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  • Q&A with Australian Health Practitioners

    Am I more likely to have a cesarean section if I have an epidural for my labor?

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    Pregnancy & Breastfeeding
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    Dr Ken Law

    Gynaecologist, Gynaecologist - Infertility (IVF) Specialist, Obstetrician

    Dr Ken Law is an Obstetrician and Gynaecologist in Brisbane, operating out of Greenslopes Private Hospital, delivering babies at Greenslopes Maternity. He has special interests … View Profile

    Epidurals have not been shown in reviews or studied in the literature to increase your chances of needing a caesarean section.
    It may prolong the pushing stage of labor by about 15 minutes or so, and may increase your chances of requiring an instrumental delivery, such as a vacuum-assisted delivery.

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    Dr Gary Sykes

    Obstetrician

    Dr Gary Sykes is a graduate Bachelor of Medicine and Bachelor of Surgery (M.B, B.S.) from Sydney University. He commenced his initial postgraduate training at … View Profile

    I agree with Dr Law. There is no reason why an epidural will increase the likelihood of a Caesarean section delivery.

    The most common indications for emergency Caesarean section delivery in labour are lack of progress in labour (cephalo-pelvic disproportion or the baby is too big for the birth canal) and foetal distress in labour.

    Sometimes there can be a brief episode of foetal distress immediately after an epidural is sited because of a fall in maternal blood pressure. But with correct management this can be corrected (intravenous fluids and correct positioning on your side). This risk can be minimised with preloading (before the epidural is sited) the patient with intravenous fluids

    I agree there is an increased risk of an operative vaginal delivery with an epidural working. This is because you don’t have that incredible desire to bear down in second stage labour, and so pushing is often not as effective or as strong. Also you are not sure about correct direction for pushing.

    The increased risk of an operative vaginal delivery can be minimised by waiting in second stage until the baby’s head is very low in the pelvis before you start pushing, so you are not pushing too long and don’t get too tired. Also the risk can also be minimised by allowing the epidural to start to wear off, so you get some sensation back. But many women don’t want this option

    For the same reason an epidural is associated with a greater likelihood of an intact perineum and if there is perineal tearing a less severe tear. This is because you do not have that incredibly strong desire to push and so there can be a slower and more controlled delivery of the baby’s head, with a more controlled and gradual stretch of the vaginal entrance.

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    Melissa Maimann

    Midwife

    Melissa is an Endorsed Eligible Midwife in private practice in Sydney.  She provides pregnancy, birth and postnatal care for women across Sydney.  Melissa has practised … View Profile

    Some would say that there is an association between epidurals and caesarean.  This may be because the reasons that lead a woman to request an epidural may also be reasons that a caesarean is eventually eprformed.  Dr Gary Sykes speaks of a situation where the labour is long and the baby is too big for the pelvis.  In a case where the labour is long, the woman may request an epidural and she may end up having a caesarean, but if the reason for needing the epidural was a long labour owing to a large baby, then that may also be the reason that she needs a caesarean in time.

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