For expectant mothers, the decision of whether to receive an epidural, spinal or general anesthesia during labor comes with certain risks to consider. But a new study suggests serious complications from such anodynes are quite rare and occur in only 1 in every 3,000 births.
The study - led by Dr. Robert D'Angelo, of Wake Forest University School of Medicine in North Carolina - is published in Anesthesiology, the journal of the American Society of Anesthesiologists.
An epidural is a local anesthetic that is delivered to the mother through a catheter placed in the back. While a spinal is similar to an epidural and is administered through a needle into the spinal canal, the effects of this procedure are felt immediately.
According to the American Pregnancy Association, epidurals are the most popular method of pain relief during labor; 50% of women who give birth at hospitals use epidurals.
Though these anesthetics provide comfort from the pain of childbirth, they also carry some risks. Some of these include serious complications, such as:
- High neuraxial block - an unexpected high level of anesthesia that develops in the central nervous system
- Respiratory arrest in labor and delivery
- Unrecognized spinal catheter - an undetected infusion of local anesthetic through an accidental puncture of an outer spinal cord membrane.
In the first multi-center study of its kind to look at rates of serious complications linked to anesthesia, Dr. D'Angelo and his team used data from the Society for Obstetric Anesthesia and Perinatology's (SOAP's) Serious Complication Repository (SCORE) project.
This is a large database that captures delivery statistics and tracks complications.
Complications rare, but anesthesiologists 'should remain vigilant'
From 30 institutions between 2004 and 2009, the team found more than 257,000 deliveries where epidural, spinal or general anesthesia was given during childbirth; this included both vaginal and cesarean deliveries.
In total, there were 157 complications reported, and 85 of them were linked to anesthesia.
Though this is a small number of complications given the large sample size, the researchers observed the most common anesthesia-related complications: 1 in 4,336 deliveries resulted in high neuraxial block, 1 in 10,042 resulted in respiratory arrest in labor and delivery, and 1 in 15,435 resulted in unrecognized spinal catheter.
Commenting on their findings, Dr. D'Angelo says:
"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 anesthesiologists remain vigilant and prepared to rapidly diagnose and treat any complication, should it arise."
The team intended to identify risk factors associated with the complications so that they could create formal practice advisories or guidelines, but because serious complications linked to anesthesia were so rare, they say there were too few complications in each category to identify these risk factors.
Even so, the researchers say their findings can be used to guide discussions with patients.
Additionally, the findings will be used to create a national obstetric anesthesia complication registry, as part of the Anesthesia Incident Reporting System. This system will be able to alert anesthesiologists and create new educational materials for patient safety, the team says.
Medical News Today recently reported on a study that suggested changing the way a baby is held before its umbilical cord is clamped could improve rates of iron deficiencies in newborns.