So, You Want An Epidural?

August 10, 2013 in All by wildandwisdom

epi

It is the Rolls Royce of pain relief for a grueling labour.  The most up to date statistics (here) currently state that, overall in the USA, 61% of women giving birth to a singleton make use of the wondrous epidural.

In the UK, figures (here) reveal that percentage of women to be 33%.

Like many other women, I was all for an epidural at the start of my pregnancy, probably even before I was pregnant when I think about it!  I planned to just show up at hospital and make it my first request!  The more I read about them though, the more nervous I got that i might need one, aside from the needle in the spine, there were some surprising facts floating around that started to change my opinion of what I considered a routine and safe procedure.

So I thought I would take a closer look at some of the facts that I found particularly interesting, and share them with you…

What is an epidural?

Starting with the basics, lets straighten out the types available:

Spinal block is an instant and total numbing that lasts for a short period of maybe a couple of hours.  Medicine is injected into the fluid of the spinal cord, just the once, no catheter is left in place.  Because of its instant and total numbing effects it is good just before a c-section.

Epidural takes 10-20 minutes to have an effect, the anesthetic is injected just outside of the fluid of the spine.  A catheter is taped in place and medication can be administered over a long period of time to provide numbness to the lower half of the body.

Walking epidural is a low dose or combination form of epidural.  The lower dose of anaesthetic is combined with a painkilling opiate like pethidine or morphine, this usually allows the woman to move around with support but don’t expect to be pacing the corridors as you will likely be attached to a drip and baby monitor which can make moving around difficult.

CSE is a combined spinal-epidural.  A one-off dose of painkilling opiate, with or without anaesthetic, is injected into the spinal space, very close to the end of the spinal cord.  Pain relief lasts for around 2 hours, and then if more pain relief is needed, it can be given as an epidural.  The spinal administration is combined with the placement of the epidural catheter into one procedure.

How does an epidural work?

The spinal cord runs through a space in the bones of the spine.  Nerves running from the spine send messages to different parts of the body enabling them to function.  The nerves from the lover section of the the spinal cord control the lower sections of the body.

By injecting anesthetic into the epidural space of the lower back, as seen in the diagram above, the nerves controlling the lower body will be blocked, and feeling will be lost in the legs and the torso from the belly button down.

Can this medication reach baby?

This is the big question that we all want an answer to.  Although injected around the spinal cord, the drugs used will still enter your blood stream.  It is claimed that the amount of medication that does enter the blood stream is very low with an epidural and even lower with a spinal, but it will still cross over to the baby via the placenta.  I am guessing that the longer the epidural is being administered the more medication ends up reaching the baby.

It also takes a couple of hours for feeling to return to your legs after having an epidural, while the medication starts to wear off.  The Royal College Of Anesthesiologists states (here) that while the effects are typically not visible within hours of receiving a general anesthetic, traces can still be found in the body and breast milk for a few days.   That’s not something I fancy floating around in my newborn!

Breast feeding after epidural.

close up of newborn baby near breast

Studies have shown (here) epidurals to have a negative effect on breast-feeding.

That’s a sweeping statement sure to make many mothers angry…after all, we all know that breast feeding is temperamental even in the most ideal of situations.

But one really fascinating study worth looking at (here) showed a deficiency in oxytocin at delivery with epidural analgesia.

This I find interesting…oxytocin is the hormone that stimulates let down and brings milk or colostrum with it.  Low oxytocin…problems breast feeding…makes sense to me!  I have to admit I thought it was maybe down to the anesthetic effect of the drugs on the baby which made it harder for them to latch on, so I really like this scientific stand point, much more compelling.

So what about mum?

Ok, so you managed to handle the big needle in the spine, but what are some of the effects on mum apart from the feeling of total relief from contractions that just started to get the better of you…

Allergic reaction to the anesthesia used
Bleeding around the spinal column (hematoma)
Difficulty urinating
Drop in blood pressure
Infection in your spine (meningitis or abscess)
Nerve damage
Seizures (this is rare)
Severe headache

You can Google the risks of an epidural easily like I have just done for the list above.  No doubt you have done it at some point, so I won’t go into too much detail, as the list is almost endless!

Two particular points that were of interest that I want to look at have a knock on effect on baby are:

  • Low blood pressure (hypotension)
  • Elevated maternal temperature

Low blood pressure has a direct effect on how much blood is pumped into the placenta.  This in turn affects how much oxygen reaches the baby which is obviously not ideal.  To remedy the problem it is likely that you will get hooked up to IV fluids which may restrict how freely you can move into different positions for labour (another reason why your walking epidural might end up less mobile).

Elevated maternal temperature has the potential to spark a whole cascade of meddling, not least because a temperature can be a sign of infection but also because it may lead to a faster heart rate in the baby.  Fast heart rate can be a sign of a baby in distress and may lead to a c-section.  Baby may need tests to rule out infection and may require treatment with antibiotics after the birth, interfering with those precious first moments of skin to skin contact, breast feeding and bonding.  That right there is a good enough reason for me to try and stay away from the epidural!

Does an epidural really slow down labour and lead to a higher chance of c-section?

This isn’t just something they say to scare you away from an epidural, it’s not just hear say from the natural childbirth advocates, there is a simple reason why this is the case.

Plain and simply put, epidural anesthesia is indiscriminate, it freezes up the pelvic floor muscle which are crucial to guiding and delivering a baby safely and steadily.  This once active muscle that was guiding baby out so nicely, becomes a little bit too relaxed giving baby the opportunity to turn around in the birth canal.  This is where forceps may be needed to reposition baby, episiotomy cuts may be needed to allow forceps access, or c-section may be required if labour is too obstructed to deliver vaginally.

Will an epidural be so high on your birth plan now?

The epidural will always have a place on the delivery ward, it is essential at times, every labour is so different and who knows how yours will turn out.  What I think is important is to really study for a birth, prepare with as many natural aids as possible, yoga, meditation, hypno birthing, aromatherapy, TENS, massage…the more prepared you are in the earlier stages, the further you may get into your labour naturally, that might be all the incentive you need to go that final leg alone!!

How did you handle the pain of childbirth?  How did you find the epidural if you went down that route?  Would you make the same choices for the next time?  Let me know, leave a message below…

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