Epidural

An epidural is a regional anesthetic which involves injecting a sterile guide needle in the lower back, between the spinal cord and epidural space (outer membrane of the spinal cord), and a catheter is positioned at or below the lower part of the waist.

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This type of anesthesia numbs the area while allowing the laboring mother to stay awake during child delivery. Epidural anesthesia is also referred to as:

  • Intraspinal anesthesia
  • Subarachnoid anesthesia
  • Peridural anesthesia

Types of epidurals

Regular epidural

Regular epidural is a combination of narcotics [such as fentanyl and morphine] and higher doeses of anesthesia [such as bupivacaine, chloroprocaine, lidocaine, levobupivacaine, and opioid]. This can be administered on 2 ways:

  • Pump
  • Periodic injections

Combined spinal – epidural

Combined spinal – epidural (CSE), also called as walking epidural, is the initial dose or a combination of narcotics and anesthetics which provide pain relief for 4 – 8 hours.

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CSE is placed by the following process below:

  1. CSE is injected below the outermost membrane that covers the spinal cord and in the intrathecal area (inner area of the epidural).
  2. The anesthesiologist pulls the needle back in the epidural area, threads the catheter through the needle, withdraws the needle and leaves the catheter in place.

Moreover, CSE has a lot of benefits such as:

  • Allows the laboring mother to move freely
  • Ability to alter positions with assistance from the spouse, a doula, or even the hospital staff
  • Freedom to request more amount of epidural once the intrathecal injection begins to run out
  • Reduced muscle strength, balance, and reaction

Blood patch

Blood patch is the injecting of [from the name itself] blood in the epidural area to relieve severe headache.

Light epidural

Light epidural refers to a low dose of anesthetic drug. This allows the laboring mother to be active during the process, and decreases the chances of going the cesarean section.

Moreover, this allows the laboring mother to retain a level of sensation and strength to move around and alter lying positions whenever she wishes to.

Injection with top – ups

Painkiller drugs will be injected into a tube to numb the lower abdominal cavity and top – ups will be provided as the epidural effect begins to fade.

Continuous infusion

The edge of the tube of an epidural catheter is attached to a pump which will continuously supply the laboring mother’s back with painkiller drugs.

The process of placing an epidural anesthesia

Placing an epidural anesthesia is performed by an anesthetist or anesthesiologist inside an obstetrician – led birth center with the following step – by – step process below:

Before the epidural placement

Before labor and delivery begins, the dose of epidural anesthesia can be decrease depending on the mother – to – be’s request. An epidural catheter can also be used to numb the perineum area (skin between the vaginal opening and rectum).

  1. The patient must sit still on the edge of the hospital bed and lean forward as the anesthesiologist places the epidural anesthesia. This is to open up the spaces between the bones in the spinal cord. If the patient still feels a level of pain in the legs, she must let the anesthesiologist know immediately, since it may be a sign of temporary nerve damage which requires repositioning of the needle.
  2. Before placing the epidural, the anesthesiologist will insert an intravenous cannula (small tube) into the patient’s hand or arm.
  3. A local anesthesia is injected to numb the area where the sterile guide needle will be injected between the small bones in her spine. The needle goes into the epidural space (tissue layers of the spinal column). The painkilling drug carries pain signals from the uterus and cervix to the brain during the course of labor.
  4. The anesthesiologist will pass an epidural catheter (small tube) through the needle and gently removes it once the catheter is in place.
  5. An epidural and a spinal (a similar painkilling drug) are inserted into the catheter (small tube) to numb the body above and below the area of injection. Once the epidural is in place, it can remain until the baby is born and the placenta is delivered.
  6. The catheter is taped on the central part of the back with its end taped on top of the shoulder to remain in place. The epidural catheter should be removed. It can be left in place for maximum one day. The anesthesiologist may also give her a pain reliever right after child delivery.

If labor persists for how many hours, a urinary catheterization is required since the abdomen will become numb.

After the epidural placement

After the epidural placement, a newborn mother’s uterine nerves begin to numb after 10 – 20 minutes after the initial dose. Small bruises will appear and the skin around the epidural area becomes sore. This will last for up to 2 days.

Once the initial dose’s effect begins to fade more doses will be placed after 1 – 2 hours. This is because the epidural effect can last for up to 2 hours after the medicine is stopped.

On the other hand, some newborn mothers experience a burning sensation around the birth canal once the dose’s effect begins to fade.

