Evaluating the adverse effects of epidurals is difficult for the following reasons:

• Women in the comparison group have almost always had some drug (Pitocin, narcotic, a different type of epidural), procedure (I.V., rupture of membranes), or restriction (confinement to bed, nothing by mouth) that could also affect them, their babies, or the labor pattern
• Every variation in drug or drug combination, dosage and procedure, could affect mothers, babies and the labor differently, but none have undergone scrutiny before becoming widely used.

  As a general principle, the incidence of adverse effects goes up when mixing different types of medication, as when a woman starts with injected narcotic and later decides on an epidural. However, in the case of epidurals, this hasn’t been investigated either.

Even so, here is what we know about the downside of epidurals:

• Delay in obtaining relief -- It can easily take an hour between the time you request an epidural to the time it takes effect … and that’s if the anesthesiologist is readily available.
• Changes the psychological experience of labor -- It converts labor and birth from a natural, normal experience in which you are an active agent to one in which the equipment (I.V., Pitocin pump, epidural pump, electronic fetal monitor, blood pressure cuff, etc.) takes center stage.
• Requires an I.V. and continuous electronic fetal monitoring -- It also frequently requires Pitocin and bladder catheterization. These procedures have their own potential adverse effects.
• Slows labor -- This leads to more vaginal instrumental deliveries and episiotomies and it can lead to more cesareans, especially if the epidural is given early (28). These procedures also can harm mother or baby.
• Fever -- Fever becomes more likely the longer the epidural is in place (28). In one study, 15 percent of women who had epidurals ran fevers versus one percent of women who didn’t have them (16). Among women who had epidurals, seven percent of women with epidurals whose labors lasted six or fewer hours ran fevers rising to more than one-third of women whose labors lasted over eighteen hours.

  Because fever is a symptom of infection, babies of mothers who run fevers will likely be subjected to a septic work-up, (multiple blood tests and a spinal tap) kept in the nursery for observation and possibly given preventative I.V. antibiotics until cultures come back negative. In this same study, newborns whose mothers had epidurals were over three times more likely (34 percent versus 10 percent) to have septic workups and four times more likely (15 percent versus 4 percent) to have antibiotic treatment.