EPIDURALS - AN EPIDEMIC?
If birth is a normal, natural process why are so many woman choosing epidurals during labour? And in making this decision are women doing themselves and their babies more harm than good without knowing it? We investigate the type of epidurals on offer and what, if any, side-effects epidurals may have.
Epidural anaesthesia is a popular choice of pain-relief for women in labour, especially among moms having their first babies. But why should this be? One of the arguments put forward is that plenty of women are just not prepared to tough-out the pain of childbirth and don't trust their bodies to cope without pain relief. But the counter argument of epidural devotees is that there are no medals for bravery doing a drug-free labour, so why be a martyr?
Other moms opt for epidurals on the strength of a difficult first birth experience and still others are simply unable to deal with the pain of natural childbirth while they're in labour.
No two labours are the same and this extract from a piece written by Nina Shapiro published in the SEATTLE WEEKLY is a reminder that drugs can be a welcome release.
I have a friend who experienced labour with and without drugs in giving birth to two children. She went natural the first time, which she says put her into an extremely focused Zen-like state and gave her a feeling of tremendous accomplishment. She's glad she did it that way. The position of the baby in the second birth, however, prolonged her labour and intensified her agony. She finally got an epidural. And she found an interesting thing: freed from her pain, she was able to appreciate the moment of her child's arrival in a way she had not been able to do the first time.
Epidurals are a wonderful alternative to general anaesthetic for moms delivering by Caesarean. But before deciding on your pain relief in a normal vaginal delivery, find out what you can expect.
There are several types of epidurals used in hospitals.
A dose of local anaesthetic is injected through the lower back into the epidural space, around the spinal cord. This numbs the nerves which bring sensation from the uterus and birth canal. The local anaesthetic can numb the nerves, which control the pelvic muscles and legs, making you unable to move your legs. This depends on the dose used and the time the epidural catheter has been in place. Unless the epidural has worn off you won't be able to push your baby out in the second stage of labour.
Low dose or walking epidural.
More recent forms of epidurals use a lower dose, so you have the option of moving around with support. This option is not readily available in South African hospitals and if you're interested in it, discuss it with your gynaecologist or anaesthesiologist.
The "walking epidural" uses the same technique as the combined spinal epidural, with the exception that the drug used is a one-off dose of opiate.
"Walking epidurals" may seem beneficial but being attached to a CTG machine to monitor the baby and hooked up to a drip which is necessary when an epidural is in place, can make walking impossible.
Combined spinal epidural.
Combines a spinal block with an epidural. An anaesthetic is injected directly into the spinal fluid, which gives immediate pain relief, and at the same time an epidural catheter is inserted. It's fast acting and if the mom-to-be has her epidural catheter in place and needs a Caesar, it provides good anaesthesia for surgery.
Yes, with the exception of moms-to-be with blood disorders as the chances of bleeding or infection increase. Abnormalities of the spine such as scoliosis (spinal curvature) can also make it difficult to position the epidural properly.
An epidural may be recommended if you have raised blood pressure such as pre-eclampsia. In these cases an epidural can be used to help control the situation. If a difficult delivery is expected and there's a good chance that you may need a Caesar, an epidural may be recommended.
One of the most commonly recognised side effects of an epidural is a drop in blood pressure. Up to one woman in eight will have this side effect to some degree and for this reason extra fluids are usually given in a drip. A drop in blood pressure will affect how much oxygen is pumped to the placenta and can lead to less oxygen for the baby.
The pushing stage of labour may slow down because of the epidural effect on a woman's pelvic floor muscles. These muscles guide the baby's head so that it enters the birth canal in the best position. When these muscles aren" t working, forceps may be needed to turn the baby and assist with delivery of the baby.
When forceps are used or the second stage is too long, a woman may also need an episiotomy to enlarge the birth outlet. Stitches are given and it may be painful to sit until the episiotomy has healed in two to four weeks.
Whether epidurals cause back pain is controversial - studies show that backache is more likely after an epidural birth, although there seems no greater likelihood of back pain a week or even six weeks later.
Women often worry about nerve injury after an epidural but this is rare and usually a temporary injury.
About one percent of women experience a bad headache caused by accidental puncturing of the membrane surrounding the spinal sac. This is treated with an injection to seal the hole through which spinal fluid is leaking.
All things considered, many women have good experiences with epidurals, as relief from pain can allow mom to rest and relax sufficiently to deliver vaginally.
But it's also worth knowing that an epidural or other drug used for pain relief can also turn a normal birth into a medically managed affair, which can be disappointing if you're not prepared.
Gas and Air (Entonox)
A mixture of nitrous oxide and oxygen inhaled through a mouthpiece or mask.
An analgesic given by injection. Takes the edge off the pain but doesn't provide total pain relief. Can cross the placenta and make baby drowsy and you nauseous and confused.
Electrodes attached to the back, which emit mild electrical impulses that interrupt pain messages to the brain and stimulate endorphin production, the body's natural painkillers.