Epidurals and Medication

Epidural Anesthesia

An epidural, or epidural analgesia, is a regional anesthesia used for rapid pain relief and is the most commonly used anesthesia in childbirth. The purpose of an epidural is to provide analgesia, or pain relief, rather than anesthesia, which is a total lack of feeling. After the injection of an epidural, the mother usually does not feel pain in labor but will still feel pressure. Over half of women who deliver in hospitals ask for an epidural.
“An epidural is a catheter that’s placed in to the back that delivers a combination of an anesthetic and a narcotic that helps to numb the lower half of the body and relieve the pain. It does that by numbing the nerves that innervate the lower half of the body,” says board-certified obstetrician gynecologist Dr. Lauren Hyman.
To receive an epidural, the laboring mother lays on her side or sits up. An antiseptic solution is used to minimize the chance of infection. A local anesthetic is injected into a small area of the back to numb it. A needle is then inserted into the numbed area surrounding ... Read more

Epidural Benefits and Risks

Benefits

• Allows the mother to rest through a prolonged labor
• Reduces the discomfort of birth
• Allows the mother to be an active participant in the birth
• Helps with exhaustion, irritability, and fatigue

Risks

• Epidurals may cause the mother’s blood pressure to drop suddenly. Due to this, blood pressure is routinely checked. If a drop is detected, they may be treated with IV fluids, medications, and oxygen.
• After the epidural, the mother must alternate sides while lying in bed
• Some experience shivering, ringing of the ears, backache, soreness where the needle is inserted, nausea, or difficulty urinating
• Epidurals might make pushing more difficult and require additional medication or interventions to help the labor along
• For a few hours post-birth, the lower half of the body may remain numb
• Epidurals fail to achieve analgesia in about 5% of cases and another 15% of cases only partial analgesia. In some cases, if analgesia is inadequate, another epidural will be administered. Some of the factors associated with failure to achieve analgesia are obesity, multiparity, history of regular opiate use, and cervical dilation of more than 7 cm.
• Accidental dural punctures occur in 1 out of 100 epidural insertions. The epidural space in the lumbar spine is only 3-5 mm thick, which means it is relatively easy to cross it and accidentaly puncture the dura with the needle. This causes spinal fluid to leak into the epidural space, which may cause post-dural puncture headaches. These headaches can be serve and last several days or longer. Most cases resolve spontaneously over time.
• Epidural veins can also be inadvertently punctured with the needle during the procedure. This is called a bloody tap and occurs in about 1 to 30 or 1 to 50 epidurals. It is a common occurrence and not considered a complication unless a person does not have normal blood clotting.

An epidural may not be an option to relieve pain during labor if any of the following apply:

• You use blood thinners
• Have low platelet counts
• Are hemorrhaging or in shock
• Have an infection in the back
• Have a blood infection
• If you are not at least 4 cm dilated
• Epidural space can’t be located by the physician
• If labor is moving too fast and there is not enough time to administer the drug

Epidural Effect on baby

Research on the effects of epidurals on newborns is fairly ambiguous. How much of an effect an epidural has is difficult to predetermine and can vary based on dosage, the length of labor, and the characteristics of the baby. Some believe that a possible side effect of an epidural is some babies struggling with “latching on” for breastfeeding. Another possible side effect is the baby might become lethargic in-utero and have trouble getting into position for delivery.

Epidural Alternatives

Though some mothers may opt out of using an epidural, all laboring mothers need an approach to deal with pain management.
“The pain of childbirth is obviously quite serious and there are natural ways that people can deal with that pain that have been utilized over the last 30 or 40 years. The Lamaze method, the Bradley method, hypnobirthing, yoga techniques – they are all valuable and can be utilized to get through pain,” says board certified obstetrician and gynecologist, Dr. Paul Crane.
For more information on epidurals and pain management, check out what top experts have to say on the best ways to help your child at kidsinthehouse.com.