As the end of a pregnancy approaches it is natural for any woman to feel anxious and apprehensive about childbirth especially if it’s her first child. It is a crucial time that needs to be well prepared for and researched so that she may feel as much ease as possible during the childbirth. One of the more recent advances is the usage of epidural anaesthesia during child labour. This procedure is much more popular in western countries but of late there has been a rise in its usage in India as well. Should you consider using epidural anaesthesia for your childbirth? Here are some of the facts and stigmas surrounding epidural pain relief that can help you better understand if this method is suitable for you.
WHAT EXACTLY IS EPIDURAL ANAESTHESIA?
Epidural anaesthesia is a regional anaesthesia that blocks pain in a particular region of the body. The goal of an epidural is to provide analgesia or pain relief which leads to total lack of feeling. Epidurals block the nerve impulses from the lower spinal segments. This results in decreased sensation in the lower half of the body.
An epidural delivers continuous pain relief to the lower part of your body while allowing you to remain fully conscious. It decreases sensation but doesn’t result in a total lack of feeling.
There are two basic epidurals in use today, the regular epidural that uses purely local types of anaesthetics and the combined epidural that combines a narcotic like fentanyl (which dulls pain) with a lower dose of anaesthesia (which blocks all sensation in one part of the body).
Medication is delivered through a catheter (a very thin, flexible, hollow tube) that’s inserted into the epidural space (area surrounding the spinal cord filled with spinal fluid), this is usually administered at the lower back region(lumbar region).
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WHAT WILL YOU EXPERIENCE DURING EPIDURAL ANAESTHESIA?
For the catheter to be inserted, you lie curled on your side or sit on the edge of the bed while an anaesthesiologist cleans your back, injects the area with numbing medicine, and carefully guides a needle into your lower back. (This may sound painful, but for most women, it’s not.)
The anesthesiologist then passes a catheter through the needle, withdraws the needle, and tapes the catheter in place so medication can be administered through it as needed. You can lie down at this point without disturbing the catheter.
Your baby’s heart rate is monitored continuously, and your blood pressure is taken every five minutes or so for a while after the epidural is in to make sure it isn’t having any negative effects.
You’ll start to notice the numbing effect about ten to 20 minutes after the first dose of medication, though the nerves in your uterus will begin numbing within a few minutes. You’ll receive continuous doses of medication through the catheter for the rest of your labour.
After you deliver your baby, the catheter will be removed. (If you’ve had a C-section, sometimes the catheter is left in to administer postoperative pain medication.) Having the catheter removed doesn’t hurt at all beyond the sting of having the tape pulled off.
What are the benefits of epidural anaesthesia?
Allows you to rest if your labour is prolonged.
By reducing the discomfort of childbirth, some women have a more positive birth experience.
Normally, an epidural will allow you to stay alerted and remain an active participant in your birth.
If you deliver by cesarian, an epidural anaesthesia will allow you to stay awake and also provide effective pain relief during recovery.
When other types of coping mechanisms are no longer helping, an epidural can help you deal with exhaustion, irritability, and fatigue. An epidural can allow you to rest, relax, get focused, and give you the strength to move forward as an active participant in your birth experience.
What are the risks?
The drugs used in your epidural may temporarily lower your blood pressure, reducing blood flow to your baby, which in turn slows his heart rate. (This is treated with fluids and sometimes medication.)
In 1 in 100 women, an epidural causes a bad headache that may last for days. This is caused by a leakage of spinal fluid. (You can reduce the risk of a headache by lying as still as possible while the needle is being placed.)In very rare cases, an epidural affects your breathing, and in extremely rare cases it causes nerve injury or infection.
You might experience the following side effects: fever, shivering, a ringing of the ears, backache, soreness where the needle is inserted, nausea, or difficulty urinating.
For a few hours after the birth, the lower half of your body may feel numb. Numbness will require you to walk with assistance.In rare instances, permanent nerve damage may result in the area where the catheter was inserted.
What are some myths surrounding epidural anaesthesia?
An epidural makes pushing difficult.
One advantage of combining spinal with epidurals is that it typically allows for less medication to be given than with an epidural, so you get pain relief without total numbness. This lower dose makes pushing easier than with a higher-dose epidural, reducing the likelihood of a forceps- or vacuum-assisted delivery.
None of the medication used reaches the baby.
Any medication that you take to relieve pain will reach the baby, however, with an epidural, the amount that enters your bloodstream is quite small, and with a spinal, it’s even smaller. While further studies are needed, the small amount of medication absorbed by the baby is not known to cause harm.
The needle used is gigantic, and it hurts when inserted.
The epidural needle is left in place for only a minute or two—just long enough to insert a skinny, flexible catheter the size of a pencil lead into the epidural space. The spinal needle is much smaller—the width of a thick piece of hair. But before this happens, the injection site is numbed with a local anaesthetic, at which point you will feel a pinch and sting for about 10 seconds. You’ll feel pressure, but not pain, when the epidural and/or spinal itself is given.
A woman can move around throughout labour if she has a combined epidural.
Most women do not walk with one, Once one is given, continuous fetal monitoring and an IV are needed, and many doctors do not encourage women to walk with these.
Although the concept of using epidural anaesthesia is fairly new to Indian women, the option of utilising it should not be easily dismissed. It is definitely not a conventional mode of childbirth but that does not necessarily mean that it shouldn’t be considered. It can be greatly beneficial for women that aren’t able to withstand labour pain and/or for women that exhaust themselves in the case of prolonged or difficult labour. Either way, it’s an option that can possibly alleviate a lot of child labour woes for a woman.
Doctor by profession, ardent animal lover by choice; she finds writing to be therapeutic. She loves meeting new people, hopes to travel the world and has karaoking with Oprah on top of her bucket list. @kirtana_ponnuswamy