Epidural
Anesthesia and Childbirth:
The Choice is Yours!
What
is Epidural Anesthesia?
An
epidural is a method of controlling pain during childbirth
and is commonly used in the United States. It is a form
of regional anesthesia, which means feelings of pain from
a part of the body are blocked while a person remains conscious.
How
does epidural anesthesia work?
A
local anesthetic drug is given in the epidural space of
the spinal area, which numbs the nerves from the uterus
and birth canal. When the nerve impulses are blocked, there
is decreased feeling in the lower half of the body. With
the numbing effect, the labor contractions of birth are
barely felt.
How
is it given?
Before an epidural is given a woman has an IV started and
receives extra fluids. She is then positioned on her left
side or in a sitting position. The waistline area of the
lower back is cleansed. The skin is numbed with a local
anesthetic. A larger needle is placed through the numbed
area and into the epidural space of the spine, and then
a catheter (smaller tube) is threaded through the needle
into the epidural space so that the needle can be removed.
The catheter remains in place so that more doses of medication
can be given if needed. The catheter is removed after the
baby is born and the anesthesia wears off in one or two
hours.
Is
the epidural a painful procedure?
There is some discomfort when the skin is numbed, and after
that slight pain or pressure may be felt as the catheter
is placed.
When
will the epidural be placed?
The epidural is usually placed when a woman is in the active
stage of labor, usually at 4 centimeters dilation. An epidural
can also be given before a cesarean section delivery.
Can
anyone get an epidural?
No, an epidural may not be an option in certain situations.
If labor is progressing rapidly there may not be time to
receive an epidural. If a woman uses blood thinners, has
had back surgery, has heart or blood disorders, or has allergies
to medications, she should discuss these with her provider
and anesthesiologist, because an epidural may not be advised.
What
are the benefits of epidural anesthesia?
A woman can be awake, alert and comfortable in
labor and childbirth. The reduced discomfort can help women
to rest during labor. If other coping medications are no
longer helping, this rest and pain relief can help her to
relax, and get re-focused. Complications and side effects
are rare.
What
are the possible complications, side effects and risks?
The medications used may cause decreased blood pressure.
This can be recognized and treated. Less than 1 out of 100
women may experience a headache following an epidural. If
this occurs, it can also be treated. A woman’s back
may be sore from the injection for a few days. Occasionally
an epidural does not work effectively and a woman may still
feel pain, or pain on one side. Labor contractions may slow
down, and a woman may not be able to push as effectively,
so interventions such as the medication Pitocin to stimulate
contractions, forceps or vacuum extraction to help deliver
the baby’s head, or a cesarean birth may become necessary.
Studies have suggested that there are more breastfeeding
difficulties after birth in mothers who have used epidural
anesthesia. Minimal amounts of medication are used, and
these medications will not harm the baby before birth, but
can cause subtle effects such as a lower heart rate, and
less movement getting into position for delivery. Because
different medications and amounts used influence the amount
of these effects, it is difficult for research to measure
the incidence of these potential side effects. Until an
epidural wears off, a woman is not able to walk around or
go to the bathroom. Serious complications are very rare,
but if the drug enters a vein a woman could get dizzy or
have a seizure, and if the drug enters the spinal fluid
it can make it hard to breathe. To avoid these complications,
a test dose is given and a woman is monitored very closely
when an epidural is in place.
What
are some of the other methods for reducing pain in labor?
There are many techniques used in labor that help women
to cope with pain in childbirth, such as relaxation, massage,
visualization, distraction, focusing and breathing. These
can be learned and practiced in childbirth classes. Pain
can also be lessened with analgesic medications, pain medications
that do not cause total loss of feeling. Analgesics also
have side effects and must be used cautiously.
There
are a variety of techniques and methods for pain reduction
in childbirth, the epidural being one of them. A better
understanding of the epidural procedure can help you to
make a decision that is right for you. If you feel you would
like to use an epidural during your birth or have questions
about epidurals, it is important for you to talk with you
doctor or midwife. This information is for educational purposes
only, and is not intended to replace the advice of a trained
health care professional.
References
The
American College of Obstetricians and Gynecologists (2005).
Your Pregnancy & Birth. Washington, DC: The American
College of Obstetricians and Gynecologist published jointly
with Meredith Books.
Epidural
Anesthesia. American Pregnancy Association. Retrieved Sept.
20, 2006 from the World Wide Web: http://www.americanpregnancy.org/labornbirth/epidural.html.
Women’s
Health: Epidural Anesthesia. Atlanta Health Pages. Retrieved
Sept. 20, 2006 from the World Wide Web: http://www.healthpages.org/AHP/LIBRARY/WOMEN/PREGNANT/LABRDELV/epidural.htm.
Effect
of Labor Epidural Anesthesia on Breast-Feeding of Healthy
Full-Term Newborns Delivered Vaginally. Journal of the American
Board of Family Practice. Posted 03/05/2003. Retrieved Sept.
20, 2006 from the World Wide Web.
