Epidurals are the most common form of pain relief used by laboring women in America. Understanding how an epidural is done, how it works, and what the benefits and risks of using an epidural are is one way that women can better prepare themselves for their impending birth and ensure they are making informed and educated decisions for themselves and their baby.
What is epidural anesthesia?
Epidural anesthesia is administered into the epidural space of the spine through a catheter that provides pain relief, and even the elimination of pain all together. The intended outcome for the epidural is to relieve pain without removing the woman’s ability to feel anything, although many times women are unable to feel anything at all when an epidural is in place.
How does an epidural work?
An epidural works by blocking the nerve signals sent from the lower portion of the spinal cord, thus reducing and even eliminating feelings and sensations of pain. The medications administered in an epidural usually belong to a class of drugs known as local anesthetics. These drugs may include chlorprocaine, lidocaine, and buprivacaine. These anesthetizing drugs may be administered along with narcotics such as fentanyl to help decrease the dose of anesthetic required. Other medications may be administered through the epidural as well, to help prolong the effectiveness of the epidural, or even maintain the mother’s blood pressure.
How is an epidural administered?
When an epidural is being administered, the woman is often asked to lie on their side curled, or sitting up curled over a pillow, or leaning on a support person, such as a partner, doula or nurse, allowing their spine to curve. Creating more open space between the vertebrae. The nurse or anesthesiologist will then scrub the woman’s back with an antiseptic solution. This is done to help prevent any contamination from the mother’s body from entering the site of the epidural. For this reason, hospital personnel performing and assisting with the epidural will be attired using sterile gloves and often gowns to help prevent contamination and reduce the risk of infection.
Once the woman’s back has been cleaned thoroughly, the anesthesiologist will inject a small needle filled with a local anesthetic, numbing the epidural site. This is done because the needle used for the actual epidural is large, and it can be quite uncomfortable and even painful as the epidural needle breaks through the tough spinal tissues. After this local anesthetic is administered, the anesthesiologist gives it a few minutes to take effect before inserting a large, specially designed needle between two vertebrae and into the epidural space of the spine. A thin, flexible plastic tube is then threaded through the needle and into the epidural space. The needle is then slid off of the catheter and discarded. The external portion of the catheter is then securely taped in place on the mothers back ensuring that the internal portion of the catheter does not come loose. A test dose of the medication is administered and is then administered using a pump providing a frequent and continuous flow of medication through the epidural, ensuring the level of pain relief for the mother is maintained.
Is there more than one type of epidural?
There are a handful of epidural types, however, only two of these types are commonly used in laboring women to relieve pain.
In a standard epidural, once the catheter is in place, a stead stream of medication (usually an anesthetic combined with a narcotic) is administered using a pump. This ensures the mother is receiving and adequate and steady amount of medication to relieve pain. If a pump is not available, the medication may be periodically injected by a nurse or physician.
Combined spinal epidurals, also known as a “walking epidural,” are a combination of a spinal block and standard epidural. This combination often allows the mother to maintain mobility to rotate and reposition herself in bed unassisted and some women are even able to walk on it. An initial dose of anesthetizing medication is injected into the intrathecal area (just beneath the outermost membrane of the spinal cord). The needle is then pulled back into the epidural space and a catheter is placed and medication is administered just as it would be in a standard epidural.
What are the benefits of epidural anesthesia?
An epidural is very effective in relieving and even eliminating pain. An epidural may allow a woman to relax and rest, which may help to promote healthy labor progression.
An epidural does not affect the woman’s awareness of the environment around her, allowing her to still be active and engaged in the birth of her baby without feeling “out of it.”
An epidural may increase blood flow to the uterus.
Epidural anesthetics can be more easily controlled than narcotic pain medications, although this is not an exact science and it may be difficult to determine how to adjust the levels of medications when the woman needs to have more feeling in order to push, while maintaining adequate pain relief.
What are the disadvantages of epidurals?
If the needle used to place the catheter in the epidural space punctures the membrane (known as the dura) surrounding the spinal fluid, the woman may suffer from spinal headaches. These headaches may last several days and in some cases, even weeks. If these headaches become severe, they may require what is known as a “blood patch,” to correct them. This occurs in less than 1% of women who receive epidurals.
The medications in the epidural often cause a loss of feeling and numbness of legs, thus confining the woman to bed. This can be detrimental to labor progression as movement helps aid in dilation and effacement of the cervix.
An epidural may be difficult to place. If it is not possible to place, the woman is then left with puncture wounds and discomfort that may later become infected.
The medications in an epidural generally take 20-30 minutes to take effect. Because of this, if the medication is administered too late into labor, it may be of no benefit to the mother.
An epidural may cause a sudden drop in the blood pressure of the woman receiving it. This can be dangerous, which is why patients receiving epidurals have their blood pressure checked periodically to ensure that both she and her baby are receiving adequate oxygen. If the woman’s blood pressure does drop, she may need to be treated with medications and IV fluids.
If a woman would like an epidural, she must have blood work done prior to receiving it, which may take time. This lab work is done to ensure she is not at risk for developing certain complications that may be caused or worsened by the epidural.
Women who receive epidurals are more likely to need assistance delivering through the use of forceps and vacuum extraction. This is due to the lack of feeling and control over the muscles, which may make it difficult for the woman to push effectively.
Epidurals can slow down, stall and even stop labor. This can cause a great number of problems, especially if the woman’s waters have been broken for an extended period of time.
The woman may also experience shivering, fever, backache, nausea, soreness in the epidural site, itchiness, metallic taste in the mouth, numbness of the lips and mouth, lightheadedness and difficulty or trouble urinating. In much less frequent occurrences, seizures, coma and even death can occur.
Some more recent studies suggest that babies born to mothers who used epidurals for pain relief in labor may be less alert following birth and have difficulties latching on to breastfeed.
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