Severe spinal pain and body pain after epidural injection during labour

Posted on 27th Mar, 2011 and filed under Chiropractic, Uncategorized | 19 Comments

I have started to come across a lot of women who have had epidurals during labour. It’s not surprising, I believe I read that one in three labouring women will have an epidural. With 30-50% of labours ending in Caesarian sections, I’m sure that it’s probably more than one in three. The disturbing thing is how this is creeping into the cohort of people that I see for back pain. Suddenly there’s a number of women who have sever and bizzare back pain (stomach pain, body pain etc too) and a whole raft of symptoms that aren’t associated with simple dysfunction of the spinal joints. These women typically present with a history of no previous problems before they had a epidural. Generally the epidural was ineffective or the doctor had trouble inserting the needle and catheter. After their birth they are rocked with symptoms.

One women describes a severe neurological reaction which apparently has a 1 in 10,000 chance of occurring. This, for her, included convulsions and vomiting. She now experiences the feeling of crippling spinal pain from her neck to her low back, constant headaches, excruciating pain when bending forward – yet she is able to perform normal spinal range of motion. She’s been through endless tests by doctors and they’ve all put it down to stress or called her crazy (in their round-about way).

Another woman describes waking at night locked into her body which is raging with pain. She is able to wiggle enough to break out of the locked in feeling, and once she gets moving, is able to dissipate the pain. This has been going on since her first birth, where they had difficulty inserting an epidural needle and no pain relief was achieved. It’s hard not to think that it didn’t quite go in the right spot. She is still able to work and mother but is concerned by this distressing pain.

Other women, say my hairdresser, complains of a funny pain in her back ever since the epidural she had for her 3rd child. Nothing severe enough to prevent her from hairdressing, but enough to constantly bother her directly at the site of the injection, and more than 12 months post partum.

There are several things that can go wrong with an epidural and side effects which I have copied from the following website: http://www.kimjames.net/maternal%20risk%20chart.htm

Risks and/or Side Effects How often this happens Why is this a problem What you can do
Hypotension (Drop in blood pressure) The most commonly occurring risk:

30 – 35%[14][15]

  • Mother’s blood pressure must be of sufficient levels to assure oxygenation of the fetal blood.
  • Reduces blood supply to the placenta; baby is distressed.
  • At-risk babies may not have the reserves to handle an even small drop in mother’s blood pressure.
  • Maternal and fetal respiratory distress

 

  • To help prevent epidural-induced hypotension, you’ll receive 1 – 2 L. of IV saline before the epidural is placed.  You may also be asked to lie on your left side.
  • Ephedrine may also be given through your IV to restore blood pressure.  You may also be given more IV saline fluid.
  • Stay off your back.  Compression of the abdominal aorta and the inferior vena cava may decrease uterine arterial pressure and increases uterine venous pressure.
Urinary Retention;

Postpartum bladder dysfunction

Virtually all women will have a urinary catheter to prevent urine retention and bladder distention during labor.

25% – 34% will have bladder dysfunction after childbirth.[16][17]

  • Increase in urinary tract infection.
  • Full bladder inhibits dilation of cervix and rotation of the baby’s head
  • Bladder control may be lost for days, weeks, or months because of strain on numbed pelvic floor muscles.
  • Nurse will insert a urinary catheter to drain your bladder.
  • Choose a CSE, or intrathecal epidural so that you are more likely to feel the need to urinate and may also go to the bathroom yourself, if hospital policy allows.
  • Practice pelvic floor exercises (Kegels) before and after childbirth.
Uncontrollable Shivering Frequent[18]
  • Uncomfortable for mother.
  • Use blankets, heat sources and massage to relieve shivering
Itching of the face, neck and throat Common[19]
  • More common with CSE epidurals because of the narcotics used.
  • More of a nuisance than a serious medical problem.
  • You may be given a drug to combat the itching, which may have side effects of its own.
Nausea/Vomiting Common[20]
  • Uncomfortable for mother.  Usually lasts for a short time (30 minutes?).
  • Can waste needed resources and deplete mother of energy.
  • Medicine may be given to treat nausea.  This sometimes makes the mother intensely sleepy.
Postpartum Backache 10% – 22%[21][22]
  • May last a few days or continue for years. Possibly due to “stressed” positions in labor exacerbated by muscular relaxation and the absence of feedback pain to tell you to get out of a damaging position.
  • May (rarely) be caused by nerve damage.
  • Change positions frequently
  • Stay off your back
  • Practice pelvic and back strengthening exercises to prepare for childbirth.
  • Consider choosing a CSE, or intrathecal epidural to allow you more sensation and to avoid awkward positions.
Maternal Fever 15%  if epidural is in place longer than 4 hours.

