Birth and Babies

So there are ways to try and reduce the possible side effects you or your baby may experience from an epidural.  here are a few ways:

• Labor as much as possible naturally before you accept the epidural.  While it may be more painful in the end to have to sit still for the procedure, the longer you can stay up and active (which helps reduce pain on its own) the length of labor time you have left (and as a result, the amount of exposure to the medication), will be less.
• Request lighter medication
• The staff will monitor you and your baby

The following intervention can/will take place:

• Restriction to bed
• frequent checks of blood pressure and oxygenation
• Monitoring mothers heart w/ EKG
• Restriction of food & usually drink
• IV fluids
• Bladder cath
• continuous electronic fetal monitoring
• aggressive use of pitocin to prevent a stall in labor
• additional drugs to counteract itching, nausea, low blood pressure
• forceps, vacuum, cesarean, episiotomy
• if mother has a fever, baby will be taken to nursery for observtion, septic workup and IV antibiotics
• issues with breastfeeding may occur as a result of the medication

As I mentioned before, epidurals have pro’s and con’s.

I think the obvious “pro” is pain relief.  When administered correctly, most women are able to stay awake and alert while experiencing no pain.  Women are also able to sleep.  In long or difficult labors, an epidural can prevent exhaustion, allow the mom to relax while her body continues to labor, and still allow her the ability to have a peaceful and positive birth experience.

Epidurals are not without their con’s, however. I am typing this up as these come to me and may be out of the order of events… I tried to cut/paste some segments where they should be and for some reason I can’t. 

• Epidurals may not always work.  Women may experience windows of pain, or pain on half of their body.  Your experiences can differ from one birth to the next, so you can’t count on an epidural for complete pain relief.
• Epidurals slow labor, which increases the use of pitocin to stimulate stronger contractions (because you will be unable to stimulate stronger contractions on your own laying in bed).  Increased use of pitocin leads to higher episiotomy rates, instrumental delivery (forceps or vacuum), and cesareans.
• Epidurals easily pass into the maternal blood vessels  and crosses the placenta into the babys circulation.  Once there, it may slow the fetal heart.
• Other issues, such as a catheter or needle piercing a blood vessle, needle going further than it should, or catheter migrating inward can cause convulsions, respiratory paralysis, and/or cardiac arrest. This can happen as commonly as 1 in 3000 cases!  Interesting to note that drugs causing serious adverse reactions in this range have been take off the market or forced into restricted use.
• Allergic shock is a possibility.
• You generally aren’t able to move around to keep your labor moving.  In some instances you can still walk with assistance, but your movement will be severely limited.  You will also be hooked up to a fetal monitor, blood pressure cuff and IV which restricts your movement even more.
• Body temperature rises over time, so you are more likely to develop a fever (which can also signal uterine infection and will cause your baby to undergo observation, blood tests, spinal taps and other testing/procedures to ensure the baby does not have an infection). 
• Test doses and some of the tests done to be sure the epidural is properly placed can cause problems. 
• Some women will experience a significant drop in blood pressure (even with the IV fluid given to try and avoid this, which in its self also carries risks such as fluid overload, pulmonary edema, possible excessive breast engorgement, excessive urine production, neonatal tachypnea and others.)
• Postpartum complications can involve urinary incontinence, nerve injury, hematoma, spinal headache (a debilitating headache which can last for days, interfere with bonding and breastfeeding and overall quality of life).  In the newborn, adverse physical and behavioral effects may be noted, including trouble with breastfeeding, sleeping, self soothing and adjustment. 
• Other side effects of an epiural in the mother include inability to push, itching and nausea (if narcotics are used), and psychological effects (with all that is involved in getting an epidural and monitoring, what was a normal process is now a high-tech event that the mother no longer has control over).  Loss of internal pelvic muscle tone can lead to unfavorable positioning of baby which can lead to longer labors or cesarean deliveries.
• in the fetus, other side effects ine heart rate decelerations, hypoxia (from a drop in moms blood pressure), tachycardia and fever (from mothers fever).
• Complications arrising from epidural use may lead to cesarean sections.

Most women are not told about epidural facts, especially in hospital-based childbirth classes.  It is important for you to think “outside of the box” and take a childbirth class given by an independent childbirth educator, in addition to the hospital class if you wish, so you are fully informed. 

Choosing an epidural is a highly personal choice, but one that should not be taken lightly.  We have the right in this day and age to exercise our rights.  We have options. Before we jump into them, let’s make a fully informed decision.  Epidurals are not “bad” when they are used for the right reasons, but it is up to each women to decide what those right reasons are. 

As an educator, I do think it is important for women to be educated about epidurals even if they are choosing a completely natural birth.  Complications or situations can arrise that might make an epidural favorable or necessary, in which case it is very helpful to be informed.  I also feel that students planning an epidural should  be well informed about natural childbirth and pain relief techniques in case they go into labor and cannot get their epidural as quickly, or incase the epidural does not work, then they are still prepared and can make the birth a positive experience.

