Effects of Epidural Analgesia on Labor and the Infant

  • Sanjay Datta
  • Bhavani Shankar Kodali
  • Scott Segal


Properly conducted epidural analgesia is generally quite safe and effective. However, even in the absence of complications, epidural blockade can have effects on the course of labor and on the baby. Regional anesthesia can affect the fetus indirectly through alterations in uterine perfusion and directly through placental transfer of drug. These effects are discussed in  Chapters 3 and  5. This chapter discusses the three most important additional phenomena: effect on the progress of labor and mode of delivery, effect on maternal temperature, and effect on breastfeeding.


Cerebral Palsy Cesarean Delivery Epidural Analgesia Labor Analgesia Epidural Blockade 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Segal BS, Birnbach DJ. Epidurals and cesarean deliveries: a new look at an old problem. Anesth Analg. 2000;90(4):775–777.CrossRefPubMedGoogle Scholar
  2. 2.
    Panni MK, Segal S. Local anesthetic requirements are greater in dystocia than in normal labor. Anesthesiology. 2003;98(4):957–963.CrossRefPubMedGoogle Scholar
  3. 3.
    Thorp JA, Hu DH, Albin RM, et al. The effect of intrapartum epidural analgesia on nulliparous labor: a randomized, controlled, prospective trial. Am J Obstet Gynecol. 1993;169(4):851–858.PubMedGoogle Scholar
  4. 4.
    Lieberman E, Lang JM, Cohen A, D’Agostino R, Jr., Datta S, Frigoletto FD, Jr. Association of epidural analgesia with cesarean delivery in nulliparas. Obstet Gynecol. 1996;88(6):993–1000.CrossRefPubMedGoogle Scholar
  5. 5.
    Chestnut DH, McGrath JM, Vincent RD, Jr., et al. Does early administration of epidural analgesia affect obstetric outcome in nulliparous women who are in spontaneous labor? Anesthesiology. 1994;80(6):1201–1208.CrossRefPubMedGoogle Scholar
  6. 6.
    Ohel G, Gonen R, Vaida S, Barak S, Gaitini L. Early versus late initiation of epidural analgesia in labor: does it increase the risk of cesarean section? A randomized trial. Am J Obstet Gynecol. 2006;194(3):600–605.CrossRefPubMedGoogle Scholar
  7. 7.
    American College of Obstetricians and Gynecologists, Committee on Obstetric Practice. Pain relief in labor. ACOG Committee opinion No. 231. Washington, DC: ACOG; 2000.Google Scholar
  8. 8.
    American College of Obstetricians and Gynecologists, Committee on Obstetric Practice. ACOG committee opinion. No. 339: Analgesia and cesarean delivery rates. Obstet Gynecol. 2006;107(6):1487–1488.Google Scholar
  9. 9.
    Cheek TG, Samuels P, Miller F, Tobin M, Gutsche BB. Normal saline i.v. fluid load decreases uterine activity in active labour. Br J Anaesth. 1996;77(5):632–635.PubMedGoogle Scholar
  10. 10.
    Bleyaert A, Soetens M, Vaes L, Van Steenberge AL, Van der Donck A. Bupivacaine, 0.125 per cent, in obstetric epidural analgesia: experience in three thousand cases. Anesthesiology. 1979;51(5):435–438.CrossRefPubMedGoogle Scholar
  11. 11.
    Abboud TK, David S, Nagappala S, et al. Maternal, fetal, and neonatal effects of lidocaine with and without epinephrine for epidural anesthesia in obstetrics. Anesth Analg. 1984;63(11):973–979.CrossRefPubMedGoogle Scholar
  12. 12.
    Anim-Somuah M, Smyth R, Howell C. Epidural versus non-epidural or no analgesia in labour. Cochrane Database Syst Rev. 2005;4:CD000331.PubMedGoogle Scholar
  13. 13.
