spinal or combined spinal-epidural anesthesia to control their pain during childbirth, according to the National Center for Health Statistics.
But only recently has the risk of serious complications related to obstetric anesthesia been analyzed in a large scale study.
Researchers for the Society for Obstetric Anesthesia and Perinatology gathered data from over 257,000 deliveries in which epidural, spinal or general anesthesia was administered during childbirth. Thirty healthcare facilities participated in the Serious Complication Repository (SCORE) Project between 2004 and 2009.
They found a total of 157 serious complications, 85 of which were anesthesia-related. The two most frequent complications were an excessive dose of anesthesia (one in 4,336 deliveries) and respiratory arrest during labor and delivery (one in 10,042).
An “unrecognized spinal catheter” – the accidental puncture of a spinal membrane – occurred in about one in 15,435 deliveries.
“This is the first multicenter study to examine the incidence of serious complications associated with obstetric anesthesia,” said lead author Robert D’Angelo, MD, a professor of anesthesiology at Wake Forest University School of Medicine in Winston-Salem, North Carolina.
“We were extremely pleased to find that serious complications such as bleeding, infection, paralysis and maternal death were extremely rare. However, since many complications can lead to catastrophic outcomes, it is important that physician anesthesiologists remain vigilant and prepared to rapidly diagnose and treat any complication, should it arise.”
The numbers may be reassuring to anesthesiologists, but many expectant mothers remain leery about epidurals. In a study published last year in the International Journal of Obstetric Anethesia, over a third of the women (39%) surveyed expressed concern about epidurals, with many saying they were worried about complications and preferred a natural childbirth.
“My own mother didn’t want me to have an epidural because she thought it would hurt my baby,” said lead author Paloma Toledo, MD, an obstetric physician anesthesiologist and assistant professor of anesthesiology at Northwestern University Feinberg School of Medicine, Chicago.
“But when I showed her the overwhelming scientific evidence that it was safe for me and the baby, she felt good about my decision.”
Dawn Gonzalez is not convinced and says researchers need to follow mothers for years after their epidurals to determine the long term risks from the procedure.
“The complications a lot of the times do not show immediately,” Gonzalez wrote in an email to National Pain Report.
“These injections are done completely blindly, so the chance of missing is quite high. I had a slight, unnoticeable scoliosis myself, and that is how I was damaged so badly. Other things come into play, like being overweight, or any of the bony landmarks that they use being different on your body. It’s basically playing roulette!”