Is there an increased risk of a Caesarean section? | Complications of epidural anesthesia

Is there an increased risk of a Caesarean section?

Performing epidural or epidural anesthesia alone does not increase the risk of requiring a caesarean section. An increased risk of a caesarean section is caused by other risk factors, such as the position of the child in the womb or complications occurring in the mother or child.

Can the birth process be prolonged?

It has been observed through studies that women who gave birth naturally with epidural anesthesia had a longer delivery compared to women without epidural anesthesia. However, it has not been proven whether epidural anesthesia is responsible for this. It is assumed that the reduced pain during labour and the reduced pressing may be responsible for this.

Rare problems of epidural anesthesia

The following complications should be mentioned for the sake of completeness, but are extremely rare:

• Injection into the spinal space: As explained at the beginning, the drug develops its effect in the epidural space. If the anesthetist inadvertently injects the medication into the spinal space immediately behind it, this can lead to a slowing of the heartbeat, drops in blood pressure and paralysis of breathing. However, these complications can be treated well by an experienced anesthetist.
• Direct damage to the spinal cord during insertion of the puncture needle
• Allergic reactions to any of the drugs used
• Piercing a larger vein in the epidural space: The blood that emerges from the vein can press on the spinal cord and – if this process goes unnoticed – lead to permanent damage. The risk of this complication can be minimized considerably by first checking the blood for intact coagulation (=> see next paragraph! )

Blood coagulation must also be observed and examined

The blood must be examined to see if the coagulation is intact.In a preliminary discussion with the anesthetist, it must be clarified when medication that inhibits blood clotting may no longer be taken. This applies in particular to ASS 100 heparin and Marcumar. The following guidelines for discontinuing medication can serve as a rough guide: Of course, this information does not only apply to long-term medication prescribed by the doctor: caution is also advised when taking painkillers on your own responsibility in the days before the operation.

• 4h after normal (unfractionated) heparin
• 12 hours after low molecular weight heparin
• 1 day after taking non-steroidal anti-inflammatory drugs (NSAIDs): Ibuprofen, Diclofenac, etc.
• 3 days after acetylsalicylic acid (e.g. Aspirin®) at single doses of more than 100mg per day
• 10 days after taking clopidogrel (e.g. Plavix®)
• Marcumar or warfarin must be converted to heparin in good time beforehand

The epidural space also contains veins that can be injured by the puncture. When this happens, it can bleed into this anatomical space.

Normally, these are small bleedings that can be resorbed in the course of the procedure. However, if there is increased bleeding, which is an extremely rare complication, the spinal cord can be compressed (squeezed). Then surgery is necessary to remove this bruise. However, such an incident is very rare.