Percentage increases the longer epidural is in place.[23]

  • Epidural anesthesia affects your ability to sweat.  If you can’t sweat, you can’t as easily dissipate excess body heat.
  • Uncomfortable for mother.
  • Baby’s heart rate may become distressed from mother’s fever, increasing odds of cesarean section.
  • Babies are often separated from their mothers immediately after birth to check for infection.  May include a spinal tap to check for sepsis.  Baby may stay in hospital for several days for antibiotic treatment while mother goes home.
  • Do not accept epidural anesthesia before active labor is established (5 cms or more).
  • Try to keep cool.  Eat ice chips or drink ice water, keep ice packs under arms, under belly or between legs.
  • Have a birth attendant mist and fan you during labor to promote heat dissipation.
Spinal Headache 1% – 10%[24]
  • Most likely caused by postdural puncture and leaking cerebrospinal fluid.  Can range from mild to debilitating and last from days to weeks.
  • Rest at home in a supine position (on your back).
  • Drink caffinated drinks, with the approval of your care provider.
  • May resolve on its own or you may need a blood patch procedure.
Uneven, incomplete or nonexistent pain relief. 10%[25],[26],[27]
  • Some mothers find incomplete, blotchy pain relief to be just as stressful as no pain relief at all.
  • Talk to your care provider if feel there is inadequate pain relief.
  • Epidural can be replaced or needle moved.
Feelings of emotional detachment Depends on the mother.
  • Some mothers report feeling “detached” from the experience of childbirth as a result of the full effects of epidural anesthesia. Some mothers may not feel like participants in their births.
  • May affect mother-baby bonding.
  • Talk to your care provider and get support for new parents.
Postpartum feelings of regret or loss of autonomy Depends on the mother.
  • Mother may have felt pressured to have epidural anesthesia or regrets her decision. Mother may not have been well supported or respected during her labor.
  • Talk to your care provider and get support for new parents.
Inability to move about freely on your own. 100%
  • Inhibits labor progress
  • Boring, annoying, and discouraging for some mothers.
  • Increases likelihood of cascade of interventions
  • Talk to your care provider about your concerns.
  • Wait until you are at least 5 cms dilated before you request an epidural.
  • Exhaust all other comfort measures before requesting an epidural.
Loss of perineal sensation and sexual function[28] Unknown
  • Most likely due to use of forceps and episiotomy, but may also be due to nerve damage.
  • Talk to your care provider about any sexual dysfunction after childbirth.  This is certainly not normal and there are options for correcting perineal pain.  There may be no treatment for nerve damage, however.
Very serious risks

  • Convulsions    Resp.paralysis     Cardiac Arrest Allergic shock
  • Nerve Injury
  • Epid. absces
  • Maternal death
Extremely rare.

Ranging from 1/3,000 to

2/million[29]

  • —–
  • —–

Other websites of interest include the ASAM society and an article on medical risks on epidual anaesthesia in childbirth but there are a lot of studies out there saying that the risk of back pain a year after childbirth is the same for women who had epidurals and those who didn’t – what I wonder about is whether they are rally talking about just normal mechanical back pain or this strange spinal pain.

All you have to do is type in “severe back pain after epidural” into google and you’ll find yourself surrounded by women with similar experiences trying to get some answers. Can chiropractic help? In cases where the pain is mainly coming from the joints and cord tension, maybe some scar tissue – well that’s what we do. If there are epidural haematomas (blood clots) or major scarring or true nerve damage or death – an MRI and surgical consult are the way to go. For those who have already been through everything and the surgeons have given up and chiropractic is their last hope – it may not be a fast solution but in my experience increasing the health and movement of the spine and spinal cord through chiropractic is fortunately showing some results.

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  15. On September 7, 2012, asiya said:

    so…… if i have an epidural should i see a chiro afterwards? am i less likely to have after effect pain should i see one?

  16. On March 9, 2013, Molina said:

    This has been so helpful , Im 21 years old , my son is almost 2 and I’ve been suffering for these severe back pains, . I’ve even contemplated quitting my job because i work on a cay and catching the ferry every morning and evening have been horrible to say the least. I neer thought the epidural would have been the cause. Totally going to see my doc. today to talk about it. And hopefully we will get some results.

  17. On May 22, 2013, Tina said:

    there are times that my back seizes and i can’t move or hardly breath i’ve had 3 epidoral shots and C- Sections with all my kids. all the doctors have done for me is given me muscle relaxers to help with the seizing. could there be something more i should worry about? my kids are 6, 5 and 3

    • On May 22, 2013, ClaireRaggio said:

      I’ d definitely find a good chiropractor in your area. They are specialists in mobilising the spine which will help relax your muscles. It may take a while since it has been many years and there is likely a lot of scar tissue and constrictions in the tissue and limitations in movement in your vertebral joints. Without examining you though the information I can give you is limited.

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