    Leighton BL, Halpern SH. Epidural analgesia: effects on labor progress and maternal and neonatal outcome. Semin Perinatol. 2002;26(2):122–135.CrossRefPubMedGoogle Scholar
  14. 14.
    Phillips KC, Thomas TA. Second stage of labour with or without extradural analgesia. Anaesthesia. 1983;38(10):972–976.CrossRefPubMedGoogle Scholar
  15. 15.
    Chestnut DH, Laszewski LJ, Pollack KL, Bates JN, Manago NK, Choi WW. Continuous epidural infusion of 0.0625% bupivacaine–0.0002% fentanyl during the second stage of labor. Anesthesiology. 1990;72(4):613–618.CrossRefPubMedGoogle Scholar
  16. 16.
    Segal S, Su M, Gilbert P. The effect of a rapid change in availability of epidural analgesia on the cesarean delivery rate: a meta-analysis. Am J Obstet Gynecol. 2000;183(4):974–978.CrossRefPubMedGoogle Scholar
  17. 17.
    Camann WR, Hortvet LA, Hughes N, Bader AM, Datta S. Maternal temperature regulation during extradural analgesia for labour. Br J Anaesth. 1991;67(5):565–568.CrossRefPubMedGoogle Scholar
  18. 18.
    Fusi L, Steer PJ, Maresh MJ, Beard RW. Maternal pyrexia associated with the use of epidural analgesia in labour. Lancet. 1989;1(8649):1250–1252.CrossRefPubMedGoogle Scholar
  19. 19.
    Goetzl L, Rivers J, Zighelboim I, Wali A, Badell M, Suresh MS. Intrapartum epidural analgesia and maternal temperature regulation. Obstet Gynecol. 2007;109(3):687–690.CrossRefPubMedGoogle Scholar
  20. 20.
    Gelfand T, Palanisamy A, Tsen LC, Segal S. Warming in parturients with epidurals is an averaging artifact. Anesthesiology. 2007;106:A5.Google Scholar
  21. 21.
    Leighton BL, Halpern SH. The effects of epidural analgesia on labor, maternal, and neonatal outcomes: a systematic review. Am J Obstet Gynecol. 2002;186(5 Suppl Nature):S69–S77.PubMedGoogle Scholar
  22. 22.
    Lieberman E, Lang JM, Frigoletto F, Jr., Richardson DK, Ringer SA, Cohen A. Epidural analgesia, intrapartum fever, and neonatal sepsis evaluation. Pediatrics. 1997;99(3):415–419.CrossRefPubMedGoogle Scholar
  23. 23.
    Yancey MK, Zhang J, Schwarz J, Dietrich CS, 3rd, Klebanoff M. Labor epidural analgesia and intrapartum maternal hyperthermia. Obstet Gynecol. 2001;98(5 Pt 1):763–770.CrossRefPubMedGoogle Scholar
  24. 24.
    Vallejo MC, Kaul B, Adler LJ, et al. Chorioamnionitis, not epidural analgesia, is associated with maternal fever during labour. Can J Anaesth. 2001;48(11):1122–1126.CrossRefPubMedGoogle Scholar
  25. 25.
    Lieberman E, Lang J, Richardson DK, Frigoletto FD, Heffner LJ, Cohen A. Intrapartum maternal fever and neonatal outcome. Pediatrics. 2000;105(1 Pt 1):8–13.CrossRefPubMedGoogle Scholar
  26. 26.
    Grether JK, Nelson KB. Maternal infection and cerebral palsy in infants of normal birth weight. JAMA. 1997;278(3):207–211.CrossRefPubMedGoogle Scholar
  27. 27.
    Wu YW, Escobar GJ, Grether JK, Croen LA, Greene JD, Newman TB. Chorioamnionitis and cerebral palsy in term and near-term infants. JAMA. 2003;290(20):2677–2684.CrossRefPubMedGoogle Scholar
  28. 28.
