Editing Epidural administration (section)

=== Pain relief during childbirth ===
Epidural injections are commonly used to provide pain relief ([[analgesia]]) during childbirth.<ref>{{cite journal |last1=Schrock |first1=SD |last2=Harraway-Smith |first2=C |title=Labor analgesia |journal=American Family Physician |date=1 March 2012 |volume=85 |issue=5 |pages=447–54 |pmid=22534222}}</ref> This usually involves epidural injection of a local anesthetic and [[opioid]]s, commonly called an "epidural". This is more effective than oral or [[Intravenous therapy|intravenous]] (IV) opioids and other common modalities of analgesia in childbirth.<ref name="Anim-Somuah2018">{{cite journal |vauthors = Anim-Somuah M, Smyth RM, Cyna AM, Cuthbert A |title = Epidural versus non-epidural or no analgesia in labour |journal = The Cochrane Database of Systematic Reviews |volume = 2018 |pages = CD000331 |year = 2018 |issue = 5 |pmid = 29781504 |pmc = 6494646 |doi = 10.1002/14651858.CD000331.pub4}}</ref> After an epidural is administered, the recipient may not feel pain, but may still feel pressure.<ref>{{cite journal |last=Buckley |first=Sarah |title=Epidurals: risks and concerns for mother and baby |journal=Midwifery Today with International Midwife |url=http://sarahbuckley.com/epidurals-risks-and-concerns-for-mother-and-baby#ref |publisher=Mothering No.133 |access-date=April 18, 2014 |date=2014-01-24 |issue=81|pages=21–3, 63–6 |pmid=17447690}}</ref> Epidural [[clonidine]] is rarely used but has been extensively studied for management of analgesia during labor.<ref name=Patel1996>{{cite journal |vauthors=Patel SS, Dunn CJ, Bryson HM |s2cid=72544106 |title=Epidural clonidine: a review of its pharmacology and efficacy in the management of pain during labour and postoperative and intractable pain |journal=CNS Drugs |year=1996 |volume=6 |issue=6 |pages=474–497 |doi=10.2165/00023210-199606060-00007}}</ref>

Epidural analgesia is considered a safer and more effective method of relieving pain in labor as compared to intravenous or oral analgesia. In a 2018 [[Cochrane Collaboration|Cochrane review]] of studies which compared epidural analgesia with [[oral administration|oral]] opioids, some advantages of epidural analgesia versus opioids included fewer instances of [[naloxone]] use in newborns, and decreased risk of maternal hyperventilation.<ref name="Anim-Somuah2018" /> Some disadvantages of epidural analgesia versus opioids included longer labor durations, an increased need for [[oxytocin]] to stimulate [[uterine contraction]]s, and an increased risk of fever, low blood pressure, and muscle weakness.<ref name="Anim-Somuah2018" /> 

However, the review found no difference in overall Caesarean delivery rates between epidural analgesia versus no analgesia. Additionally, there was no difference found on the immediate neonatal health of the child between epidural analgesia versus no analgesia. Furthermore, the occurrence of long-term backache was unchanged after epidural use.<ref name="Anim-Somuah2018" /> Complications of epidural analgesia are rare, but may include headaches, dizziness, difficulty breathing and seizures for the mother. The child may experience a slow heartbeat, decreased ability to regulate temperature, and potential exposure to the drugs administered to the mother.<ref>{{cite web |title=Anesthesia |url=http://search.credoreference.com/content/entry/hupwh/anesthesia/0?searchId=9b195ee2-c732-11e3-b874-0aea1e3b2a47&result=1 |publisher=Harvard University Press |access-date=April 18, 2014}}</ref>

There is no overall difference in outcomes based on the time the epidural is administered to the mother,<ref name="Cochrane2014">{{cite journal |vauthors=Sng BL, Leong WL, Zeng Y, Siddiqui FJ, Assam PN, Lim Y, Chan ES, Sia AT |title = Early versus late initiation of epidural analgesia for labour. |journal = The Cochrane Database of Systematic Reviews |volume = 2014 |issue = 10 |pages = CD007238 |date = October 9, 2014 |pmid = 25300169 |doi=10.1002/14651858.CD007238.pub2|doi-access = free |pmc = 10726979 }}</ref> specifically no change in the rate of caesarean section, [[Childbirth#Management|birth which must be assisted by instruments]], and duration of labor. There is also no change in the [[Apgar score]] of the newborn between early and late epidural administration.<ref name="Cochrane2014" /> Epidurals other than low-dose ambulatory epidurals also impact the ability of the mother to move during labor. Movement such as walking or changing positions may help improve labor comfort and decrease the risk of complications.<ref name=Lothian2009>{{cite journal |vauthors = Lothian JA |title = Safe, healthy birth: what every pregnant woman needs to know |journal = J Perinat Educ |volume = 18 |issue = 3 |pages = 48–54 |year = 2009 |pmid = 19750214 |pmc = 2730905 |doi = 10.1624/105812409X461225 }}</ref>