In addition to that, the catheter is removed and the effects of epidural begin to fade within 1 – 2 hours after the baby is born.

Moreover, here is what a newborn mother must do after the epidural placement:

  1. A few hours after the epidural placement, expect the lower half of the body to feel numb, which will require a newborn mother to walk with assistance.
  2. Change sides. This is because lying in 1 position only can cause slow or stalled labor. Plus, it will also result to a pressured sore on the numbed area.
  3. Monitor the fetal heart rate continuously.
  4. If she wishes [or wants] to move and walk around, a mobile epidural will be provided.

The newborn mother could be confined and not allowed to get up nor move around, solely depends on the epidural type and administered dosage.

Pros and cons of epidural anesthesia

Before considering the option of receiving an epidural anesthesia, enlisted below are the benefits, risks, and side effects brought by this painkilling process:

Benefits

  • Allows the mother – to – be to rest if the labor is prolonged
  • Aims a comfortable childbirth experience by reducing pain during labor
  • Generally, epidural allows a laboring mother to remain aware and attentive
  • In cesarean cases, an epidural allows a laboring mother to stay awake
  • Aids in the recovery process by providing effective pain relief
  • Helps a newborn mother cope with exhaustion, irritability, and over – fatigue
  • Allows a newborn mother to relax and gain strength

Risks

  • Epidurals may cause hypotension
  • Leakage of the spinal fluid which will cause severe headache
  • In rare cases, the area where the catheter was injected causes permanent nerve damage

Side effects

Mother:

  • Trembling
  • Hypotension
  • Severe headache right after delivery
  • Difficulty moving and/or walking around right after delivery
  • Tinnitus – ringing in the ears
  • Hip and/or back pain right after child delivery
  • Soreness around the epidural area
  • Nausea and vomiting
  • Difficulty passing urine
  • Makes the laboring process more difficult which increases the chances of having additional medications and interventions

Baby:

The epidural effects on babies vary and have a lot of factors that can affect him such as:

  • Trouble latching on which causes difficulty during breastfeeding sessions
  • Hypoventilation (widely known as respiratory depression)
  • Malpresentation and malposition information of the fetal head
  • While inside the womb, the unborn baby might become sluggish
  • Difficulty rotating into the proper position for childbirth
  • Hypotension which affects the flow of oxygen from the mother to the unborn baby

With that being said, the aforementioned side effects increase the instances of forceps, vacuum – assisted delivery, cesarean delivery, and episiotomy.

 Frequently asked questions (FAQs) about epidurals

Below are the frequently asked questions (FAQs) regarding epidurals:

General FAQs

How painful is the placement of an epidural anesthesia?

The level of pain caused by epidural anesthesia varies from woman to woman. Some described it as causing a slight discomfort in the numbed area, while some describe it as a slight pressure on where the catheter is inserted.

How does an epidural anesthesia affect labor?

An epidural anesthesia slows down labor and weakens the contractions.

Are epidurals exclusively available in hospitals?

A laboring mother can only have an epidural anesthesia in a medical hospital’s obstetrician – gynecologist – led maternity unit. An epidural is not available at birth centers, though some are selfless enough to provide epidurals in a hospital – based home center.

Is an epidural anesthesia always effective?

Basically, epidurals are proven effective in relieving labor pain. Some women reported that they still feel pain while some say that the dosage worked on some sides or parts of the body.

At what phase of labor should a mother – to – be to have an epidural?

A mother – to – be can usually receive an epidural anesthesia at any phase of labor.

When is an epidural anesthesia necessary?

  • If the placenta is engaged and the medical practitioner needs to remove it manually
  • To relieve pain caused by sutures

When is an epidural anesthesia unnecessary?

An epidural anesthesia may not be the [best] option to relieve labor pain due to the following situations:

  • The mother – to – be took blood thinners
  • The mother – to – be is not dilated for at least 4 centimeters
  • Have thrombocytopenia (low platelet count)
  • Has Hypovolemic (hemorrhaging shock)
  • Has spinal infection
  • Has blood infection
  • Physician is having a hard time to locate the epidural area
  • Labor is too fast which results to having inadequate time to administer the painkilling drug

FAQs for the anesthesiologist

  • What combination of painkilling drugs will be used?
  • Amount of painkilling drug dosage will be used?
  • Will a newborn mother be able to get up and move around after the epidural placement?
  • What liquids and solids is a newborn mother allowed to consume?