An epidural is one of the most common medical procedures performed in American hospitals, yet complications from obstetric anesthesia can cause serious harm to mothers and babies. Understanding what an epidural injury during labor looks like — and when it may give rise to a lawsuit — requires understanding the specific standards that govern obstetric anesthesia and what anesthesiologists are required to do to prevent foreseeable harm.
This article provides general legal information; consult a licensed Illinois attorney for advice specific to your situation.
This article covers obstetric anesthesia only — epidurals, spinals, and combined spinal-epidural techniques used during labor and delivery. It does not address general anesthesia used during surgical procedures, which is governed by different standards and covered separately on this site.
The Standard of Care for Obstetric Anesthesia
The American Society of Anesthesiologists (ASA) has published Practice Guidelines for Obstetric Anesthesia, most recently reaffirmed in 2023, that set out minimum requirements for safe neuraxial anesthesia — the category that includes epidurals, spinals, and combined techniques. These guidelines cover patient monitoring before and after placement, blood pressure management during a neuraxial block, recognition of complications such as high spinal anesthesia, and the availability of resuscitative equipment. When an anesthesiologist or certified registered nurse anesthetist (CRNA) departs from these standards in a way that causes a preventable injury, that departure may constitute malpractice under Illinois law.
Illinois medical malpractice actions involving anesthesia injuries are subject to the statute of limitations under 735 ILCS 5/13-212, which generally requires a claim to be filed within two years of when the patient knew or reasonably should have known of the injury and its likely cause. For a child injured during delivery, the statute may be tolled until the child reaches age 18 in certain circumstances — but consulting an attorney promptly is always the right approach, because the underlying evidence (anesthesia records, medication logs, fetal monitoring strips) is time-sensitive.
Hypotension and Fetal Distress from Neuraxial Block
The most common complication of neuraxial anesthesia in obstetrics is maternal hypotension — a significant drop in blood pressure after the epidural or spinal takes effect. The mechanism is well understood: the block interrupts sympathetic nerve signals, causing blood vessels to dilate and blood pressure to fall. Because the placenta does not regulate its own blood flow independently of maternal blood pressure, a significant drop in the mother’s blood pressure reduces oxygen delivery to the fetus. If hypotension is not recognized and corrected quickly, the result can be fetal bradycardia, hypoxia, and injury.
The ASA guidelines and supporting peer-reviewed literature in publications such as Obstetrics and Gynecology and the International Journal of Obstetric Anesthesia are consistent: blood pressure must be monitored at frequent intervals after neuraxial block placement, vasopressors and intravenous fluids must be readily available to treat hypotension, and the anesthesia team must be positioned to respond within minutes. A failure to monitor blood pressure at required intervals, a failure to administer a vasopressor when hypotension is documented, or an unexplained delay in treatment are the types of departures that anesthesia experts examine in litigation.
High Spinal Anesthesia
High spinal anesthesia occurs when local anesthetic spreads higher in the spinal canal than intended, blocking the nerves that control breathing. In obstetric settings, high spinal most often occurs when a spinal dose is administered — either as a standalone spinal or as part of a combined spinal-epidural — and the patient’s positioning, medication volume, or the baricity of the solution causes an unintended cephalad spread. The consequences can be severe: the patient may be unable to breathe, become unconscious, experience cardiovascular collapse, and require emergency intubation.
Recognition is the critical variable. An anesthesiologist who identifies a rising block early — through systematic sensory testing and monitoring of respiratory function — can intervene before the patient decompensates. A failure to monitor the level of the block, a failure to recognize that the patient is developing respiratory distress, or a delay in providing oxygen and airway support can convert a manageable complication into a catastrophic one. When a mother suffers brain injury, cardiac arrest, or death from an unrecognized high spinal, the anesthesia record and nursing documentation become central to evaluating whether the standard of care was met.
Nerve Injuries from Epidural Placement
Epidural and spinal placement requires the needle to pass through the soft tissues of the back and into the epidural or subarachnoid space. When placement injures a nerve root, the spinal cord, or surrounding structures, the result can be persistent pain, numbness, weakness, or in rare cases paraplegia. Causes include direct needle trauma, epidural hematoma (bleeding into the epidural space that compresses the spinal cord), and epidural abscess (infection that causes spinal cord compression).
Epidural hematoma and abscess are particularly important from a malpractice standpoint because both are treatable if recognized early. The presenting symptom is usually back pain or new neurological symptoms — leg weakness, bowel or bladder dysfunction — in the hours or days after delivery. If a patient reports these symptoms and the treating team does not investigate promptly with imaging and neurosurgical consultation, the delay itself may constitute a departure from the standard of care. For mothers who experienced new neurological symptoms after delivery that were dismissed or not investigated, this is a question worth raising with an attorney.
How These Claims Relate to Maternal Injury Cases
Obstetric anesthesia injuries are a significant component of maternal injuries during childbirth cases our firm handles. Whether the injury is to the mother alone, to the baby through hypotension-induced fetal distress, or to both, the legal framework requires establishing what the anesthesia team knew or should have known, what they did, and what they should have done differently. These cases require anesthesia experts and, where fetal injury is involved, perinatal medicine experts as well.
Talk to a Chicago Attorney — Free Consultation
If you or your baby were injured as a result of complications from an epidural, spinal, or combined spinal-epidural during labor, Phillips Law Offices is available to review your situation. We serve families throughout Illinois and handle obstetric anesthesia injury cases as part of our birth injury practice. Call (312) 346-4262 or use our contact page to schedule a free consultation. There is no fee unless we recover on your behalf.