Wednesday, April 17, 2013

Epidurals: The Good, The Bad, and The Ugly

I'm pleased to host anesthesiologist and suspense author, H.S. Clark, as he discusses his thoughts on epidurals. Very informative post. I hope you'll check out his medical thriller Secret Thoughts available on Amazon. 

On the morning on April 7, 1853, a little known innovative physician, Dr. John Snow, was called to Buckingham Palace to administer Chloroform anesthesia to Queen Victoria for the birth of her fourth child, Prince Leopold. The Prince was healthy, and the Queen did not feel the pain of childbirth. That was the beginning of the end for “natural” childbirth, and the dawn of modern anesthesia for labor and delivery.

Buckingham Palace
Now, 25% of mothers give birth by Caesarian section, and 75% of the remaining vaginal births receive either a spinal or epidural anesthetic, so that leaves less than 20% to experience “natural” childbirth. We know now that the designation “natural” does not mean medically superior. The pain and stress of labor and delivery raises maternal blood pressure, increases circulating adrenaline, impairs breathing, and interferes with muscle control and fetal descent, all to the detriment of both mom and her unborn baby. Pain also leads to expulsive deliveries that increase the occurrence and severity of pelvic lacerations.

We’ve now progressed from Chloroform to the use of epidural anesthesia. Small amounts of local anesthetic placed in the lower back near the spinal nerves set up a regional block of the bottom half of the body. It’s like two cops stopping all the highway traffic with a roadblock. Modern epidural anesthesia reduces stress for mom and baby, which is especially helpful if the baby is medically compromised. Epidurals are used not just for pain control, but also as an active tool to manage labor and delivery, and to provide flexible options, safety, and control that is not possible during “natural” childbirth. Unlike the early days of epidural anesthesia, modern epidural methods do not slow labor, have minimal effects on the unborn child, and often help to speed labor and fetal descent.

But in medicine, there is always a down side. Epidurals are wonderful, when they work. Even in the most skilled of hands, epidurals are highly technical, difficult to place and maintain, sometimes marginally effective, and frequently fail. They are best placed after the labor is well established, usually at 3 to 5 cm of cervical dilation. If labor is rapid, there may not be adequate time to place an epidural. Minor complications include a 1% chance of a migraine-like headache that may require treatment, and the rare possibility of nerve damage, seizures, infection, or other life threatening problems. Techniques, drugs, equipment, and monitoring used during an epidural anesthetic are all geared toward preventing complications.

Epidurals are usually an elective choice, but not always. There are labor situations in which epidurals may be mandatory for the safety of both mom and baby. Anesthesia for childbirth is unique because the anesthesiologist must treat two patients at once, each one with very special needs. Epidurals are used by default, because other methods of pain control have unacceptable effects on mom or her unborn child. The delicate balance between pain control and safety during labor and delivery is like a tightrope walk. I wonder if Dr. John Snow realized what he started on that foggy April morning in London.

Secret Thoughts Book Trailer:


H.S. Clark is a mystery writer, physician, anesthesiologist, and the author of Secret Thoughts: a Medical Thriller, set in Seattle. His thrillers are ultimately about the interface of ethics and medicine, and the human struggle for health and wellness. The technology he writes about is 99% cutting edge fact mixed with a 1% glimpse into the future. He showcases the abuses of medicine in order to focus attention on the wonders of medical achievement. Mostly, he wants the reader to enjoy the journey. You can connect with H.S. at his website at:

Secret Thoughts: a Medical Thriller is available for immediate download from Kindle, and in paperback from Amazon  


  1. The anesthesiologist accidentally injected my spinal cord instead of a blood vein and I stopped breathing momentarily. After I read about a study in Japan of hospitals, and the hospitals that never used anesthesia for delivery had half the incidence of autism in the children than the hospitals that always used anesthesia, I decided the bolus of anesthesia that also hit my baby's brain must have contributed to her severe autism. Decades later, I discovered that she got the autism from me, as I am on the high end of the spectrum. I still think she might have been like me if the anesthesia accident had not happened. Well, God put us in a world dominated by chance and statistics, and accidents happen. I hold no bitterness against the anesthesiologist who was doing the best he could during a wild night in the training hospital.

  2. Vey interesting HS and Jordyn! Thank you!

  3. Autism is a devastating problem, and many attempts have been made to find the cause. Studies worldwide involving in total over 100,000 mothers during childbirth have found no causal relationship between autism and labor and delivery anesthesia. These studies did find a higher incidence of autism in babies born to mothers in high-risk delivery situations, but no single cause was identified. Epidural anesthesia is often used to reduce risk in high-risk delivery situations, and may help to protect both mother and baby from serious injury. There is no reason to believe that forgoing labor anesthesia and enduring the pain of “natural” childbirth will benefit the child by reducing the chances for autism, or any other disorder.

  4. Great comments. I, for one, am very thankful for epidurals. I don't think my delivery would have ever progressed without one.

  5. Thank you for this... I write about pregnancy/childbirth and it's honestly really hard to find POSITIVE articles about epidurals. I guess the naysayers are really vocal! I think there's a cultural phenomenon that many people seem to trust the loud voices on the internet over the highly trained professionals who deal with these situations every day. I for one, trust my doctor! Anyway, I appreciate this perspective-- I just sent it to my sister who is about to deliver a baby any day. She said it brought her much peace.

  6. Thanks for the great information!