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Headache following an epidural

Again, in a few instances, headache soon after delivery may be a direct consequence of an epidural. This normally results from what is known as a "dural tap". This simply means the needle had extended into another space (the sub-arachnoid), causing the fluid in this space to leak.

 

The headache from a dural tap is usually frontal but may also be felt at the back. It is normally felt on rising from a lying position or on standing up, the so-called postural headache. The person will also complain of nausea and/or vomiting, occasionally sensitivity to light (photophobia) and neck stiffness.

 

Maintaining a flat position is very effective in keeping her free of pain but is normally not a practical solution for a new mother. In such a case, treatment using a ‘blood patch’ is very effective and quick. This involves injecting the patient's own blood (about 10-15 ml) into the site of the epidural puncture.

 

This complication is very uncommon but can be quite distressing.

 

 

Paralysis as a direct result of an epidural: Can this happen?

No.

In years gone by, severe neurological damage taking weeks, even months, to recover was occasionally reported. The issue then was the use of other chemicals (not the local anesthetic used in epidural) and also involved injection of those chemicals in the sub-arachnoid space (not epidural).

 

Childbirth that has been improperly managed has a far greater potential of producing neurological damage than an epidural ever can.

 

Circumstances where epidural in labor is specially recommended

An epidural is first and foremost a method of pain relief. There are, however, circumstances in labor when it has additional advantages by facilitating successful vaginal delivery and preventing potential complications.

 

Epidural analgesia is strongly recommended in pre-eclampsia as it improves blood supply to the womb (which may be tenuous in such cases) and hence the baby. It also effectively combats one of the main catalysts of worsening high blood pressure, i.e. pain.

 

It is also strongly recommended in the case of a breech presentation or twin delivery. In the latter case, it is especially useful if the second twin is in an abnormal lie, where some kind of manipulation may be required.

 

It is also quite useful in preterm labor where the fetus is rather delicate, and in medical conditions such as heart disease, where maternal exertion may be a bad idea. It also prevents maternal exhaustion and distress in prolonged labor.

 

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Severe postural headache, neck stiffness,  photophobia and vomiting can follow a ‘dural-tap’; a quite uncommon complication of epidural pain relief.