Epidural as a cause of prolonging labor

The epidural does not reduce the strength or frequency of contractions. Therefore, it does not influence the length of the first stage of labor one way or the other.

There is, however, irrefutable evidence that it tends to prolong the second stage of labor. Ironically, this is a direct result of its effectiveness in controlling pain.

When the cervix is fully dilated and the leading part of the baby has descended low enough to allow for pushing and delivery, the laboring woman may not actually feel the urge to push. This may cause a lengthening of this (second) stage of labor.

This problem is overcome by the attending midwife or doctor assisting in the second stage where, by palpating the uterine activity, she can encourage the woman to push whenever there is a contraction. This works well, in most cases. However, in a few cases, the absence of the painful urges to push removes the only effective motivating factor. I

In such a situation, the exhortations of the midwife or doctor may not be sufficient to make the woman push effectively to achieve delivery. This is the situation where an instrumental delivery in the form of ventouse or forceps becomes more likely.

There is no evidence that epidural analgesia increases the likelihood of an emergency cesarean section.

Other (delayed) unwanted effects of an epidural

Bruising may occur around the injection site and this may be sore for a day or two.

In a few instances, especially if catheter insertion involved several attempts before eventually succeeding, there is a small risk of a hematoma (blood-clot) forming and, even more rarely, an abscess. This will present in the form of worsening low backache (within one to three days). Appropriate treatment will be required.

Backache following an epidural

This is one of the most unfortunate myths. Backache does occur after an epidural, but is by no means common.

Apart from the potential causes described above, there are a few other possible causes. Probably the most common cause of prolonged low-intensity low backache following an epidural is bad posture. When an epidural is very effective, the laboring woman may assume a posture that puts considerable strain on her back for several hours. Because she is pain-free, she will remain oblivious to that strain. Once the epidural wears off, she will start feeling the effect of that posture. It may take several weeks before she is completely free of pain. Understandably, this will be blamed on the epidural.