Q: How safe and effective is epidural anaesthesia during labour? Are there any complications arising out of epidural? My doctor isn't too keen on that. Is it true that the chances of a c-section increase when given epidural?

A:Your question is quite simple and I wish there was a simple answer as well. Like most things in modern medicine epidural anaesthesia during labour (and now low spinal is in fashion) can be safe and effective and can be potentially hazardous. There is no hard and fast rule. To answer your questions pointedly, epidural significantly reduces labour pains in about 70% women during labour (it also means that it does not in 30%, and the decrease is not significant in some others). The complications can be a slow labour and a higher chance of an instrumental delivery as in forceps/vacuum delivery with all its possible complications. The anaesthesia itself may lead to an incorrect placement of the catheter (initially or while topping up) and hence complications due to the drug going to the wrong places which is potentially hazardous. Other side effects like sudden drop in blood pressure and hence a fetal distress should be manageable in a good centre. There are some studies correlating epidural during labour and long term backache (not proven either way so far). The labour is longer with epidural and this sometimes leads to a feeling that it is taking too long and may lead to a caesarean section. At this stage all I can say is that you should go ahead with it and see how it works for you provided you deliver in a place where an experienced anaesthetist and the obstetrician is available round the clock and is going to monitor labour carefully. So only if your treating doctor is comfortable with the team and you are aware of all possible pros and cons should you plan for it. It should not be used as a consumer demand to achieve a painless delivery at any cost. As explained above painless delivery is a myth though in most cases (70%) the pain is reduced significantly there is always some pain. As your doctor you say is reluctant it would be unwise to insist for it. The doctor would be aware of all the possibilities in the setup he/she is working in and would have taken a decision based on that.