What are the effects of epidural (peridural) anesthesia on a newborn baby?

From the Guidelines

Epidural anesthesia has minimal direct effects on a newborn baby, with the majority of the medication remaining localized to the mother's epidural space and minimal amounts crossing the placenta to reach the baby. The effects of epidural anesthesia on a newborn baby are generally mild and temporary, with some studies suggesting that babies born to mothers who received epidurals may be slightly less alert or have subtle differences in behavior immediately after birth 1. However, these effects are typically short-lived, resolving within the first day of life.

Key Points to Consider

• The medications used in epidurals, such as bupivacaine and fentanyl, have been shown to increase the risk of fetal bradycardia, although the risk of subsequent caesarean delivery is not increased 1.
• There is insufficient evidence to determine differences in fetal heart rate abnormalities between those who have an intrathecal catheter and those who have a re-sited epidural catheter, as well as differences in mode of delivery between the two groups 1.
• Epidurals can indirectly benefit babies by reducing maternal stress hormones like cortisol and adrenaline that can affect placental blood flow, and allowing mothers to rest during labor, potentially providing them with more energy for pushing during delivery.

Clinical Implications

• The benefits of pain relief for the mother typically outweigh any potential minor effects on the newborn, making epidurals a safe pain management option during childbirth.
• Clinicians should be aware of the potential risks and benefits of epidural anesthesia and discuss these with their patients to make informed decisions about pain management during labor.
• Overall, the current evidence suggests that epidural anesthesia is a safe and effective option for pain management during childbirth, with minimal direct effects on the newborn baby.

From the FDA Drug Label

Local anesthetics rapidly cross the placenta, and when used for epidural, caudal, or pudendal block anesthesia, can cause varying degrees of maternal, fetal, and neonatal toxicity The incidence and degree of toxicity depend upon the procedure performed, the type, and amount of drug used, and the technique of drug administration. Adverse reactions in the parturient, fetus, and neonate involve alterations of the CNS, peripheral vascular tone, and cardiac function. The use of some local anesthetic drug products during labor and delivery may be followed by diminished muscle strength and tone for the first day or two of life.

The effects of epidural anesthesia on a newborn baby may include neonatal toxicity, with possible alterations in:

• CNS (Central Nervous System)
• peripheral vascular tone
• cardiac function Additionally, some local anesthetic drug products may cause diminished muscle strength and tone for the first day or two of life, although this has not been reported with bupivacaine 2.

From the Research

Effects of Epidural Anesthesia on Newborn Babies

• Epidural opioid analgesia has been associated with neonatal respiratory depression, as reported in a study published in the Journal of Perinatology 3.
• The study found that two newborns developed respiratory depression following epidural fentanyl analgesia, requiring administration of naloxone.
• Another study published in the European Journal of Obstetrics, Gynecology, and Reproductive Biology found that properly administered epidural analgesia provides adequate pain relief during labor and delivery, but may have adverse effects on the newborn 4.
• A population-based cohort study published in Women and Birth found that epidural analgesia during birth was associated with low Apgar score and admission to the neonatal intensive care unit in neonates of low-risk women 5.
• The study suggested that the impact of epidural analgesia on adverse neonatal outcomes was mediated by obstetric complications such as maternal fever, labor augmentation, and fetal malpresentation.
• A review of labor analgesia options published in Minnesota Medicine noted that epidurals can have undesirable side effects, including lower-extremity motor block, hypotension, urinary retention, and pruritus, and may increase the risk for a slightly prolonged labor, a forceps or vacuum delivery, and fever during labor 6.

Adverse Neonatal Outcomes

• Low Apgar score: epidural analgesia was associated with low Apgar score, adjusted odds ratio 1.76 (95% CI 1.07-2.90) 5.
• Admission to the neonatal intensive care unit: epidural analgesia was associated with admission to the neonatal intensive care unit, adjusted odds ratio 1.43 (95% CI 1.26-1.62) 5.
• Neonatal respiratory depression: epidural opioid analgesia has been associated with neonatal respiratory depression, requiring administration of naloxone 3.

Maternal-Fetal-Placental Pharmacokinetics

• The maternal-fetal-placental pharmacokinetics of epidural fentanyl and the possible mechanisms for the causation of neonatal respiratory depression were reviewed in a study published in the Journal of Perinatology 3.