Introduction
Having a baby is not a joke, ask any pregnant woman. She is for sure anxious about one thing, the labor pains. There is a lot of labor involved and unfortunately a lot of pain involved.
Why is the labor so painful? It's because uterus is contracting to push it's content into the exterior, plus tissues and nerves in the cervix, vagina and perineum are stretching during the contraction and when the baby is coming down.
In fact, providing the pain relief during labor is one of the most important tasks we doctors have during labor monitoring.
There are plenty of choices available but today we will talk about a very effective but less popular method of pain relief in our dear country Nigeria, the epidural analgesia.
Is it safe? How is it done? When is it given? Does it have any side effects?
What is an epidural analgesia?
An epidural analgesia is giving a numbing medicine by inserting a needle and a catheter into epidural space of the patient. So what is a catheter? Catheter is a small flexible tube inserted into the lower part of a woman's back in the epidural space.
That's why it's sometimes called epidural alone. Epidural space is the space outside the spinal canal where the spinal nerves are exiting. Now this numbing medicine blocks the nerve impulses resulting in relief from the pain.
These medicines numb the spinal nerves and create a band of numbness from the belly button to the top of the legs allowing a woman to stay awake and feel the pressure of the labour without any pain.
How Epidural Analgesia is Being Done
So let's see how it's done. First intravenous fluids will be started before the procedure of putting the epidural.
An anesthesiologist, is a doctor who specializes in administering anesthesia, usually is the one that will administer your epidural analgesia. You will be asked to sit down and lean forward or lie on your side with your knees up close to your chest. Then an antiseptic solution will be used to wipe your mid back to minimize the chances of infection.
A small area on your lower back will be injected with a small anesthetic injection to numb it. A needle is then inserted into that numbed area outside the spinal cord in the epidural space. After ensuring its correct placement a small tube or a catheter is threaded through the needle into the epidural space.
After that the needle is removed but the catheter remains inside to deliver the pain medication as needed throughout the labor. The catheter is placed and taped to the woman's back and is attached to a special pump which is calibrated to deliver the exact doses of pain medication at regular intervals or maybe as a continuous infusion.
How do I feel after an epidural injection?
The pain relief usually begins 10 to 15 minutes after receiving the epidural and then continues throughout the labor.
Most women report a feeling of drastic relief in the pain of labor. Many women are so relaxed to the point of being sleepy. You might just feel the pressure of the contractions but there is no pain. Most women can move their legs also.
Can I go to the washroom to empty the bladder with an epidural analgesia?
Usually we advise the women to stay in bed after receiving an epidural because the decreased sensation in their legs makes the legs little wobbly which increases the risk of falling. So a bedpan can be given to empty the bladder.
At what point during labor can I receive an epidural analgesia?
Previously we used to debate about how many centimeters a woman should be dilated before we can give an epidural analgesia, but today a woman can get an epidural at almost any time in labor.
However an epidural analgesia is generally not given if your baby is just about to come which means if you're already eight to nine centimeters dilated then there's no point giving an epidural analgesia. There isn't any minimum cervical dilatation.
The epidural analgesia can be given on admission in very early labor too and only a request from the mother is sufficient to give an epidural.
What are advantages of an epidurlal analgesia?
The greatest benefit of an epidural is the potential for a painless delivery, a painless experience and an increased motivation for vaginal birth.
Some women might require an emergency c-section in the middle of labor. Therefore, if you already have an epidural catheter placed now just a stronger dose of medication for surgical anesthesia can be given through the same catheter.
The epidurals also help to lower these stress hormone levels which can help lower the blood pressure and heart rate which can actually become elevated because of the labor pains.
In some expert's experience also epidural analgesia helps in expediting the cervical dilatation and labor by allowing the mother to relax. Epidural analgesia is also known to reduce the chances of postpartum depression.
Will an epidural analgesia increase my chances of having a c-section?
No. Getting an epidural will not increase the risk of having a caesarean delivery.
However it may slightly increase the risk of a vacuum or a forceps delivery as the mother may not be able to push the baby as hard or as strongly as she should do.
Do epidural analgesia cause nerve damage?
It's extremely rare and occurs in less than one percent of cases. This would occur in case the needle is inserted in a long location, advances too far or comes in contact with the nerve root.
However even if that occurs it's usually temporary and usually resolves typically within a matter of weeks.
Does an epidural analgesia would ever cause chronic backache?
No an epidural is not a cause of backache. The back pain after childbirth is actually from labor.
Labor is an intense process which involves stretching of muscles and ligaments. Epidural analgesia is not the culprit.
Are there any risks of epidural analgesia?
Epidurals may cause your blood pressure to suddenly drop. So for this reason your blood pressure will be routinely monitored to help ensure the adequate blood flow going to the baby in case there's a sudden drop in the blood pressure. You might need to be treated with IV fluids, medications and oxygen.
You might find that your epidural makes pushing of the baby more difficult and additional medications or interventions might be needed like a forceps, vacuum or a caesarean birth.
Sometimes there could be failed epidural or a one-sided pain relief for which we might require redoing the epidural.
Some women find it difficult to empty the bladder while the epidural is in place and might require a placement of the catheter to drain the urine.
Some women may also experience a low-grade fever and heaviness or tingling in their legs during labor depending on how much medication has been administered.
For a few hours after the birth the lower half of your body may feel numb and you might require some assistance to walk.
Another very common complication if epidural analgesia is postdural puncture headache, which is mild to moderate headache that may follow up to some few weeks after giving epidural analgesia.
When can epidural analgesia not to be used?
If you are on blood thinners, if you have low platelet counts, if you are bleeding profusely or in shock, if you have an infection on or in your back, if you have a blood infection, if the epidural space cannot be located by the physician, if the labor is moving too fast and there is not enough time to place the epidural.
So as you prepare yourself for the labor day try to learn as much as possible about pain relief options so that you are better prepared to make decisions during the labor.
Conclusion
Whether you plan to use an epidural analgesia or not it's your personal choice, but it's a good idea to talk to your doctor about the benefits and risks of epidural analgesia and other pain management options.
Remember there is nothing as the best or perfect choice when it comes to pain relief in labor. We have started a new season of pregnancy series so for all of those who are pregnant do let me know the topic you want me to speak about.
0 Comments