Epidural & Anesthesia Injuries During Childbirth

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.

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.

A Hypothetical: The Unmonitored Hypotension Episode

The following is a hypothetical scenario, not a description of any actual case, provided to illustrate how these issues typically arise. An epidural is placed and working well. Per protocol, blood pressure should be checked every five minutes for the first twenty minutes after placement. The first two checks are documented; the third is not charted at all. Fifteen minutes later, the fetal monitor shows a prolonged deceleration, and when blood pressure is finally rechecked it has dropped substantially from baseline. A vasopressor is given and the tracing recovers, but not before a period of reduced fetal oxygenation that a reviewing expert would examine closely against the missing monitoring interval.

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.

Anesthesia Unavailability and Emergency Cesarean Delays

A separate category of obstetric anesthesia claim involves delay rather than a complication of the epidural itself. When an emergency cesarean is called, ASA guidance and most hospital protocols expect anesthesia coverage to be available promptly, since a functioning epidural already in place can often be “topped up” for surgery quickly, while a patient without an epidural may need general anesthesia, which carries its own risks including difficult airway management and aspiration. If an anesthesia provider is unavailable, is covering multiple patients, or takes an unreasonable amount of time to respond to an emergency cesarean call, the resulting delay in delivery can itself be the injury-causing event, separate from any complication of the anesthesia procedure once performed. These cases often overlap with delayed C-section claims, since the anesthesia team’s availability is frequently one of the bottlenecks that determines how quickly an emergency delivery can actually happen.

Illinois Filing Deadlines and Damages

An obstetric anesthesia claim follows the same Illinois deadlines that apply to birth injury and medical malpractice cases generally, and the applicable deadline depends on who was injured. If the anesthesia complication injured the baby, for example through prolonged hypotension-induced hypoxia, the child’s own claim is governed by 735 ILCS 5/13-212, which generally allows eight years from the negligent act and never after the child’s 22nd birthday; because the anesthesia event happens on a fixed date at delivery, the eight-year prong is almost always the one that controls. If the injury was to the mother alone, a nerve injury, a high spinal complication, or another anesthesia-related harm, her own claim generally must be filed within two years of discovering the injury, with a four-year outer limit, a separate and typically shorter deadline from any claim her child may have. If the delivery occurred at a public or county hospital, a different, shorter notice period applies under 745 ILCS 10/8-102 of the Local Governmental and Governmental Employees Tort Immunity Act. Before a complaint may be filed, 735 ILCS 5/2-622 requires a written certification from a qualified reviewing health professional, typically an anesthesiologist for these claims, confirming the claim has a reasonable and meritorious basis.

Illinois places no cap on non-economic damages in medical malpractice cases. The Illinois Supreme Court struck down the state’s previous statutory damages cap in Lebron v. Gottlieb Memorial Hospital, 237 Ill. 2d 217 (2010). Illinois law also does not generally allow punitive damages in medical malpractice actions; compensation is intended to address the documented harm and its costs, not to punish the provider.

Common Defenses Anesthesia Providers Raise

Anesthesia malpractice cases are defended in part on the basis that most complications, including hypotension and even high spinal spread, are recognized risks of neuraxial anesthesia that can occur even when the procedure is performed and monitored correctly. The defense will often argue that any drop in blood pressure was addressed within an acceptable window, or that the informed consent process disclosed the general risk of the complication that occurred. Consent to a known risk, however, is not the same as consent to a failure to monitor for or respond to that risk once it develops, an anesthesia expert’s review of the monitoring record is what distinguishes a disclosed, well-managed complication from a preventable one.

Hospitals defending an anesthesia-delay claim will often point to competing emergency demands on the anesthesia team, or argue that the overall time from decision-to-incision fell within the range professional guidelines treat as acceptable for the level of urgency involved. Not every cesarean is equally emergent, and the standard of care distinguishes between a true category-one emergency, requiring the fastest possible response, and a more urgent-but-not-immediately-life-threatening situation. What matters is whether the anesthesia team’s response matched the actual urgency documented in the record at the time, not what is argued after the fact.

What Compensation Can Cover

When an obstetric anesthesia claim succeeds, compensation can address past and future medical care, any rehabilitative or developmental therapy the child needs if the injury affected the baby, and the mother’s own medical treatment and recovery if she was directly injured. Because a mother’s claim and her child’s claim are evaluated separately, an attorney will typically walk through both possibilities where an anesthesia complication affected the delivery broadly.

How These Cases Are Investigated

An anesthesia injury investigation centers on the anesthesia record itself: the time of block placement, the documented vital sign checks and their intervals, medication administration times and doses, and any notes describing the patient’s reported symptoms during or after the procedure. Because vital signs during a neuraxial block are often charted separately from the general labor and delivery nursing notes, reconciling the two records, and identifying any gaps in the required monitoring intervals, is usually the first step a reviewing anesthesia expert takes before forming an opinion on whether the standard of care was met.

Chicago and Cook County Considerations

Chicago-area hospitals generally staff dedicated obstetric anesthesia teams, particularly at hospitals with higher-volume labor and delivery units, which typically means more detailed electronic monitoring records than a smaller or lower-volume unit might keep. If your delivery involved a CRNA working under a supervising anesthesiologist, both the CRNA’s own actions and the adequacy of supervision can be relevant to a case, and identifying who was actually present at the bedside during the relevant period is part of a thorough review.

A Chicago-area investigation into an anesthesia-delay claim will also typically request the anesthesia department’s on-call schedule and staffing logs for the shift in question, since these records can show whether the delay resulted from a genuinely unavoidable competing emergency or from a staffing gap the hospital could have addressed with better coverage.

What to Gather Before You Call

The complete anesthesia record, including the time of block placement and all documented vital sign checks
Medication administration records showing what was given and when
Nursing notes from the period immediately following epidural or spinal placement
Any records of new symptoms reported after delivery, such as back pain, weakness, or numbness
A timeline, to the best of your recollection, of what happened and what you were told

Frequently Asked Questions

My cesarean was called an emergency, but it still took over 40 minutes for anesthesia to arrive. Is that automatically too long?
Not automatically, but it is exactly the kind of interval a reviewing anesthesia expert will examine against the urgency documented in the record at the time and against the hospital’s own emergency-response protocols, to determine whether the delay was reasonable or a departure from the standard of care.

Is every case of low blood pressure after an epidural a sign of malpractice?
No. Mild, promptly treated hypotension is a known and generally well-managed risk of neuraxial anesthesia. A claim typically arises when the drop was not monitored for or responded to within the required timeframe, and that failure is what caused the injury.

What if I signed a consent form listing these risks before the epidural?
Signing a consent form that discloses a general risk does not waive the provider’s obligation to monitor for and respond appropriately if that risk actually develops. Consent to a risk is different from consent to substandard care once the risk materializes.

Can the hospital be responsible in addition to the anesthesiologist?
Yes. Depending on who was involved and their employment relationship with the hospital, both the individual anesthesia provider and the hospital may bear responsibility, particularly where a CRNA’s supervision or the facility’s own monitoring protocols are at issue.

My baby was fine, but I developed lasting back pain and weakness after my epidural. Do I have a claim?
A mother’s own injury from an epidural, such as an unrecognized hematoma or nerve injury, can support a claim independent of whether the baby was affected. Her claim is evaluated under her own, generally shorter statute of limitations.

What kind of expert do these cases require?
Obstetric anesthesia cases typically require an anesthesiologist experienced in obstetric practice to establish the standard of care, and, where the baby was affected, an additional perinatal medicine or neonatology expert to address causation and the resulting injury.

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.

Epidural and Anesthesia Injuries During Childbirth