Epidural anaesthesia is the most popular method of pain relief during labour. Women request an epidural by name more than any other method of pain relief. More than 50% of women giving birth at hospitals use epidural anaesthesia.
As you prepare yourself for “labour day,” try to learn as much as possible about pain relief options so that you will be better prepared to make decisions during the labour and birth process.
Understanding the different types of epidurals, how they are administered, and their benefits and risks will help you in your decision-making during the course of labour and delivery.
What Is Epidural Anaesthesia?
Epidural anaesthesia is a regional anaesthesia that blocks pain in a particular region of the body. The goal of an epidural is to provide analgesia, or pain relief, rather than anaesthesia, which leads to total lack of feeling. Epidurals block the nerve impulses from the lower spinal segments. This results in decreased sensation in the lower half of the body.
Epidural medications fall into a class of drugs called local anesthetics, such as bupivacaine, chloroprocaine, or lidocaine. They are often delivered in combination with opioids or narcotics such as fentanyl and sufentanil in order to decrease the required dose of local anesthetic. This produces pain relief with minimal effects. These medications may be used in combination with epinephrine, fentanyl, morphine, or clonidine to prolong the epidural’s effect or to stabilize the mother’s blood pressure.
How Is An Epidural Given?
Intravenous (IV) fluids will be started before active labour begins and prior to the procedure of placing the epidural. You can expect to receive 1-2 liters of IV fluids throughout labour and delivery. An anaesthesiologist (a doctor specialized in administering anaesthesia), an obstetrician or nurse anaesthetist will administer your epidural.
You will be asked to arch your back and remain still while lying on your left side or sitting up. This position is vital for preventing problems and increasing the epidural effectiveness. An antiseptic solution will be used to wipe the waistline area of your mid-back to minimize the chance of infection. A small area on your back will be injected with a local anesthetic to numb it. A needle is then inserted into the numbed area surrounding the spinal cord in the lower back. After that, a small tube or catheter is threaded through the needle into the epidural space. The needle is then carefully removed, leaving the catheter in place to provide medication either through periodic injections or by continuous infusion. The catheter is taped to the back to prevent it from slipping out.
What Are The Types of Epidurals?
There are two basic epidurals in use today. Hospitals and anaesthesiologists will differ on the dosages and combinations of medication. You should ask your care providers at the hospital about their practices in this regard.
After the catheter is in place, a combination of narcotic and anaesthesia is administered either by a pump or by periodic injections into the epidural space. A narcotic such as fentanyl or morphine is given to replace some of the higher doses of anaesthetic like bupivacaine, chloroprocaine, or lidocaine. This helps reduce some of the adverse effects of the anaesthesia. You will want to ask about your hospital’s policies about staying in bed and eating.
Combined Spinal-Epidural (CSE) Or “Walking Epidural”
An initial dose of narcotic, anaesthetic or a combination of the two is injected beneath the outermost membrane covering the spinal cord, and inward of the epidural space. This is the intrathecal area. The anaesthesiologist will pull the needle back into the epidural space, thread a catheter through the needle, then withdraw the needle and leave the catheter in place. This allows more freedom to move while in the bed and greater ability to change positions with assistance. With the catheter in place, you can request an epidural at any time if the initial intrathecal injection is inadequate. You should ask about your hospital’s policy on moving around, eating and drinking after the epidural has been placed.
With the use of these drugs, muscle strength, balance, and reaction are reduced. CSE should provide pain relief for 4-8 hours.
What Are The Benefits Of Epidural Anaesthesia?
Allows you to rest if your labor is prolonged. By reducing the discomfort of childbirth, some women have a more positive birth experience. Normally, an epidural will allow you to stay alerted and remain an active participant in your birth. If you deliver by cesarean, an epidural anesthesia will allow you to stay awake and also provide effective pain relief during recovery. When other types of coping mechanisms are no longer helping, an epidural can help you deal with exhaustion, irritability, and fatigue. An epidural can allow you to rest, relax, get focused, and give you the strength to move forward as an active participant in your birth experience.
The use of epidural anaesthesia during childbirth is continually being refined, and much of its success depends on the skill with which it is administered.
