Henci,

As an educator I always include the information about the "epidural fever" which is a side-effect that natural birth advocates always include.  I have seen stats in around the 15% area for this. 

But I have to say-- some of my doula colleaugues and I have talked and we represent a good number of births, and certainly quite a few epidurals-- and none of us have ever seen it (as far as we know). 

Yesterday I was with a woman in labor who after 3 days decided to choose an epidural and developed a fever maybe 2 or 3 hours later-- and I said "aha!" -- but then the OB and Ped decided it was chorioamnionitis (which I know is what they always blame it on) but the smell of the amniotic fluid that came out after the birth was -- well, not dreadful, but unusually foul in my experience, so it makes sense to me that there was an infection.  I want to follow up with the family when they came home as to what they may know, but so far it's not sounding like epidural fever.

I just want to know why we have not seen it-- have they emproved the drug cocktail perhaps?

Thanks,

Shayna

I'm not sure why you and your colleagues haven't seen it. I don't think it has anything to do with the drug cocktail--although it might conceivably have to do with how heavy or light the epidural is. One theory about the fever is the epidural disrupts the autonomic nervous system as well as sensation to the lower half of the body, and the autonomic system controls things like sweating to regulate temperature. At any rate, the likelihood of fever goes up with time, so maybe you and your colleagues haven't been seeing enough women who have had an epidural in place for long enough. Speaking of which, given the fairly short time on the epidural before the fever showed up, it sounds like your client did not have an epidural-related fever but an infection.

-- Henci

Follow-up:

The Peds and staff made no further mention of infection during mother and baby's stay-- the parents did not really seem to notice the whole issue even. 

So how long does it take to develop the fever-- maybe sometimes it only shows up P-partum?

Shayna

This is more of a clinical question and I am not a clinician. I do know from reading definitions in the methods sections of studies that the symptoms your client had fit the diagnosis "chorioamnionitis," which translates "inflammation of the fetal membranes." The "itis" ending means "inflammation" not "infection," so I misspoke when I called it "infection," although in my defense, it does seem to be loosely regarded as "infection."

My guess is that with mom and babe doing fine after the birth, their care providers decided there wasn't anything to be concerned about. They may also have done some testing such as, maybe, a white blood cell count, that was reassuring, but as I said, I'm not a clinician so I don't know what would be the usual follow up. Anyone who knows more about this can feel free to chime in. 

-- Henci

I experienced an epidural fever while I was in labor with my daughter. I had previously spoken with my doctor about the risks vs. benefits of epidural anesthesia, and she never told me that epidural fever was a possibility. Her exact words were, "There is no reason you shouldn't have an epidural." So yes, she is a bold-faced liar. Blood cultures were obtained when the nurse finally noticed that I was running a fever, all of which came back negative. The official diagnosis was "fever of unknown origin." How lovely.

Here is a great research paper on the real risks of epidural anesthesia. The results are quite startling. For exapmle, the authors found that nearly 1 in 4 women will experience some kind of complication resulting from epidural anesthesia. Their position is that epidurals do have risks and that these risks are under-communicated to women, and that true informed consent is not given. That was certainly true in my case.

http://www.healing-arts.org/mehl-madrona/mmepidural.htm#footnote62

~Sara

In order to give informed consent (or refusal), patients are entitled to know:

• the benefits of what is being proposed
• the potential harms
• the alternatives, including doing nothing
• the benefits versus harms of the alternatives

I would hardly say that you got that. Your experience is, unfortunately, all too common. For more information on making informed choices, I recommend Informed Decision Making on the Childbirth Connection website.

-- Henci