Epidurals - What You Need to KnowKatlyn Joy | 2, March 2009
Epidurals are the most popular form of pain relief, and are used in over half of all hospital births. They are regional anesthetics, not total pain blockers, but rather meant to be pain relievers. They work by blocking nerve impulses in the lower half of the body. They are not meant to block all sensation, however.
How is an epidural administered?
Typically, an IV is started before active labor begins, and an anesthesiologist will administer the epidural. The mother will usually be instructed to either lie down on her side, or sit up, arching her back and must lie very still. An antiseptic wipe will be used on the lower back to prevent infection from occurring. Then a local anesthetic will be used prior to the needle being inserted into the epidural area of the spine. A small tube or catheter will be threaded through the needle into the epidural space, the needle removed, and the catheter taped down.
Most often the drugs used include bupivacaine, chloroprocaine, lidocaine and often added to the mix are narcotics such as fentanyl and sufentanil. The narcotics are added to achieve pain relief while limiting the side effects. Sometimes fentanyl, morphine, epinephrine, or clonidine are added to prolong the epidural's effect or to stabilize the mother's blood pressure. The medication is delivered either with periodic injections, or by continuous infusion.
What types of edpidurals are there?
There are two types of epidural, the regular kind described previously, and the so-called "walking epidural," which involves injecting the medication into the membrane covering the spinal cord, the intrathecal area. This type of epidural allows more freedom of movement and the ability to change positions independently. If the pain relief is not to the level desired, a regular epidural can then be performed.
What are the benefits of having an epidural?
- Edpidural allows a period of rest during prolonged labor
- Edpidural will not sedate you so that you are alert during labor and delivery
- Relieves discomfort providing a chance for a more positive birth
- Will allow for mother to be awake if cesarean section becomes necessary
- Can buy mother time to gather energy and focus for final stages of labor
What are the disadvantages of having an epidural?
The disadvantages of an epidural include:
- Epidurals can cause sharp drop in mother's blood pressure
- You must change positions to maintain good fetal heart rate
- Epidurals can affect your ability to push during delivery
- Rarely spinal headaches can occur
- Rarely, itching may result, which may or not need treating with simple Benadryl or something similar
- You may possibly be associated with interventions like Pitocen, forceps, vacuum extraction, or cesarean section.
- A few hours post birth, you may still experience numbness and require assistance to move about
- It is rare but possible that nerve damage could result
- Some research indicates some respiratory depression in newborn, and fetal heart rate variation.
Questions to Ask Your Doctor
- What drugs will be used?
- How long will it take before I feel the medication working?
- What side effects are possible?
- How will the baby be affected?
- Can I eat and drink following the epidural?
Reasons an Epidural Cannot be Performed
- If you use a blood thinner
- If labor is progressing too rapidly
- If you have a blood disorder, or are bleeding
- If you are not at least 4 cm. dilated
- Epidural space cannot be determined by doctor
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