In the next segment I will discuss how we can reduce the chances of complications, how the staff might also, and what intervention you will experience with epidural use. 

Ever wonder how an epidural is put in?

First you’ll likely have an IV and about a quart of fluid to try and prevent a fall in blood pressure.  Electronic fetal monitor will be used to pick up any problems that may arrise (this is the external device that attaches to your belly with the stretchy bands).  Your blood pressure will be closely monitored - in most hospitals the cuff will be placed and automatically take your blood pressure. You will be asked to get into position - either sitting on the edge of the bed or lying on your side.  Your back will be cleaned off with antiseptic and covered with a sterile drape.

You will be asked to arch your back as a local anesthetic is injected, then a large needle will push between two vertebrae just above the level of your waist.  It is vitally important that you hold absolutely still for this, even during contractions which are likely to occur during this time period.  The needle will be guided in slowly and carefully feeling for the epidural space.  Once placed, the anesthesiologist will perform one or more tests to ensure that the needle has not #1 peirced a blood vessel nor #2 gone below the epidural space which can cause life-threatening complications.

If all seems well, the anesthesiologist will guide a tiny flexible plastic catheter through the nddle and remove the needle.  Then the full dose of anesthetic will be injected, the catheter will be looped and taped to your back.

The quality of the anesthetic will be assessed.  If it is unsatisfactory, you will be asked to shift position to redistribute the dose, or more may be injected.  The area under anesthetic will be tested with pinpricks or ice.

If you are getting “continuous infusion” the catheter will be hooked up to syringe which will be hooked up to a pump to deliver a continuous flow of anesthetic.  Or, you may instead get “periodic top-ups” where additional anesthetic is injected when you feel the return of pain.

Ideally, you’ll feel no pain with the epidural.  However, some women experience pain only on one side of their body or windows of no anesthesia.

Ideally, when it comes time to push the anesthetic will be reduced so you can have a chance to push effectively .

The pain relief may not come for another 15-30 minutes after the epidural has been placed.  This means you will be contracting during the procedure and for a while afterwards.  In many cases, the anesthesiologist is not available immediately when you request an epidural, so there may be a wait before s/he even gets to your room. If the epidural was not placed correctly, or the anesthesiologist has to make several attempts, relief will take even longer.

In the next segment I’ll discuss the trade off of epidurals.  Stay tuned!

Epidurals can cost around $500-$2500.   Wow!

Considering most hospitals have to maintain staff anesthesiologists around the clock to handle emergencies, the hospital has to maintain about a 80% epidural rate so these ansethesiologists can make an adequate income.

One reason epidurals are suggested and even pushed so much in hospitals is because they do make a decent amount of money for the hospital. 

Well, hospitals have to make their money right?  Does that mean that you have to subject yourself and your baby to a procedure that has potentially serious side effects?  No.

Stay tuned to learn more about epidurals as I post additional information on this common form of pain relief.

In terms of pain relief for labor, the epidural is a regional anesthetic drug injected into the lower back of a laboring woman. Generally, it will numb you from right around under your ribs to your thighs. 

The epidural is injected into the space just outside the dura (the outer membrane surrounding the spinal cord).  A thin tube is injected through the needle and stays within the epidural space delivering the medication, while the needle is pulled out. 

A pump operates the distribution of the medication.  The epidural can be reduced or turned off, which will gradually reduce the effects of the medication.  You will start to have feeling again, which can be helpful during pushing.

For many women, epidurals are the pain relief of choice during labor and birth.  Unfortunately, many women are led to believe that they are completely safe, work effectively every time, and are nothing to worry about.  Many women and sometimes doctors claim they enhance the labor and birthing process and make for a happy, memorable event for the parents.  Some women decide early in their pregnancy that they want an epidural as soon as they go into labor.  It seems to be a growing trend that women “shouldn’t have to” experience pain during labor.
While epidurals are used nearly routinely in most hospital environments, they are not without their side effects to mom and baby, nor are they something to be worry-free about.  I am very surprised by the frequency of doctors claiming they are safe while there is evidence documenting the opposite.  The more I teach and follow up with my students and talk with pregnant women who are not students but have questions, the more frequently I run into women who have had short term or long term problems as a result of their epidurals, or their labor was effected in such a way from the epidural that a cesarean section or instrumental delivery had to be done. 
I’d like to start blogging about epidurals, doing little parts at a time. I think it makes for easier reading instead of putting everything out there at once.  This is something women need to know about, and need to educate themselves from a variety of sources.  There are a variety of ways to reduce pain during labor – both medical and non-medical – and each is capable of enhancing your labor and birth experience, while still making for happy memories.
Epidurals DO have their place in labor and delivery, and I will get into that.  But first I’d like to start off with what an epidural is and how it’s used, so we’re all familiar with it before I go into more detail.

Stay tuned…