What Are The Risks Of Epidural Anaesthesia?
Epidurals may cause your blood pressure to suddenly drop. For this reason, your blood pressure will be routinely checked to help ensure an adequate blood flow to your baby. If there is a sudden drop in blood pressure, you may need to be treated with IV fluids, medications, and oxygen. You may experience a severe headache caused by leakage of spinal fluid. Less than 1% of women experience this side effect. If symptoms persist, a procedure called a “blood patch”, which is an injection of your blood into the epidural space can be performed to relieve a headache. After your epidural is placed, you will need to alternate sides while lying in bed and have continuous monitoring for changes in fetal heart rate. Lying in one position can sometimes cause labour to slow down or stop. You might experience the following side effects: shivering, a ringing of the ears, backache, soreness where the needle is inserted, nausea, or difficulty urinating. You might find that your epidural makes pushing more difficult and additional medications or interventions may be needed, such as forceps or cesarean. Talk to your doctor when creating your birth plan about what interventions he or she generally uses in such cases. For a few hours after the birth, the lower half of your body may feel numb. Numbness will require you to walk with assistance. In rare instances, permanent nerve damage may result in the area where the catheter was inserted. Though research is somewhat ambiguous, most studies suggest that some babies will have trouble “latching on” causing breastfeeding difficulties. Other studies suggest that a baby might experience respiratory depression, fetal malpositioning, and an increase in fetal heart rate variability, thus increasing the need for forceps, vacuum, caesarean deliveries, and episiotomies.
Common Questions About Epidurals
Does the placement of epidural anaesthesia hurt?
The answer depends on who you ask. Some women describe an epidural placement as creating a bit of discomfort in the area where the back was numbed, and a feeling of pressure as the small tube or catheter was placed.
When will my epidural be placed?
Typically epidurals are placed when the cervix is dilated to 4-5 centimeters and you are in true active labor.
How can my epidural affect labour?
Your epidural can cause your labour to slow down and make your contractions weaker. If this occurs, you may be given the medicine Pitocin (Syntocinon) drip to help speed up labour.
How can an epidural affect my baby?
As previously stated, research on the effects of epidurals on newborns is somewhat ambiguous, and many factors can affect the health of a newborn. How much of an effect these medications will have is difficult to predetermine and can vary based on dosage, the length of labour, and the characteristics of each individual baby. Since dosages and medications can vary, concrete information from research is currently unavailable. One possible side effect of an epidural with some babies is a struggle with “latching on” in breastfeeding. Another is that while in-utero, a baby might also become lethargic and have trouble getting into position for delivery. These medications have also been known to cause respiratory depression and decreased fetal heart rate in newborns. Though the medication might not harm these babies, they may have subtle effects on the newborn.
How will I feel after the placement of an epidural?
The nerves of the uterus should begin to numb within a few minutes after the initial dose. You will probably feel the entire numbing effect after 10-20 minutes. As the anaesthetic dose begins to wear off, more doses will be given–usually every one to two hours. Depending on the type of epidural and dosage administered, you can be confined to your bed and not allowed to get up and move around. If labour continues for more than a few hours you will probably need urinary catheterization, because your abdomen will be numb, making urinating difficult. After your baby is born, the catheter is removed and the effects of the anaesthesia will usually disappear within one or two hours. Some women report experiencing an uncomfortable burning sensation around the birth canal as the medication wears off.
Will I be able to push?
You might not be able to tell that you are having a contraction because of your epidural anaesthesia. If you can not feel your contractions, then pushing may be difficult to control. For this reason, your baby might need additional help coming down the birth canal. This is usually done by the use of forceps.
Does an epidural always work?
For the most part, epidurals are effective in relieving pain during labor. Some women complain of being able to feel pain, or they feel that the drug worked better on one side of the body.
When can an epidural NOT be used?
An epidural may not be an option to relieve pain during labour if any of the following apply:
You use blood thinners
Have low platelet counts
Are hemorrhaging or in shock
Have an infection on or in your back
Have a blood infection
If you are not at least 4 cm dilated
Epidural space can not be located by the physician
If labor is moving too fast and there is not enough time to administer the drug.
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Credits – americanpregnancy.org.
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