    Impey L, Greenwood C, MacQuillan K, Reynolds M, Sheil O. Fever in labour and neonatal encephalopathy: a prospective cohort study. BJOG. 2001;108(6):594–597.CrossRefPubMedGoogle Scholar
  29. 29.
    Dammann O, Drescher J, Veelken N. Maternal fever at birth and non-verbal intelligence at age 9 years in preterm infants. Dev Med Child Neurol. 2003;45(3):148–151.CrossRefPubMedGoogle Scholar
  30. 30.
    Yoon BH, Kim CJ, Romero R, et al. Experimentally induced intrauterine infection causes fetal brain white matter lesions in rabbits. Am J Obstet Gynecol. 1997;177(4):797–802.CrossRefPubMedGoogle Scholar
  31. 31.
    Yoon BH, Romero R, Park JS, et al. Fetal exposure to an intra-amniotic inflammation and the development of cerebral palsy at the age of three years. Am J Obstet Gynecol. 2000;182(3):675–681.CrossRefPubMedGoogle Scholar
  32. 32.
    Goetzl L, Zighelboim I, Badell M, et al. Maternal corticosteroids to prevent intrauterine exposure to hyperthermia and inflammation: a randomized, double-blind, placebo-controlled trial. Am J Obstet Gynecol. 2006;195(4):1031–1037.CrossRefPubMedGoogle Scholar
  33. 33.
    Walker M. Do labor medications affect breastfeeding? J Hum Lact. 1997;13(2):131–137.CrossRefPubMedGoogle Scholar
  34. 34.
    Halpern SH, Ioscovich A. Epidural analgesia and breast-feeding. Anesthesiology. 2005;103(6):1111–1112.CrossRefPubMedGoogle Scholar
  35. 35.
    Torvaldsen S, Roberts CL, Simpson JM, Thompson JF, Ellwood DA. Intrapartum epidural analgesia and breastfeeding: a prospective cohort study. Int Breastfeed J. 2006;1:24.CrossRefPubMedGoogle Scholar
  36. 36.
    Camann W. Labor analgesia and breast feeding: avoid parenteral narcotics and provide lactation support. Int J Obstet Anesth. 2007;16(3):199–201.CrossRefPubMedGoogle Scholar
  37. 37.
    Albani A, Addamo P, Renghi A, Voltolin G, Peano L, Ivani G. [The effect on breastfeeding rate of regional anesthesia technique for cesarean and vaginal childbirth]. Minerva Anestesiol. 1999;65(9):625–630.PubMedGoogle Scholar
  38. 38.
    Riordan J, Gross A, Angeron J, Krumwiede B, Melin J. The effect of labor pain relief medication on neonatal suckling and breastfeeding duration. J Hum Lact. 2000;16(1):7–12.CrossRefPubMedGoogle Scholar
  39. 39.
    Halpern SH, Levine T, Wilson DB, MacDonell J, Katsiris SE, Leighton BL. Effect of labor analgesia on breastfeeding success. Birth. 1999;26(2):83–88.CrossRefPubMedGoogle Scholar
  40. 40.
    Beilin Y, Bodian CA, Weiser J, et al. Effect of labor epidural analgesia with and without fentanyl on infant breast-feeding: a prospective, randomized, double-blind study. Anesthesiology. 2005;103(6):1211–1217.CrossRefPubMedGoogle Scholar
  41. 41.
    Nissen E, Widstrom AM, Lilja G, et al. Effects of routinely given pethidine during labour on infants’ developing breastfeeding behaviour. Effects of dose–delivery time interval and various concentrations of pethidine/norpethidine in cord plasma. Acta Paediatr. 1997;86(2):201–208.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Sanjay Datta
    • 1
    • 2
  • Bhavani Shankar Kodali
    • 1
    • 2
  • Scott Segal
    • 1
    • 2
  1. 1.Brigham & Women’s HospitalBostonUSA
  2. 2.Harvard Medical SchoolBostonUSA

Personalised recommendations