Pregnancy

Epidurals (The Good And The Bad)

EpiduralIf you have recently discovered you are pregnant – you are probably very excited and possibly a little overwhelmed! Over the next few months you will be hearing a wide range of views and opinions about birthing and pain relief medications that are regularly administered to women during labour.

The epidural is one of the most common of all pain medications and because epidurals are so powerful and effective, they have the ability to block out all childbirth pains.

 

How are epidurals administered?

The epidural is administered intravenously and is given before active labour is underway (the cervix cannot be dilated more than 4 to 5 centimetres). An anaesthesiologist, together with the obstetrician, and labour ward nurse will be called upon to administer the epidural. Before the epidural is given, the doctors will explain how the back needs to be arched and will stress the importance of remaining completely still during the procedure. An antiseptic solution is dabbed onto the waistline area which helps to reduce the risk of infection. A local anaesthetic will be injected into the small of the back, to numb it and the needle will then inserted into the numbed area surrounding the spinal cord in the lower back region. A small tube is threaded through the needle into the epidural space, after which the needle will be cautiously removed, leaving the tube through which medication is administered.

Most women describe the procedure as being a little uncomfortable and they report only feeling pressure on their back once the small tube (or catheter) is inserted.

Once the epidural has been setup, it will take a little over 20 minutes to start working and the effects of the drugs will last throughout labour and birth, and this allows for a completely pain-free labour and birth.

An epidural contains a combination of anaesthetic medications, such as lidocaine or chloroprocaine as well as Demerol or morphine.

 

Is the baby at any risk because of the epidural?

Although there is no concrete evidence available to support the claims, reports have been issued that relate to epidurals and the possible risk to the unborn or birthing baby. A few mothers have reported problems with breastfeeding and it is believed that the drugs may have negative effective on the infant and cause the infant to have trouble latching. Similar reports associated with the risks of epidurals have indicated that they adversely affect the release of oxytocin which aids with bonding between mother and child, and breastfeeding.

The additional unconfirmed reports which have been issued state that babies born with epidurals displayed abnormal behavioural patterns, while other imply that mothers who give birth with the aid of an epidural spend less time with their newborn babies. Many of these claims are unconfirmed and the studies have not been conducted by experts – but were merely based on findings after monitoring a handful of women. In terms of health risk, there is no evidence to suggest that the baby is at any risk if an epidural is administered before active labour.

 

As with all choices, epidurals have pros and cons, and these include:

Advantages:

  • Access to pain relieving medication as effective as epidurals allows women to enjoy their birthing experience;
  • If a c-section is required, the epidural will permit birthing mothers to remain awake and alert during the procedure;
  • Epidurals give women the control to be active participants during birth. The medication is far more effective than any other pain relieving medication and women who have had epidurals feel relaxed and focused.
  • The process of administering epidurals is being perfected continually which means that many of the previous risks are being minimized.

 

The Disadvantages

  • Additional side effects which may result from an epidural include backache, ringing in the ears, shivering, nausea, difficulty  urinating and pain where the needle was inserted;
  • Due to the fact the epidural blocks all pain, it may cause birthing mothers to experience difficulty when pushing and this may lead to the use of forceps, vacuum extractions or possible a c-section birth.
  • After birth, the new mothers are unable to feel their lower body and will need to be aided when walking;
  • When opting for an epidural during childbirth, the unborn infant will require frequent monitoring;
  • The medication may cause blood pressure to drop suddenly. If this does occur, doctors will treat the soon to be mom with IV fluids, medication and oxygen;
  • Less than 1% of women experience side effects after the epidural, including severe headaches. The headaches are caused by a leakage of the spinal fluid and this must be rectified by a blood patch. This is done by injecting blood into the epidural site;
  • Although rare, epidurals can lead to permanent nerve damage where the catheter was inserted.
      

When can an epidural not be used?

There are certain instances, when epidurals are not given, and these include:

  • A mother who is taking blood thinning medication;
  • If the blood platelet count is too low;
  • Mothers who are in shock or who are haemorrhaging;
  • If the mother has a blood infection;
  • An epidural will not be given during active labour and will not be administered before the cervix is at least 4 centimetres dilated;
  • If labour is progressing at a rapid rate, there may not be sufficient time to administer the epidural.

 

The alternatives to epidurals

Women, who are concerned about the possible side effects or the disadvantages of an epidural, will be able to choose from other pain relieving medications, such as the paracervical block. This is a local anaesthetic and it is injected into an area on the left and right sides of the cervix.

The other alternative is sterile water papules for injection, which will block or disrupt the sensors which inform the brain that the body is experiencing any pain.

Besides the pain relieving medications, there are also non-medicated pain relieving techniques, such as birthing breathing methods, tub births, heat packs, massages and acupuncture.

Prior to deciding on a specific method of pain relief, try to find out about the potential side effects, the advantages and disadvantages and discuss the methods with your obstetrician or midwife. They will offer a professional opinion, based on experience.

 

 – Kathy Baron

 

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